Interference by Tannic Acid with the Effectiveness of Activated Charcoal in “Universal Antidote”

Daly, John S.; Cooney, David O.

doi:10.3109/15563657809150025

Cited by 17 publications

(5 citation statements)

References 4 publications

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“…Finally, none of the leaflets refers to MedDev–drug interactions although plausible: TA is known to adsorb iron, many compounds and drugs71–73 89 and is an inhibitor of cytochrome P450, other enzymes and P-glycoprotein (P-gp) 90–92. HA/Pol407 complexes enhance or delay drug absorption88 93 while Pol407 itself inhibits P-gp, multidrug resistance-associated proteins and (blood–brain barrier) efflux transporters and interferes with delivery of proteins and peptides 94–96…”

Section: Resultsmentioning

confidence: 99%

Medical devices that look like medicines: safety and regulatory concerns for children in Europe

Huijghebaert

Bruyne²,

Allegaert³

et al. 2019

Arch Dis Child

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IntroductionMedical devices (MedDevs) and medicines are assessed (and monitored) differently before and after launch. There are products for repeated oral ingestion that are marketed in the European Union as MedDevs.Objectives and methodsTo illustrate the consequences of these differences in assessment, we compared the leaflet information of three MedDevs with the standards for medicines and with published evidence at launch. As examples, gelatin tannate (GT), its combination with tyndalised probiotics (TP) (GTTP) for diarrhoea and a gel containing hyaluronic acid (HA)/chondroitin sulfate (CS)/poloxamer (Pol407) (HACSPol) for gastro-oesophageal reflux disease were examined.ResultsApplying standards for medicines, product composition is insufficiently defined in the MedDev leaflet (eg, plant origin, polymerisation grade, dose and ratio of the relevant constituents). As no age limit is mentioned in the leaflets, all 3 products allow use in children from birth onwards, although published clinical documentation in children was poor (GT) or lacking (GTTP and HACSPol). MedDev leaflets do not mention adverse events (AEs), while literature search suggests safety concerns such as tannic acid (TA) cytotoxicity, potentially more diarrhoea/AEs with TP, use of doses higher than established safe (TA and HA) and lack of chronic toxicity studies for oral Pol407. None refers to interactions with medicines, although some ingredients may affect medicine absorption.ConclusionAlthough these MedDevs require repeated oral intake as do medicines, their assessment and monitoring differ significantly from the standards for medicines. Compared with medicines, MedDevs for repeated oral use are poorly labelled and rely on very limited clinical information at market release.

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Section: Resultsmentioning

confidence: 99%

Medical devices that look like medicines: safety and regulatory concerns for children in Europe

Huijghebaert

Bruyne²,

Allegaert³

et al. 2019

Arch Dis Child

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“…In traditional medicine, TA usage has a long history. Previously, TA was administered in conjugation with either activated charcoal or magnesium in order to treat toxic substances, including ptomaine poisoning ( 21 ). Neanderthals used to treat burns with the extracts of plants rich in TA unknowingly ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Tannic acid mediated induction of apoptosis in human glioma Hs 683 cells

et al. 2018

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Tannic acid (TA), a natural plant compound, is known to induce the death of cancer cells in various types of cancer. The present study was designed with the aim of exploring the effects of tannic acid in vitro on HS 683, a glioma cell line, and to study the mechanism involved in the induction of cytotoxicity and apoptosis by TA. TA exhibited maximum cytotoxic activity against the Hs 683 cell line. Nuclear morphology, 4′,6-diamidino-2-phenylindole staining and annexin V/propidium iodide apoptosis assaying of Hs 683 cells confirmed that cell death was due to the induction of apoptosis by TA. Further mechanistic study of TA on Hs 683 cells revealed that it decreased cell growth with increasing TA concentration, that resulted in the activation of pro-caspase 3 and caspase 9 and the cleavage of poly (ADP-ribose) polymerase, implying the induction of apoptosis cascades. Biochemical evidence of apoptosis resulted from the loss of mitochondrial membrane potential and increased intracellular reactive oxygen species production by TA in a dose-dependent manner. Based on this data, TA may be further investigated as a potential anticancer therapeutic lead.

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“…A study was conducted in New Zealand in which a small number of poisoning cases was the major cause cited for not stocking antidotes, followed by high cost. 12 If the reason of poisoning is unknown, 9 out of 17 physicians indicate pulverized charcoal instead of universal antidote. Picchioni also stated same that activated charcoal alone is more effective than universal antidote.…”

Section: Resultsmentioning

confidence: 99%

Antidotes;

Butt¹,

Shahid²,

Gull³

et al. 2017

TPMJ

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Introduction: To assess the current status of antidotes in hospital formulary& their comparison with list of antidotes mentioned in National Essential Drug List (NEDL).Evaluation of treatments for poisoned patients and establishment of Poison Control Center (PCC).Study Design: Cross-sectional study. Setting: Different Government and Private Hospitalsof Lahore. Period: 02 months (August 2015 - September 2016). Material and Methods: Adetailed questionnaire was prepared for the collection of data. Data was illustrated as graphsand tables. Results: All antidotes mentioned in NEDL are present not in a single hospital ofLahore. Atropine (87%), Flumazenil (80%), Magnesium Sulphate (80%) were present in majorityof the hospitals. On the contrary, Penicillamine, Obidoxime and Sodium Thiosulphate wereobsolete in all hospitals. Although antidotes were not fully available in both government andprivate hospitals of Lahore but the situation is worse in case of private hospitals. Conclusion:High cost and late procurement are the reasons for Delay in treatment of poisoned patients.Not a single Poison Control Center is present in Lahore. Affirmative actions should be taken toimprove the accessibility of antidotes in hospitals. There is emergent need to establish PoisonControl Center.

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Interference by Tannic Acid with the Effectiveness of Activated Charcoal in “Universal Antidote”

Cited by 17 publications

References 4 publications

Medical devices that look like medicines: safety and regulatory concerns for children in Europe

Medical devices that look like medicines: safety and regulatory concerns for children in Europe

Tannic acid mediated induction of apoptosis in human glioma Hs 683 cells

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