Experts In Pharmacology Research Articles

The impacts of a lower protein and energy density diet in aged male Sprague Dawley rat studies

The collaboration project VASIB aims at reducing the antibiotic consumption in pig production by integrating information from consulting expertise in clinical inspection, hygiene, epidemiology, microbiology and pharmacology. In this VASIB subproject, we investigated the antimicrobial susceptibility and relatedness of porcine respiratory tract pathogens. Bordetella bronchiseptica (n = 47), Pasteurella multocida (n = 18) and Streptococcus suis (n = 58) were obtained from weaner pigs at two farms. Antimicrobial susceptibility testing was performed by broth microdilution according to CLSI standards. Resistance genes were detected via specific PCR assays. Macrorestriction analysis was conducted to determine the relatedness of the isolates and to identify clones. The B. bronchiseptica isolates showed indistinguishable (farm 1) or two closely related XbaI-patterns (farm 2). Different SmaI-PFGE patterns of P. multocida isolates were obtained at three different time points. In contrast, PFGE analysis of S. suis indicated more than one fragment pattern per pig and time point. Isolates exhibiting indistinguishable PFGE patterns were considered to represent the same clone. This study showed that only two closely related B. bronchiseptica clones were present in both farms, which had low MICs to all antimicrobials, except to β-lactams. Different P. multocida clones were present at the three time points. They showed overall low MIC values, with two clones being resistant and one intermediate to tetracycline. S. suis clones were resistant to tetracycline (n = 19) and/or erythromycin/clindamycin (n = 16). They harboured the tetracycline resistance genes tet(O), tet(M) or tet(L) and/or the macrolide/lincosamide/streptogramin B resistance gene erm(B). Five penicillin-resistant S. suis clones were also detected.

Pharmacology and drug development in rare diseases: the attractiveness and expertise of the French medical pharmacology.

Developing drugs for rare disease can be challenging due to specific rare disease characteristics. The French Medical Pharmacology is structured and positioned to play a major role in orphan drug research and development due to the required expertise concentrated into pharmacology departments, exclusively implemented within the French university hospitals, public hospitals that are linked to a medical school (and often a pharmacy school) with numerous INSERM or CNRS labelled research units. In addition, these structures allow a close collaboration between researchers, academic institutions and biotech start-up (most of them being spin-off of the academic structures). Also, within university hospitals are located the clinical investigation centres, linking to the F-CRIN network and also to Inserm and hospitals, that enable care staff and researchers to be associated and clinical research protocols to be carried out on site, in full respect with ethic and regulatory aspects. As a consequence, this intra and multidisciplinary expertise offers all resource to elaborate a tailored approach for orphan drug development, in new entities as well as in repositioning. For preclinical development: drug screening, candidate selection (taking into account PK, metabolism, variability and potential toxicity) and preclinical models (iPS, animal models) that could allow a better translation to human research. For clinical development, we will mention here dose determination, safety evaluation and Orphan Drug Designation and Protocol Assistance preparation and submission. For post marketing evaluation and surveys, the pharmacovigilance, addictovigilance and pharmacoepidemiology expertise, combined with access to large databases allow a better approach to orphan drug use and safety. As outlined through two success stories (Charcot Marie Tooth, vascular Ehlers-Danlos syndrome), the added value of French Medical Pharmacology structures and expertise has been evidenced in the know-how, multidimensional and multidisciplinary approaches, allowing the development of numerous drugs that have been granted with Orphan Drug Designation and later Market Approval. Even if specific and possibly even more, the field of orphan drugs requires the respect of highest standards of safety and quality. French Medical Pharmacology intends to continue on this way and constantly improve his involvement in this field, committed to a single objective: answer the unmet medical need of patients with rare diseases.

The 10-D assessment and evidence-based medicine tool for authors and peer reviewers in clinical pharmacology .

