Exenatide, a GLP-1 receptor agonist licensed to treat type 2 diabetes, and recently shown to be associated with reduced severity of PD

pubmed.ncbi.nlm.nih.gov/32247373/

pubmed.ncbi.nlm.nih.gov/33409802/

1 completed research findings
www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31585-4/fulltext

Exenatide had positive effects on practically defined off-medication motor scores in Parkinson’s disease, which were sustained beyond the period of exposure. Whether exenatide affects the underlying disease pathophysiology or simply induces long-lasting symptomatic effects is uncertain. Exenatide represents a major new avenue for investigation in Parkinson’s disease, and effects on everyday symptoms should be examined in longer-term trials.

Future: The A1 astrocyte paradigm: New way for pharmacological intervention in neurodegeneration – PubMed

We recently demonstrated that NLY01, a novel glucagon-like peptide-1 receptor agonist, exerts neuroprotective effects in two mouse models of PD in a glia-dependent manner. NLY01 prevented microglia from releasing inflammatory mediators known to convert astrocytes into a neurotoxic A1 reactive subtyp …

Source: The A1 astrocyte paradigm: New avenues for pharmacological intervention in neurodegeneration – PubMed

Can RYR supplements Potentially be Related to a High Risk of PD?

Red yeast rice (RYR or red Koji) is an ingredient in dietary supplements often used for people with dyslipidemia or with statin-intolerance. These supplements contain monacolin K (lovastatin). This 2017 study published by NCBI made a case-by-case assessment highlighting myopathies and liver injury as potential safety issues, thus suggesting that the safety profile of RYR is similar to statins. RYR is used in Chinese medicine as a natural statin to improves blood circulation by decreasing cholesterol and triglyceride levels. Certain studies have shown that statin use and a higher risk of PD are related and that PD symptoms appear to be stronger following use of statins. These findings raise the hypothesis that the safety profile of RYR is highly similar to that of synthetic statins and warrants further investigation to finally characterize the safety profile of RYR. The conclusion of this report is that the safety profile of RYR is similar to that of statins and the risk profile of these supplements needs to be examined and regulated.

Source: Adverse reactions to dietary supplements containing red yeast rice: assessment of cases from the Italian surveillance system

Is it Safe to Take CoQ10 While Taking Warfarin or Plavix (clopidogrel)?

Question: Does CoQ10 interact with blood thinners? Answer: There are studies with conflicting results on whether CoQ10 may interfere with warfarin treatment or decrease the effectiveness of warfarin (Coumadin). There are studies that suggest that CoQ10 may increase the risk of bleeding when on warfarin and other studies that suggest CoQ10 may decrease the risk of bleeding when on warfarin. Other studies indicate that there is no effect so long as your INR (bleeding time) is stable. It’s not clear whether CoQ10 affects Plavix treatment. Consult with your doctor before taking any supplement or medication.

Source: ConsumerLab Q&A

Initial Pramipexole vs. Initial Levodopa in Early PD – Which is Better?

A study published on the JAMA Network focused on the long-term effect of initiating pramipexole vs levodopa in early PD. The subjects were followed for up to two years and after six years. Disability was assessed using the modified Shwab and England Activities of Daily Living Scale. Other factors that were assessed included daytime sleepiness; disease severity; dopaminergic events; edema; depression; cognitive impairment and quality of life. Self-reported results were similar. Dopaminergic motor complications were more common in the initial levodopa group (68.4%) although disabling dyskinesias were uncommon in both groups. The mean (SD) Epworth Sleepiness Scale score was significantly higher in the initial pramipexole group. Mean (SD) changes from baseline in the total Unified Parkinson’s Disease Rating Scale score did not significantly differ. The study concluded that persistent differences favoring initial pramipexole were seen in the rates of dopaminergic motor complications, with less severe somnolence favoring initial levodopa.

Source: Long-term Effect of Initiating Pramipexole vs Levodopa in Early Parkinson Disease | Movement Disorders | JAMA Neurology | JAMA Network

Should Pramipexole be Used in PD Treatment?

