The objective of this review was to identify and examine the pharmacokinetic and pharmacodynamic interactions between cannabidiol (CBD)-only products, such as CBD oil, and anticancer agents. A literature search of PubMed (1980 to September 2018) and the Cochrane Collection (1980 to September 2018) was performed using the following search terms: “cannabidiol,” “cancer,” “cannabis,” “marijuana,” and “interaction,” as well as any combination of these terms. Literature was excluded if it did not appear in the search when limited to the “full text” filter on PubMed, if it was not published in the English language, or if it did not explore potential pharmacodynamic or pharmacokinetic interactions of CBD and anticancer agents. There were 10 studies that met these inclusion criteria. The majority of the facts regarding the interactions with CBD were found using in vitro studies and the true in vivo implications are not well-known. Minimal data were available regarding the interactions between CBD and anticancer agents. However, pharmacists should always consider the possibility of interactions and their consequences whenever they are aware of a patient using CBD products.
The objective of this review article was to identify and examine current evidence surrounding the potential renoprotective effects of newer antidiabetic agents such as sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucose-like peptide 1 (GLP-1) agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors. A literature search of MEDLINE and PubMed (January 2000 to April 2019) was performed using the following search terms: “diabetes treatment,” “renoprotection,” “kidneys,” “SGLT-2 inhibitors,” “GLP-1 receptor agonists,” “DPP-4 inhibitors,” and the drug names in each of those classes as well as any combination of these terms. Literature was excluded if published in a language other than English, performed in nonhuman subjects, did not include patients from the United States, was nonrandomized, or the data were available from poster presentations. There were 11 studies that met the search criteria. The majority of the studies focused on renal outcomes as secondary end points and looked at albuminuria, estimated glomerular filtration rate changes from baseline, urinary albumin-to-creatinine ratio, serum creatinine, and need for renal replacement therapy. There are fewer studies that focused on renal protection as a primary end point. After reviewing the available literature, the use of SGLT-2 inhibitors and GLP-1 agonists in addition to standard of care may be considered in patients with or at risk of developing chronic kidney disease. SGLT-2 inhibitors and GLP-1 agonists should be considered when patients’ diabetes is no longer well controlled with metformin. Other factors such as cost, cardiovascular disease, and other comorbidities may also be taken into consideration when recommending therapy for patients.
Introduction: Lifestyle interventions have been shown to produce favorable changes in some health outcomes in patients with chronic kidney disease (CKD). However, few such studies, employing real world methods have been completed in patients with CKD.
Objective: This study tested the effectiveness of a comprehensive, multicomponent, lifestyle intervention, delivered through individualized counseling on a variety of health outcomes in pre-dialysis CKD patients.
Methods: Eligible patients were assigned randomly to the intervention (TR) or usual care group (UC). A six-month home-based program involving personalized counseling to increase physical activity to recommended levels among stage G3a to G4 CKD patients while exchanging plant proteins for animal proteins was implemented. Physical function, cardiovascular function, dietary intake, medication use, and health-related quality of life (HRQOL) were assessed at baseline and after 1-month, 3-months (M3) and 6-months (M6).
Results: Forty-two, patients (age 60.2 ± 9.2, BMI 34.5 ± 7.8) participated in this study (TR=27 UC=15). The intervention reduced (p<0.05) brachial (bSBP) and central systolic blood pressures (cSBP) at month 3 (M3) but both were attenuated at month 6 (M6). Scores on the effect of kidney disease subscale of the HRQOL measure improved in the intervention group at M3 and M6. There was no change in the other measures of HRQOL or in any physical function scores.
Conclusions: This personalized multi-component lifestyle intervention enabled CKD patients to self-report fewer concerns with how CKD affected their daily lives independent of changes in physical function.
Key words: Home-based exercise programs, plant-based nutrition
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