Search Results (156)

As artificial intelligence (AI) becomes increasingly utilized to perform tasks requiring human intelligence, patients who are pregnant may turn to AI for advice on over-the-counter (OTC) medications. However, medications used in pregnancy may pose profound safety concerns limited by data availability. This study focuses on a chatbot’s ability to accurately provide information regarding OTC medications as it relates to patients that are pregnant. A prospective, descriptive design was used to compare the responses generated by the Chat Generative Pre-Trained Transformer 3.5 (ChatGPT-3.5) to the information provided by UpToDate^®. Eighty-seven of the top pharmacist-recommended OTC drugs in the United States (U.S.) as identified by Pharmacy Times were assessed for safe use in pregnancy using ChatGPT-3.5. A piloted, standard prompt was input into ChatGPT-3.5, and the responses were recorded. Two groups independently rated the responses compared to UpToDate on their correctness, completeness, and safety using a 5-point Likert scale. After independent evaluations, the groups discussed the findings to reach a consensus, with a third independent investigator giving final ratings. For correctness, the median score was 5 (interquartile range [IQR]: 5–5). For completeness, the median score was 4 (IQR: 4–5). For safety, the median score was 5 (IQR: 5–5). Despite high overall scores, the safety errors in 9% of the evaluations (n = 8), including omissions that pose a risk of serious complications, currently renders the chatbot an unsafe standalone resource for this purpose. Full article

Introduction: Falls pose a significant health risk to older adults, with a reported prevalence of 31.6% among Saudi older adults. Medication-related falls are a preventable cause of morbidity and mortality. This study aimed to assess fall risk, evaluate knowledge of fall-risk-increasing drugs, and examine the impact of pharmacist counseling on community-dwelling older adults in Jazan, Saudi Arabia. Methods: A cross-sectional survey was conducted from December 2023 to March 2024 among 391 community-dwelling individuals aged ≥60 years in Jazan, Saudi Arabia. Fall risk was assessed using the Arabic Stay Independent screening tool, which remains unvalidated in Arabic-speaking populations. Participants answered demographic questions and reported any pharmacist counseling on medication in the past six months. Knowledge of prescription and over-the-counter fall-risk-increasing drugs was evaluated. Multivariable logistic regression and ordered probit models were used to analyze factors associated with fall risk and drug knowledge. Results: Approximately 57% of the participants were at risk of falling. Only 11.5% demonstrated good knowledge of prescription fall-risk-increasing drugs, whereas 24.6% showed good knowledge of over-the-counter fall-risk-increasing drugs. Age (OR, 1.07; 95% CI, 1.00–1.14; p = 0.05), arthritis (OR, 5.73; 95% CI, 2.51–13.06; p < 0.001), obesity (OR, 6.00; 95% CI, 2.33–15.46; p < 0.001) and diabetes (OR, 2.79; 95% CI, 1.38–5.64; p = 0.004) were associated with increased fall risk. Those who received pharmacist counseling had a greater likelihood (95% CI, 0.020–0.167; p = 0.01) of being in the very likely category of willingness to discuss medication changes. Conclusions: The findings highlight the role of pharmacist counseling and recommend improving fall prevention through medication reviews for arthritis and diabetes patients, standardized counseling protocols, and implementation of the Stay Independent screening tool for risk assessment in older adults. Full article

CYP2C9 and CYP2C19 are major CYP450 enzymes that heavily influence the hepatic metabolism and bioactivation of many medications, including over-the-counter and narrow therapeutic index drugs. Compared to the wild-type alleles, genetic variants in either gene could potentially alter the pharmacokinetics of widely used medications, affect the desired therapeutic outcomes of a drug therapy, or increase the risk of undesired adverse events. The frequency of genetic polymorphisms associated with CYP450 enzymes can widely differ across and between racial and ethnic groups. This narrative review highlights the differences in CYP2C9 and CYP2C19 allele frequencies among European and Asian population subgroups, using published literature. Identifying the substantial differences across European and Asian populations, as well as within Asian subgroups, indicates the need to further scrutinize general population data. Clinical scientists and healthcare providers should advocate for more inclusive clinical pharmacogenomic data and racially and ethnically diverse pharmacogenomic databases. Clinical trials of limited racial and geographical diversity may not necessarily have strong external generalizability for all populations. Furthermore, clinical trials that designate an all-inclusive Asian population consisting of multiple ethnicities may not be adequate due to the perceived genetic differences among Asian subgroups. Gravitating towards a more comprehensive approach to utilizing pharmacogenomic data necessitates granular population-level genetic information which can be leveraged to improve how drug therapies are prescribed, achieve health equity, and advance the future of precision medicine. Full article