A 2003 study published on Springer.com looked at pramipexole in comparison with I-dopa. The study subjects were twenty right-handed patients with early or mild PD. They were evaluated using neuropsychological and clinical assessments during three treatment modalities. 1. When in the off treatment condition; 2. When on pramipexole and 3. When on i-dopa. In comparison to the off treatment condition, the DA-agonist pramipexole produced a significant impairment of short term verbal memory, attentional-executive functions, and verbal fluency, while l-dopa did not. Pramipexole opposite to l-dopa, failed to improve FAS and Stroop tests. Pramipexole may worsen cognitive functions although not exceeding normative values.

Source: Pramipexole in comparison to l-dopa: a neuropsychological study | SpringerLink

What you Should Know About your Diet and Warfarin

The blood-thinning medication, warfarin decreases the chance of harmful blood clots by blocking the effects of vitamin K which helps blood-clotting proteins form in the liver. Your warfarin dose is determined by your PT or INR measurements that show how long it takes for your blood to form clots.

A document published by ImpactTeam looks at how your diet affects warfarin and how the amount of vitamin K in your diet will determine the warfarin dose needed to prevent bleeding. Warfarin may have possible interaction with cranberry juice, mango juice, grapefruit juice, caffeine, charbroiled foods, alcohol, garlic, soy, ginger, and green tea. In addition, there is potential interaction of dietary supplements with warfarin.

Source: Warfarin and your Diet

 

How Does Fasting Affect INR and %TTR?

A report published in the Journal of Thrombosis and Haemostasis looked at the effects of fasting in Muslim patients taking warfarin. The anticoagulation medication warfarin is influenced by changes in the diet and fasting might influence the INR and the %TTR. During the month of Ramadan, when Muslims fast during daylight hours (about 13.5hrs/24), stable warfarinised Muslim patients had their INR level tested before, during, and after Ramadan. Unsurprisingly the INR measurement and %TTR changed. The study concluded that fasting significantly increases the mean INR of medically stable patients taking warfarin and the likelihood of having an INR above therapeutic targets.

Source: The effects of fasting in Muslim patients taking warfarin

 

The FDA Drug Shortage, and Availability

A drug receives FDA “resolved” status when the Drug Shortages Staff (DSS) determines that the market is covered, based on information from manufacturers and that no shortage is anticipated. The DSS monitors the supply of products with resolved status. When supply is available from at least one manufacturer to cover the entire market, it is considered “covered.” In other words, the shortage is “resolved” and the product available. On the FDA website, you can see a list of medicines/products that are currently in shortage and others that are resolved. With this list, you can get information about discontinued drugs, or if they are available, resolved, in supply, and estimated duration of shortage. It will also tell you the reason for the shortage. The list provides information about corresponding therapeutic categories, resource information, and relevant links.

Source: FDA Drug Shortages

Will Coronavirus Restrictions Mean a Shortage of Important Medical Drugs?

A recent Quartz article looks at drug company distribution under COVID restrictions and what it will mean for patients in need of life-saving drugs. The COVID-19 pandemic has meant disruption for many industries and supply chains. Pharmaceutical supply chains want to protect themselves and so they are unwilling to divulge what drugs are in short supply or may soon be in short supply. This makes it difficult for regulators and public health officials to know how to plan ahead. The problem with determining how COVID will affect the supply of medication is that many pharmaceutical ingredients are produced outside the USA and many manufacturing plants are also located in other countries. With corona restrictions limiting air travel and, in some countries, limiting business operations it is uncertain what point of the production chain could be disrupted.

Source: How Covid-19 could disrupt pharmaceutical supply chains — Quartz

The EU Parliament: The Disruption of Medical Supply Chains Under COVID-19

The EU parliament offers a Q&A page where you can get updates and ask questions regarding the disruption of medical supply chains during the COVID-19 pandemic and measures taken by all EU countries. Up to 90% of active ingredients in medicines are produced in China and India. This has made the EU national health systems vulnerable during the COVID pandemic. Not only is the EU reliant on receiving the active ingredients from abroad under coronavirus restrictions but the situation is exacerbated by some member states restricting the intra-community movement of pharmaceuticals. This may lead to shortages and disruption of the medical supply chain.

