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Pharmacokinetic Evaluation of Clozapine in Concomitant Use of Radix Rehmanniae, Fructus Schisandrae, Radix Bupleuri, or Fructus Gardeniae in Rats.

ABSTRACT: Radix Rehmanniae, Fructus Schisandrae, Radix Bupleuri, and Fructus Gardeniae are often used alongside with clozapine (CLZ) for schizophrenia patients in order to reduce side effects and enhance therapeutic efficacy. However, worse outcomes were observed raising concern about a critical issue, herb-drug interactions, which were rarely reported when antipsychotics were included. This study aims to determine whether the concomitant use of these herbal medicines affects the pharmacokinetic characteristics of CLZ in rat models. Rats were given a single or multiple intraperitoneal injections of 10 mg/kg CLZ, either alone or with individual herbal water extracts administered orally. CLZ and its two inactive metabolites, norclozapine and clozapine N-oxide, were determined by high-performance liquid chromatography/tandem mass spectrometry. In the acute treatment, the formation of both metabolites was reduced, while no significant change was observed in the CLZ pharmacokinetics for any of the herbal extracts. In the chronic treatment, none of the four herbal extracts significantly influenced the pharmacokinetic parameters of CLZ and its metabolites. Renal and liver functions stayed normal after the 11-day combined use of herbal medicines. Overall, the four herbs had limited interaction effect on CLZ pharmacokinetics in the acute and chronic treatment. Herb-drug interaction includes both pharmacokinetic and pharmacodynamic mechanisms. This result gives us a hint that pharmacodynamic herb-drug interaction, instead of pharmacokinetic types, may exist and need further confirmation.

SUBMITTER: Tian DD

PROVIDER: S-EPMC6272930 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Depression, one of the most prevalent psychiatric diseases, affects the quality of life of millions of people. Studies have shown that the lower polar fraction of Bupleuri Radix (PBR) elicited therapeutic effects in chronic unpredictable mild stress (CUMS) rats. In contrast, comparatively mild liver injury was observed in normal rats administered a high PBR dose. It is essential to clarify the effective and safe dose of PBR and its dose-effect/toxicity relationship. In this study, we used the CUMS model to evaluate the effects and toxicities of PBR and to decipher the dose-effect/toxicity relationship and mechanism using the liver metabonomics combined with multivariate statistical analysis. In CUMS rats, PBR improved the depression-like behaviors including reduced body growth rate, anhedonia, and locomotor activities, and markedly reduced the contents of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). In control rats, PBR treatment altered ALT and AST from typical levels. Moreover, the effective dose range for CUMS rats was 12.6-163 g (herb)/kg, the median toxicity dose for CUMS and normal rats were 388 and 207 g (herb)/kg. The toxicological results showed that the cytokeratin-18 fragment level was increased significantly in CUMS rats given with 100 g (herb)/kg PBR. After a comprehensive analysis, the use of PBR dose was determined to be 12.6-50 g (herb)/kg. In CUMS rats, PBR could reverse amino acid metabolism, energy metabolism, sphingolipid metabolism, and β-oxidation of fatty acids to produce an anti-depressant effect in a dose-dependent manner. In control rats, two additional metabolic pathways were significantly perturbed by PBR, including glycerophospholipid metabolism and bile acid metabolism. Moreover, the comprehensive metabolic index including dose-effect index (DEI) and dose toxicity index (DTI) had a remarkable ability (ROC = 0.912, ROC = 0.878) to predict effect and toxicity. The DEI and DTI were used to determine the dose range of effect and toxicity which was shown high concordance with previous results. Furthermore, the CUMS rats possessed a higher toxicity tolerance dose of PBR which was consistent with the theory of "You Gu Wu Yun" in traditional Chinese medicine. The metabonomics techniques combined with correlation analysis could be used to discover indicators for comprehensive evaluations of efficacy and toxicity.

Project description:This study attempted to filter active components with antioxidant activities based on the differing antioxidant abilities of Schisandrae Sphenantherae Fructus (SSF) and Schisandrae Chinensis Fructus (SCF). First, the antioxidant activity of SSF and SCF was evaluated through the DPPH free radical scavenging method and compared with the half maximal inhibitory concentration (IC50) value. Next, components of SSF and SCF were detected by employing ultrahigh-performance liquid chromatography-Q-Exactive Orbitrap mass spectrometry (UPLC-QEO/MS) technology, and differential compounds were screened out as potential antioxidant compounds by using Compound Discover 3.1 Software. After that step, in order to verify the antioxidant compounds, the network method was applied. Biological targets were searched in the GeneCards database, and that related to antioxidant ability were selected in the Comparative Toxicogenomics Database (CTD). Finally, the pharmacology network was constructed. Results showed that SSF and SCF possessed different compounds and antioxidant abilities. A total of 14 differential compounds such as γ-schizandrin, schisandrin B, schisandrin, and tigloylgomisin H between them were screened out and identified. Twenty targets associated with antioxidant activity contained MAP2K1, MAPK8, RPS6KB1, PRKCB, HIF1A, and so on were investigated. Thirty-six pathways contained HIF-1 signaling pathways, choline metabolism in cancer, serotonergic synapse, Fc epsilon RI signaling pathway, GnRH signaling pathway, and so on related to the above twenty targets were identified. The pharmacology network analysis indicated that the differential components may be helpful in treating various diseases, especially cancer, by exerting antioxidant activity. In conclusion, this study provided a novel method for identifying active components with antioxidant activity in SSF and SCF, and this method may be applicable for the filtration of bioactive components in other herbs.

Dataset Information

Pharmacokinetic Evaluation of Clozapine in Concomitant Use of Radix Rehmanniae, Fructus Schisandrae, Radix Bupleuri, or Fructus Gardeniae in Rats.

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