Background: Breast cancer (BC) is the most common cancer in women worldwide. Much progress has been made to improve treatment options for patients suffering from the disease, including a novel therapy—Poly (ADP-ribose) polymerase inhibitor (PARPi) that specifically targets tumors with deficiencies in the Homologous Recombination (HR) DNA repair pathway. To benefit better from conventional therapy, many patients seek alternative supplementation, with 20–30% of cancer patients using herbal medication on top of their regular treatment. An example of such easily available over-the-counter supplements is curcumin, a natural compound derived from turmeric (Curcuma longa). Various studies reported the potential HR deficiency (HRD) inducing effect of curcumin in cancer cells. Methods: Eight BrC and three normal cell lines and a BrC PDX model were used to evaluate the effect of curcumin on RAD51 ionizing radiation-induced focus (IRIF) formation. Three breast BrC cell lines underwent further analysis using the BRCA2 Western blot technique. To assess cell survival after treatment with curcumin and/or PARPi, a clonogenic survival assay was performed on both normal and cancerous cell lines. Results: Curcumin treatment led to a reduction in RAD51 IRIF formation capacity across all tested models. A decrease in BRCA2 levels was observed in the tested cell lines. Our findings demonstrate that HRD can be induced in both cancerous and normal cells, suggesting that curcumin treatment may increase the risk of toxicity when combined with PARPi therapy. Conclusions: The use of curcumin in combination with certain anti-cancer treatments should not be implemented without extensive monitoring for deleterious side effects. Full article

Chronic pain is a prevalent public health concern in the United States, frequently managed with over-the-counter (OTC) painkillers without professional medical supervision. This study investigates household-level patterns of over-the-counter painkiller use utilizing a nationally representative dataset from NielsenIQ, focusing on how reported health conditions, whether self-identified or professionally diagnosed, affect purchasing behaviors. By linking consumer purchase data with self-reported ailment information, this study analyzed painkiller expenditures across different ailment types and demographic groups. Results show that over-the-counter painkiller purchases were highly symptom-driven, particularly for headache-related products, which were the most frequently purchased category across all household types. Nearly one-third of single-member households purchased over-the-counter painkillers for headaches, regardless of diagnosis type, indicating a strong role of perceived need in driving behavior. Females and older individuals more frequently reported ailments, with consistently higher proportions across both pain-related and other conditions. Nonetheless, a notable share of households reported over-the-counter painkiller use without any reported ailments. The findings suggest that diagnostic status plays a limited role in determining over-the-counter painkiller usage, emphasizing the need for improved public health messaging around safe self-medication. These insights can inform targeted education, labeling regulations, and policy interventions to support safer and more equitable pain management practices at the population level. Full article

Insomnia is the most prevalent sleep disorder, estimated to affect at least one-third of the global population. There are a variety of treatment options available for both acute and chronic insomnia. Currently, the pharmacological arsenal for treating insomnia includes short- or intermediate-acting benzodiazepine hypnotics, non-benzodiazepine hypnotic sedatives, melatonin receptor agonists, orexin receptor antagonist, and sedating antidepressants. Diphenhydramine, a first-generation antihistamine, is commonly used in the treatment of allergies and dermatitis. This review examines the preclinical and clinical efficacy and safety evidence of diphenhydramine in treating short-term insomnia. Additionally, it provides expert consensus on its implementation as an over-the-counter medication for this condition. The available evidence indicates that diphenhydramine is an effective treatment for acute insomnia in adults, offering a safe and affordable option for most patients suffering from this condition. Experts concur that there is strong evidence supporting the recommendation of diphenhydramine for the treatment of acute insomnia in adults. Full article