Background: Peer reviewers and authors of clinical pharmacology manuscripts need to meet the standards for Evidence-Based Medicine (EBM) and Good Publication Practices (GPP), and editors of clinical pharmacology journals have to maintain an overview of the peer review process. Methods and results: The peer review process can be monitored and facilitated using the 10-D assessment, which comprises peer review criteria to determine if: 1. design of the study, 2. diagnoses employed, 3. drug molecules involved, 4. dosages applied, 5. data collected, 6. discussion of the findings, 7. deductions made, 8. documentation, 9. declarations, and 10. dHS (drug hypersensitivity syndrome) risk assessment is in accord with the objectives of the study and meet the requirements of EBM and GPP. Conclusions: The 10-D assessment tool, although easy to apply, requires a high level of clinical pharmacology expertise, especially in the fields of drug disposition, pharmacokinetics, and drug action. Its application will facilitate the peer review of clinical research and clinical trial reports and thus promote safety in drug development and pharmacotherapy and meet the needs of Good Publication Practices.

The Measures of French Regulatory Agency for Clinical Trials Conduction After the Rennes Disaster

To show how French system reacted to the so-called “Rennes Disaster”, in which six healthy volunteers, after a fatty acid amide hydrolase inhibitor intake, presented serious brain damage and one died subsequently to these lesions. The aim of this communication was to illustrate the requirements of French Ministry of Health after the “Rennes Disaster”, and how the safety and vigilance units of academic sponsors implemented these new requirements in their routine activity. The key points of changes in French regulatory requirements were summarized. Thereafter, a focus on the actions of the Revise (REflections on VIgilance and SafEty of Clinical trials) Network was presented. The Revise Network was created on 2007, and it now federates around fifty safety units of academic sponsors. From the beginning, the majority of them were supported by a pharmacology department in the context of French regional centres of pharmacovigilance. After the Rennes Disaster, the ministry of health imposed that in all study on drugs performed on healthy subjects, every serious adverse reaction leading to hospitalisation must be considered as an emerging safety issue and reported immediately to the French Drug Safety Agency (Agence Nationale de la securité du Médicament, ANSM). The study must be interrupted immediately and, to restart with the inclusions, the sponsor must bring proof its harmlessness to ANSM. Moreover, all healthy subjects must be informed and give a new consent before any new administration. Later on, the Jardé law considered all serious adverse events observed on healthy volunteers as a safety issue and must be reported immediately to ANSM. In any other clinical trial phases, life-threatening or fatal SUSARs (suspected unexpected adverse drug reaction) must be reported without any delay to ANSM. The extreme short time to assess serious adverse events before the transmission, imposed to reinforce the organisation of vigilance units for their management. The Revise Network proposed 30 guidelines to harmonies the procedures, such as a guideline for a safety management plan tailored to the evaluation of benefit risk assessment based on clinical pharmacology expertise. The French authorities and the vigilance units promptly reacted to the Rennes Disaster. The Revise Network, university hospital directorates and the institutional pharmacology units are working together to help in better preventing and managing the safety of people included in clinical trials.

Peer review in Clinical Pharmacology using the 8-D Assessment.

The requirement for editors of clinical pharmacology journals to maintain an overview of the peer review process for manuscripts submitted can be facilitated by use of the 8-D Assessment. The 8-D Assessment comprises peer review criteria to determine if the:1. Design of the study, 2. Diagnoses employed, 3. Drug molecules involved, 4. Dosages applied, 5. Data collected, 6. Discussion of the findings, 7. Deductions made, and 8. Documentation are in accord with the objectives of the study and meet the requirements of evidence-based medicine. This tool, although easy to apply, requires a high level of clinical pharmacology expertise, especially in the fields of drug disposition, pharmacokinetics, and drug action.

An integrated perspective on diabetic, alcoholic, and drug-induced neuropathy, etiology, and treatment in the US.

Neuropathic pain (NeuP) is a syndrome that results from damaged nerves and/or aberrant regeneration. Common etiologies of neuropathy include chronic illnesses and medication use. Chronic disorders, such as diabetes and alcoholism, can cause neuronal injury and consequently NeuP. Certain medications with antineoplastic effects also carry an exquisitely high risk for neuropathy. These culprits are a few of many that are fueling the NeuP epidemic, which currently affects 7%–10% of the population. It has been estimated that approximately 10% and 7% of US adults carry a diagnosis of diabetes and alcohol disorder, respectively. Despite its pervasiveness, many physicians are unfamiliar with adequate treatment of NeuP, partly due to the few reviews that are available that have integrated basic science and clinical practice. In light of the recent Centers for Disease Control and Prevention guidelines that advise against the routine use of μ-opioid receptor-selective opioids for chronic pain management, such a review is timely. Here, we provide a succinct overview of the etiology and treatment options of diabetic and alcohol- and drug-induced neuropathy, three different and prevalent neuropathies fusing the combined clinical and preclinical pharmacological expertise in NeuP of the authors. We discuss the anatomy of pain and pain transmission, with special attention to key ion channels, receptors, and neurotransmitters. An understanding of pain neurophysiology will lead to a better understanding of the rationale for the effectiveness of current treatment options, and may lead to better diagnostic tools to help distinguish types of neuropathy. We close with a discussion of ongoing research efforts to develop additional treatments for NeuP.