EU Parliamentary Q&A:  Disruption of medical supply chains in the EU due to COVID-19 and unilateral national measures

The FDA is Monitoring the Supply of Drugs During the COVID-19 Pandemic

The FDA is constantly monitoring the availability of medical drugs with expectations that COVID-19 will disrupt the supply chain. The FDA is in touch with more than 180 manufacturers of human drugs so that they are informed of any up-coming shortages including shortages of active ingredients produced in China. The FDA is also aware of the possible disruption of the supply chain for medical devices. COVID-19 movement restrictions, quarantines, and travel restrictions have all impacted the supply of medical drugs. The FDA will continue to monitor and update about the supply chain of human drugs, medical devices, biologics and blood supply, food and animal drugs during the pandemic.

Source: Coronavirus (COVID-19) Supply Chain Update | FDA 

Potential PD Treatment with Repurposed Drugs

A 2018 Springer article examines drug repurposing in PD due to the ever-increasing costs and lengthy processes for drug development. Existing compounds are being approved for other indications as novel treatments in PD. Advances in rational and systemic drug repurposing have identified a number of drugs with potential benefits for PD pathology and offer a potentially quicker route to drug discovery. Among the drugs being considered for repurposing for PD are ambroxol; isradipine; Inosine; ursodeoxycholic acid; deferiprone; exenatide; Nilotinib and Simvastatin. Despite the potential advantages offered by drug repurposing, as a strategy, it offers unique challenges, including the unavoidable need for expensive and risky clinical trials to demonstrate safety and efficacy in a new population while the limited patent protection often means a lack of commercial interest or incentive for further investment.

Source: Drug Repurposing in Parkinson’s Disease

The Potential of Ambroxol for PD Treatment

Dr. Stephen Mullin of the University of Plymouth talks for The Cure Parkinson’s Trust about the research into GBA Parkinson’s and the current convergent studies which all seem to be pointing towards GBA. In terms of the prospects to develop drugs to slow the development of PD, GBA is the most advanced. The next phase will be identifying PD patients who are carriers of the mutations in the GBA gene and beginning clinical human trials. Simultaneously there needs to be research into how GBA causes PD in humans. The prospects for ambroxol as a disease modifying agent in GBA PD are strong. Ambroxol has already been used by many patients and may be able to reverse some of the effects that lead to PD.

Source: The Ambroxol Trial – The facts | The Cure Parkinson’s Trust

Nattokinase as a Possible Treatment for Cardiovascular Disease

A 2018 review in the NCBI Biomarker Insights journal looks at nattokinase as a possible alternative in the prevention and treatment of cardiovascular disease. Nattokinase (NK), the most active ingredient of natto (cheese-like food made from fermented soybeans), possesses a variety of favorable cardiovascular effects. The review looks at the pharmacological effects and mechanisms of NK in terms of fibrinolytic/antithrombotic effects, anti-atherosclerotic and lipid-lowering effects, antihypertensive effects, antiplatelet/anticoagulant effects, and neuroprotective actions. The review also lists the few clinical studies that have been done with NK. NK is registered as a nutritional supplement and not a drug. In summary, compared with traditional antithrombotic and antihypertensive drugs, NK is characterized by high safety, low cost, simple production process, oral availability, and long in vivo half-life. As such, it is expected to become a new-generation drug for thrombotic disorders or CVDs.

Source: Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases

Warfarin alternatives ? – natural blood thinners

for alternative meds see www.health.harvard.edu/heart-health/new-alternatives-to-warfarin

Feverfew

שום, ג’ינג’ר, כורכום וגינקו בילובה
מזונות אלה מצטיינים בדילול טבעי של הדם ולכן עלולים להגביר דימומים.