Musculoskeletal disorders represent one of the most pervasive health concerns that drive frequent medical consultations and pharmacy encounters. Community pharmacies are well placed to help address this demand as they are accessible settings for healthcare advice and support for patients with musculoskeletal disorders complaining of pain. Heat therapy stands as a valuable component of a multimodal approach to the management of musculoskeletal pain by virtue of multiple effects: pain relief, reduction of muscle spasms and stiffness, and enhanced muscle flexibility and range of motion. However, there is limited guidance on heat therapy use in routine practice, particularly on indications and contraindications, mode of application, and precautions. Such an educational gap has been documented among pharmacists. Therefore, it is paramount that pharmacists gain knowledge about when and how to effectively integrate superficial heat therapy with both pharmacological and physical therapy, to provide patients with a comprehensive, multimodal approach to alleviating musculoskeletal pain. A multidisciplinary panel of experts gathered to develop practical guidance on heat therapy-appropriate application in patients with musculoskeletal pain. In this work, we provide actionable suggestions to build pharmacists’ competency in managing musculoskeletal pain and empower them in effectively using heat therapy as a single therapeutic option or in combination with over-the-counter analgesics. Full article

Background and Objectives: Self-medication includes the use of drugs or herbal preparations based on one’s own discretion or the recommendation of another person, often a family member, friend, neighbor, or even a pharmacist, without prior examination and consultation with a doctor. The goal of this study was to determine respondents’ reasons for using self-medication, determine the frequency of self-medication, and analyze differences in respondents’ attitudes about self-medication in relation to several factors. Materials and Methods: The study was conducted as a cross-sectional observational study. The respondents were patients seeking medical examination at the Health Center in Jagodina who had used over-the-counter medications during the COVID-19 pandemic. A total of 175 respondents participated in the study. The study design provided answers to questions about the respondents’ self-medication habits during the COVID-19 pandemic. Results: More than half of the respondents (53.71%) bought medicines without a prescription, with most cases involving analgesics (52.83%). Almost three-quarters of the respondents were completely vaccinated (74.29%) against COVID-19. Additionally, 39.62% of participants used vitamins as part of their self-medication during the COVID-19 pandemic. Among the vitamins, respondents most commonly used a combination of vitamins C and D (20.75%), vitamin D (5.66%), vitamin C (5.66%), and vitamin A (1.89%). Conclusions: Self-medication for the treatment of coronavirus is more often used by younger respondents, who are not yet married, do not have their own income, and rarely visit a doctor. As for supplements, respondents used zinc, and as for vitamins, respondents mostly used a combination of vitamins C and D. Full article

This study investigates the potential contamination of cash register employees in the Slovak Republic with 148 selected pharmaceuticals, illicit drugs, and their metabolites. Of these, 42 substances were detected, and it was found that the target group—cashiers—regularly handle large volumes of banknotes, increasing their exposure to contaminants compared to the general population. This study revealed that commonly prescribed and over-the-counter medications significantly contribute to the contamination of cash registers. This study found that cashiers exhibited notably higher detection rates of antibiotics, including penicillin-V (2×), azithromycin (23×), and erythromycin (up to 64×), than the general population. Additionally, there was an alarming increase in illegal substances, with methamphetamine levels rising fivefold and cocaine up to fifteenfold. This study highlights a broader environmental concern, suggesting that routine handling of contaminated banknotes may lead to the transfer of micropollutants. Furthermore, personal hygiene practices, particularly handwashing, could play a role in introducing pharmaceuticals and narcotics into wastewater, potentially contributing several milligrams of contaminants daily. Full article