Implementation of inpatient models of pharmacogenetics programs.

The operational elements essential for establishing an inpatient pharmacogenetic service are reviewed, and the role of the pharmacist in the provision of genotype-guided drug therapy in pharmacogenetics programs at three institutions is highlighted. Pharmacists are well positioned to assume important roles in facilitating the clinical use of genetic information to optimize drug therapy given their expertise in clinical pharmacology and therapeutics. Pharmacists have assumed important roles in implementing inpatient pharmacogenetics programs. This includes programs designed to incorporate genetic test results to optimize antiplatelet drug selection after percutaneous coronary intervention and personalize warfarin dosing. Pharmacist involvement occurs on many levels, including championing and leading pharmacogenetics implementation efforts, establishing clinical processes to support genotype-guided therapy, assisting the clinical staff with interpreting genetic test results and applying them to prescribing decisions, and educating other healthcare providers and patients on genomic medicine. The three inpatient pharmacogenetics programs described use reactive versus preemptive genotyping, the most feasible approach under the current third-party payment structure. All three sites also follow Clinical Pharmacogenetics Implementation Consortium guidelines for drug therapy recommendations based on genetic test results. With the clinical emergence of pharmacogenetics into the inpatient setting, it is important that pharmacists caring for hospitalized patients are well prepared to serve as experts in interpreting and applying genetic test results to guide drug therapy decisions. Since genetic test results may not be available until after patient discharge, pharmacists practicing in the ambulatory care setting should also be prepared to assist with genotype-guided drug therapy as part of transitions in care.

Primary care for opioid use disorder.

Primary care for opioid use disorder.

Strategies to Improve Medication Adherence in Older Persons: Consensus Statement from the Senior Italia Federanziani Advisory Board.

Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients. Non-adherence to medications affects the quality and length of life and has been associated with negative health outcomes and increasing healthcare costs. The problem of non-adherence is particularly troublesome in older patients who are affected by multiple chronic diseases and for this reason receive multiple treatments. To date, no single intervention strategy has been shown to be effective in improving adherence across all patients, conditions, and settings. Between September and October 2014, a group of experts in geriatrics, pharmacology, epidemiology, and public health applied a modified RAND appropriateness method to reach a consensus on the possible best interventions to improve adherence in older individuals. Seven interventions were identified, classified based on their target (patient, therapy, and public health/society): (1) Comprehensive Geriatric Assessment, (2) patient (and caregiver) education to improve patient empowerment, (3) optimization of treatment, (4) use of adherence aids, (5) physician and other healthcare professionals' education, (6) adherence assessment, (7) facilitating access to medicine by service integration. For each intervention, experts assessed (a) target population, (b) health professionals potentially involved in the intervention, (c) strategies/instruments needed for implementation, and (d) time of the intervention. Interventions that target adherence must combine different approaches targeting the complex aspects of older adults in a holistic approach. Tackling non-adherence, with its complexity, requires a multi-stakeholder patient-centred approach acting in a defined framework of interactions in which the different players may provide different services but are integrated with one another.

Move Over Person-Centered Care, Make Way for Precision Medicine

Move Over Person-Centered Care, Make Way for Precision Medicine

Specialty pharmacy for hematologic malignancies.

