Abstract
Late-life mild cognitive impairment and dementia represent a significant burden on healthcare systems and a unique challenge to medicine due to the currently limited treatment options. Plant phytochemicals have been considered in alternative, or complementary, prevention and treatment strategies. Herbals are consumed as such, or as food supplements, whose consumption has recently increased. However, these products are not exempt from adverse effects and pharmacological interactions, presenting a special risk in aged, polymedicated individuals. Understanding pharmacokinetic and pharmacodynamic interactions is warranted to avoid undesirable adverse drug reactions, which may result in unwanted side-effects or therapeutic failure. The present study reviews the potential interactions between selected bioactive compounds (170) used by seniors for cognitive enhancement and representative drugs of 10 pharmacotherapeutic classes commonly prescribed to the middle-aged adults, often multimorbid and polymedicated, to anticipate and prevent risks arising from their co-administration. A literature review was conducted to identify mutual targets affected (inhibition/induction/substrate), the frequency of which was taken as a measure of potential interaction. Although a limited number of drugs were studied, from this work, interaction with other drugs affecting the same targets may be anticipated and prevented, constituting a valuable tool for healthcare professionals in clinical practice.
Highlights
The aging population and the increased life expectancy have unveiled the need for effectively managing associated cognitive decline to maintain functional capacity and quality of life
Ten representative drugs commonly prescribed to the elderly, belonging to 10 pharmacotherapeutic groups, were selected according to unpublished prescription data (2017–2019) supplied by the National Pharmacies Association. They were classified according to the Anatomical Therapeutic Chemical Classification System (ATC) [36], the Biopharmaceutical Drug Disposition and Classification System (BDDCS) [37–43] and checked for increased risk if an interaction occurs [44]
Our literature search revealed the presence in botanicals (e.g., Mucuna pruriens) of one amino acid well known for its activity in cognition: levodopa (L-DOPA), a precursor of dopamine with antiparkinsonian properties [12]
Summary
The aging population and the increased life expectancy have unveiled the need for effectively managing associated cognitive decline to maintain functional capacity and quality of life. Clinical evidence of efficacy is at times rather inconsistent and scarce, many promising plants (as such or concentrated in the form of extracts) have been identified and extensively reviewed [4,5,18–21] Many of these contain bioactive compounds, belonging to different chemical classes, with good to excellent anticholinesterase activity [5,19,20,22,23], or antioxidant and anti-inflammatory effects, among others [19,21]. Understanding pharmacokinetic and pharmacodynamic interactions is warranted to avoid undesirable adverse drug reactions, which result in unwanted side-effects or therapeutic failure The aim of this narrative review of the literature is to evaluate potential risks of HDI between purported botanical cognitive enhancers often taken by the elderly and ten representative drugs of different pharmacotherapeutic classes commonly prescribed to this age group. This work identifies the bioactives with the highest HDI potential, but can be further utilized as a suitable database for physicians and healthcare professionals to improve clinical outcomes and prevent adverse effects
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