The aim of this study was to evaluate an in vitro method using the EpiOral^TM model, a three-dimensional cultured human buccal epithelium, for assessing the oral irritation potential of various products. We evaluated different concentrations of nine chemicals commonly found in over-the-counter (OTC) products and medical devices, including chlorhexidine digluconate, sodium hypochlorite, phosphoric acid, hydrogen peroxide, lactic acid, ethanol, sodium dodecyl sulfate, 1-decanol and methyl methacrylate. The method was able to identify the irritants with a clear dose–response relationship between cell viability and an increasing concentration of the chemicals in the tested solutions. Using three exposure times (1, 4 and 18 h) and calculating the ET-50 (time required to induce a 50% reduction in cell viability), the solutions were classified according to their irritant potency (strong, moderate, mild or non-irritant). The results showed excellent correlation with historical in vivo data by matching the potency classifications in most cases. This study highlighted the importance of multiple exposure times for accurate assessment, as some solutions with irritant chemicals require longer exposure to produce effects. By providing information on both the irritant potential and potency, this method proved useful for toxicologists in the risk assessment of OTC products and medical devices that come into contact with the oral cavity. Full article

In this work, a novel 3D μPAD cellulose-based colorimetric chemosensor for multiplexed detection of paracetamol and aspirin in biological samples is proposed. The easy availability of analgesics such as paracetamol and non-steroidal anti-inflammatory drugs such as aspirin, over-the-counter drugs that can be acquired without medical prescription, can entail a health problem if they are administered incorrectly. The development of analytical procedures for the rapid, sensitive, and accurate determination of such drugs in clinical samples is of utmost importance. Different parameters involved in the design of the 3D μPAD system and the colorimetric reaction conditions have been optimized. Under optimal conditions, detection limits of 0.004 mM and 0.013 mM were obtained for paracetamol and aspirin, respectively. The proposed procedure was validated against two certified reference materials and applied to the analysis of several synthetic urine and saliva samples. Synthetic urine and saliva samples were spiked at two concentration levels, showing recoveries in the range of 98–103% with a relative standard deviation of 3–6% (n = 6). Full article

Some musculoskeletal disorders, including osteoarthritis; arthrosis; post-traumatic injuries; and other inflammatory tendon, joint and muscular afflictions, still represent unmet medical needs. Cetylated fatty acids (CFAs) are key components of widely distributed over-the-counter products, especially for topical use, which are intended to reduce symptoms associated with these conditions. Nevertheless, the mechanism of action of CFAs’ analgesic and anti-inflammatory properties has not yet been clearly established. Endocannabinoids, such as 2-arachidonoylglycerol (2-AG) and anandamide (AEA), are known to produce analgesic and anti-inflammatory effects. These compounds undergo physiological inactivation operated by several enzymes, including monoacylglycerol lipase (MAGL). We herein demonstrate for the first time that the therapeutic effects of CFAs may be attributable, at least in part, to their MAGL inhibition activities, which induce a local increase in analgesic/anti-inflammatory endocannabinoids in close proximity to the site of administration. These findings pave the way for the development of new potent local analgesic agents, whose action is based on an indirect cannabinoid effect. Full article

Background/Objectives: Vulvovaginal candidiasis (VVC) is a common cause of vaginitis. Over-the-counter drugs are usually dispensed by pharmacy professionals to treat this condition without prior medical consultation. This study aimed at assessing the knowledge of Portuguese pharmacy professionals regarding VVC. Methods: An online questionnaire including questions about the symptoms and treatment of VVC was distributed between March and April of 2024. Results: A total of 376 professionals participated in this study. There was a significantly lower proportion of men (p = 0.007) and pharmacy technicians (p = 0.005) who correctly identified the main causative agent of VVC when compared to women and pharmacists. Only 30% of women correctly identified the number of VVC episodes in the same year they classified as complicated, but this was significantly higher (p = 0.038) than the proportion of men who identified complicated VVC (20%). Topical clotrimazole preparations were the more frequently identified medicines for the treatment of uncomplicated VVC, and fluconazole-containing medicines were the preferred choice for the treatment of complicated VVC. Conclusions: This study highlights the need to improve education and training for pharmacy professionals. By addressing these knowledge gaps, pharmacists and pharmacy technicians can provide more accurate and effective advice to patients. Full article