סו פלמטו
צמח זה עלול להגביר דימומים יש להשתמש בו בזהירות.

בצל
כמות גדולה יותר מ-120 גרם בערך עלולה להעלות את רמת הקומדין בדם.

ויטמינים במינון גבוה מדי
נטילת ויטמין E (במינון העולה על 400 יב”ל ליום) וויטמין A (יותר מ-10,000 יב”ל ביום) יחד עם תרופות לדילול הדם עלולה לגרום להשפעה מוגברת ולנטייה לדימומים.

פירות הדר וויטמין C
עלולים להפחית את הספיגה של תרופות מסוימות לדילול הדם, כולל קומדין.

תה ירוק ותה מאצ’ה
לסוגי תה אלה יש השפעה רבה על כלי הדם. הם מסייעים למניעת חסימות וגם מדללים מעט את הדם. זו השפעה חיובית, אבל אחרי כמה שבועות תצטרכו לבקש מהרופא שלכם להוריד את מינון התרופות.

אשכוליות ומיץ אשכוליות, מיץ רימונים ומיץ תפוזים
אשכולית עלולה להגביר את ההשפעה של מדללי דם מסוימים עד לרמה מסוכנת. כפי הנראה, מיץ רימונים ומיץ תפוזים פועלים בדרך דומה, ולכן עלולים לגרום לאותם סיבוכים.

חלב סויה
עלול להגביר דימומים.

אבוקדו

זהו מזון מזין ביותר, אך כפי הנראה, הוא מפחית את ההשפעה של הקומדין, ולפיכך, מטפלים רבים מזהירים את המטופלים שלהם שלא לצרוך אותו. למרות זאת, לדעתי מותר לאכול אבוקדו בזמן הטיפול במדללי דם, שכן הוא עשיר מאוד בנוגד החמצון גלוטתיון. פשוט בקשו מהרופא המטפל שיקבע את המינון המתאים להרגלי האכילה שלכם, והקפידו על צריכת כמות קבועה של אבוקדו.

קואנזים Q-10
אף שתוסף זה עלול להפחית מעט את ההשפעה של תרופות נוגדות קרישה, לא הייתי מוותרת עליו. זהו נוגד חמצון עוצמתי שמגן על הלב. במידת הצורך, אני חושבת שכדאי לכם לבקש מהרופא לשנות מעט את מינון התרופה.

פרע (היפריקום)
צמח זה מפחית את ההשפעה של תרופות נוגדות קרישה, ובעיקר קומדין, ולכן, ייתכן שתזדקקו למינון מעט גבוה יותר.

המידע המלא בספר “האמת על התרופות ” מאת הרוקחת המוסמכת סוזי כהן, הוצאת פוקוס

high risk Drug-herb interactions; Ellagic acid; Guava leaves; Pomegranate peel. – amed.ncbi.nlm.nih.gov/30678660-critical-pharmacokinetic-and-pharmacodynamic-drug-herb-interactions-in-rats-between-warfarin-and-pomegranate-peel-or-guava-leaves-extracts/?from_term=natural+warfarin+alternatives+&from_pos=2

genetic based inr stabilization – pubmed.ncbi.nlm.nih.gov/30961588-implementation-of-genotype-guided-dosing-of-warfarin-with-point-of-care-genetic-testing-in-three-uk-clinics-a-matched-cohort-study/?from_term=natural+blood+thinners+warfarin+alternatives&from_pos=5

Nattokinase fails – www.ncbi.nlm.nih.gov/pmc/articles/PMC4264722/

NLY01 halts PD

Similar drugs to NLY01 already approved by the Food and Drug Administration for the treatment of type 2 diabetes include exenatide, lixisenatide, liraglutide and dulaglutide, each of which can cost approximately $2,000 for a 90-day supply. NLY01 is a long-acting drug with improved the brain penetration compared to these approved drugs for diabetes.

www.sciencedaily.com/releases/2018/07/180702120505.htm

afforable:
dir.indiamart.com/impcat/liraglutide.html