The oral oncology medications used in the treatment of chronic lymphocytic leukemia, chronic myeloid leukemia, multiple myeloma, and non-Hodgkin's lymphoma are reviewed, and the specialty pharmacy services at three large academic medical centers are described. More than one dozen oral oncology medications are being used for hematologic malignancies and afford patients increased convenience and the potential to improve their quality of life. These agents include ibrutinib, idelalisib, imatinib, dasatinib, nilotinib, bosutinib, ponatinib, thalidomide, lenalidomide, pomalidomide, panobinostat, ixazomib, and vorinostat. Despite the benefits of an autonomous-driven patient care plan, these high-risk, high-cost treatments are not without their challenges. Oral oncology medications are associated with significant barriers to adherence, including low health literacy, patient forgetfulness, complex administration instructions, troublesome adverse effects, and high copayments. Many outpatient cancer center pharmacies associated with large academic medical centers are now applying for specialty pharmacy designation. This affords the onsite dispensing pharmacy access to once-limited oral oncology medications that can be dispensed to clinic patients. In addition, the specialty pharmacy services offered within these cancer centers bridge an important gap in patient care and improve the care provided to oncology patients. As oral oncology agents continue to be approved by FDA, oncology treatment teams must establish a comprehensive plan for their management. Because of their pharmacologic expertise, access to patients' medical records, and unique position within ambulatory care oncology teams, pharmacists can play an important role in patient education, laboratory monitoring, medication adherence, and cost saving.

Recommendations for selecting drug-drug interactions for clinical decision support.

Recommendations for including drug-drug interactions (DDIs) in clinical decision support (CDS) are presented. A conference series was conducted to improve CDS for DDIs. A work group consisting of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information vendors, and healthcare organizations was convened to address (1) the process to use for developing and maintaining a standard set of DDIs, (2) the information that should be included in a knowledge base of standard DDIs, (3) whether a list of contraindicated drug pairs can or should be established, and (4) how to more intelligently filter DDI alerts. We recommend a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization. We outline key DDI information needed to help guide clinician decision-making. We recommend judicious classification of DDIs as contraindicated and more research to identify methods to safely reduce repetitive and less-relevant alerts. An expert panel with a centralized organizer or convener should be established to develop and maintain a standard set of DDIs for CDS in the United States. The process should be evidence driven, transparent, and systematic, with feedback from multiple stakeholders for continuous improvement. The scope of the expert panel's work should be carefully managed to ensure that the process is sustainable. Support for research to improve DDI alerting in the future is also needed. Adoption of these steps may lead to consistent and clinically relevant content for interruptive DDIs, thus reducing alert fatigue and improving patient safety.

Nursing Assistants, Medication Errors, and Patient Safety: A New Challenge in Iran.

Today, all over the world, university nursing programs are based on professional academic training (1). In many pioneering countries in nursing, to enter a nursing program, an applicant must have a two-year accreditation in other fields such as psychology or must be educated and trained in nursing for 4 years to qualify as a registered nurse (2). In Iran, individuals enter nursing school after passing the national university entrance exam. Nursing programs offer specific theoretical and practical courses that are based on the tasks that the nurses must be able to perform in hospitals or other nursing care facilities (1). A crucial area in nursing education is pharmacology, which is the teaching of theoretical and practical approaches by pharmacology experts. Knowing the mechanisms of action and providing appropriate nursing care before and after administering medicines are among the nurses’ main duties. However, studies have shown that medication errors are prevalent among nurses; a shortage of nursing staff, a high workload, and fatigue are among the influential factors. In Iran, similar to other countries, there is a nurse shortage (3). However, many countries have decreased this problem through the implementation of several strategies. Some countries reduced nurses’ workloads by training nurse assistants who are taught to perform primary care activities, such as bathing patients and helping patients with their elimination needs, dressing, and eating. Some countries have also presented nurse assistants with higher levels of training and then assigned them more complex responsibilities, such as suctioning, removing peripheral venous catheters, rewriting orders, caring for sores, and monitoring blood sugar levels, which must be done under the supervision of a nurse (4). Some countries have also started to train medication nursing assistants (MNAs), who are licensed nursing assistants (LNAs) who have completed a board-approved medication administration program that consists of at least 30 hours of theoretical content and 30 hours of clinical training. Candidates should also have a minimum of 5 years of work experience and possess crucial competencies in basic nursing skills and the English language. MNAs can administer medical orders only for stable patients (5). Recently, a curriculum for training nursing assistants was presented in Iran, and several private institutions have attempted to train nurse assistants. However, this program has received strong criticism because the theoretical and practical content of the program is not commensurate with the task descriptions defined for nursing assistants. Although the content of the program is very simple and requires only a short period to complete, the task descriptions contain several advanced nursing activities and procedures such as drug administration and insertion of intravenous catheters. These interventions require high levels of pharmacology and anatomy knowledge and skills. A recent study reported that nursing students who has passed the required theoretical and practical content for pharmacology are not competent in the process of providing medication therapy (6). In addition, in the current issue of Nursing and Midwifery Studies, Zare Ghamari et al. presented a study on the status of clinical pharmaceutical care education during a nursing internship program and reported that the quality of education is poor in several aspects of medication administration (7). Although the quality of education in Iran’s university programs with several expert instructors is low, the quality would be much lower in private institutions. How can high school graduates with no knowledge of or experience in healthcare or care-giving be taught to be nurse assistants with 1 month of theoretical training? Would not this increase medication errors? Are we putting patients at higher risk? Are we not threatening the status of the nursing profession in the healthcare system?