The Qidong Liver Cancer Institute (QDLCI) and the Qidong Cancer Registry were established in 1972 with input from doctors, other medical practitioners, and non-medical investigators arriving from urban centers such as Shanghai and Nanjing. Medical teams were established to quantify the extent of primary liver cancer in Qidong, a corn-growing peninsula on the north side of the Yangtze River. High rates of liver cancer were documented and linked to several etiologic agents, including aflatoxins. Local corn, the primary dietary staple, was found to be consistently contaminated with high levels of aflatoxins, and bioassays using this corn established its carcinogenicity in ducks and rats. Observational studies noted a positive association between levels of aflatoxin in corn and incidence of liver cancer across townships. Biomarker studies measuring aflatoxin B₁ and its metabolite aflatoxin M₁ in biofluids reflected the exposures. Approaches to decontamination of corn from aflatoxins were also studied. In 1993, investigators from Johns Hopkins University were invited to visit the QDLCI to discuss chemoprevention studies in some townships. A series of placebo-controlled clinical trials were conducted using oltipraz (a repurposed drug), chlorophyllin (an over-the-counter drug), and beverages prepared from 3-day-old broccoli sprouts (rich in the precursor phytochemical for sulforaphane). Modulation of biomarkers of aflatoxin DNA and albumin adducts established proof of principle for the efficacy of these agents in enhancing aflatoxin detoxication. Serendipitously, by 2012, aflatoxin exposures quantified using biomarker measurements documented a many hundred-fold reduction. In turn, the Cancer Registry documents that the age-standardized incidence rate of liver cancer is now 75% lower than that seen in the 1970s. This reduction is seen in Qidongese who have never received the hepatitis B vaccination. Aflatoxin mitigation driven by economic changes switched the dietary staple of contaminated corn to rice coupled with subsequent dietary diversity leading to lower aflatoxin exposures. This 50-year effort to understand the etiology of liver cancer in Qidong provides the strongest evidence for aflatoxin mitigation as a public health strategy for reducing liver cancer burden in exposed, high-risk populations. Also highlighted are the challenges and successes of international team science to solve pressing public health issues. Full article

Background: Associations of antioxidants in prenatal over-the-counter multivitamin-mineral (OTC MVM) supplements with in-utero oxidative stress (OS), antioxidant capacity, and fetal growth are limited. Our objectives were to determine if five fetal ultrasound measurements [biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight] were associated with OTC MVM supplements and with minerals, biomarkers of OS, and total antioxidant capacity in amniotic fluid (AF). Methods: For this retrospective study, 176 pregnant women who had undergone age-related amniocentesis for genetic testing were included. Questionnaires recorded prenatal OTC MVM supplementation (yes, no). Ultrasound measurements for early (16–20 weeks) and late (32–36 weeks) gestation were extracted from medical charts. AF concentrations for 15 minerals and trace elements and OS biomarkers in AF [nitric oxide (NO), thiobarbituric acid-reactive substances (TBARS), and ferric-reducing antioxidant power (FRAP)] were measured at 12–20 weeks of gestation. Associations of AF minerals, OS biomarkers, and ultrasound measures were analyzed using multiple linear regressions. Results: Positive associations were observed between AF TBARS and seven AF minerals/elements (calcium, copper, magnesium, nickel, strontium, zinc and iron). At 16–20 weeks, AF copper, nickel, strontium, and selenium were positively associated with BPD, HC, AC, and FL, respectively, NO was positively associated with FL, and FRAP was inversely associated with estimated weight. At 32–36 weeks, calcium was positively associated with BPD and chromium and arsenic were negatively with HC. At 16–20 weeks, higher AF FRAP was inversely associated with FL and this exposure continued to be inversely associated with estimated weight at 32–36 weeks. Conclusions: Concentrations of AF minerals, trace elements and biomarkers of OS and in-utero antioxidant capacity were linked to specific ultrasound measurements at different stages of gestation, suggesting a complex interplay among in utero OS, antioxidant capacity, OTC MVM supplements, and fetal growth. Full article