Les antidépresseurs ont-ils encore un intérêt dans la dépression bipolaire ?

Bipolar disorder is a common psychiatric illness with lifetime prevalence of about 1% and up to 4% if defined by the concept of bipolar spectrum. Depression is the most difficult to treat and the most frequent state of the bipolar disorder. Bipolar depression is also probably underdiagnosed because of the limited criteria of previous hypomanic or manic episode. Antidepressants are the most common treatment prescribed in bipolar depression but their use in this context remains controversial. ObjectiveThe aim of this article is to review literature and guidelines in order to help psychiatrists in their decision to prescribe or not an antidepressant agent in bipolar depression. MethodThe author conducted a computerized literature search of the Medline and ScienceDirect databases to identify studies involving antidepressants use in bipolar disorder through 2015. ResultsUse of the antidepressants in bipolar depression in clinical practice is very large, mostly in combination with a mood stabilizer. The single use of a mood stabilizer agent is rare. Most of type 1 bipolar depressions are treated with an antidepressant in association, but the use of monotherapy is not uncommon in type 2 bipolar depression. Since the 2000's their widespread use remains (even if monotherapy is declining compared to combination with mood stabilizers). This fact can be explained by the difficulties to diagnose a bipolar depression without any history of previous manic episode. In this aim, many authors have tried to define the bipolar spectrum. Early start of the disease, family history of bipolar disorder, hyperthymic temperament, atypical depression and more than 4 previous episodes have to be considered in clinical evaluation. The risks of the use of antidepressants in bipolar disorder are now better known: Mood switch, rapid cycle, treatment-resistance, Antidepressant-associated Chronic Irritable Dysphoria, and activation syndrome. The significant use of antidepressant in bipolar depression could be explained by diagnoses difficulties and divergent findings in literature. The authors highlight the lack of strong comparative studies assessing respective efficacy between antidepressants and efficacy versus addition of a mood stabilizer concerning this important public health question. ConclusionThe prescription of an antidepressant is a matter of the clinical and pharmacological expertise of the psychiatrist. First, he has to be above in the reassurance of his prescription if he decides to prescribe an antidepressant in bipolar depression.

Clinical pharmacy in Sri Lanka: translating training into practice

Clinical pharmacy in Sri Lanka: translating training into practice

On the creation of a clinical gold standard corpus in Spanish: Mining adverse drug reactions

The advances achieved in Natural Language Processing make it possible to automatically mine information from electronically created documents. Many Natural Language Processing methods that extract information from texts make use of annotated corpora, but these are scarce in the clinical domain due to legal and ethical issues. In this paper we present the creation of the IxaMed-GS gold standard composed of real electronic health records written in Spanish and manually annotated by experts in pharmacology and pharmacovigilance. The experts mainly annotated entities related to diseases and drugs, but also relationships between entities indicating adverse drug reaction events. To help the experts in the annotation task, we adapted a general corpus linguistic analyzer to the medical domain. The quality of the annotation process in the IxaMed-GS corpus has been assessed by measuring the inter-annotator agreement, which was 90.53% for entities and 82.86% for events. In addition, the corpus has been used for the automatic extraction of adverse drug reaction events using machine learning.

Lessons learned in pediatric clinical research to evaluate safe and effective use of drugs in pregnancy.

Children and pregnant women are vulnerable populations lacking clinical data to guide drug dosing. For children, over the past 15 years, the knowledge gap in pharmacokinetic, safety, and efficacy data has been narrowed as a result of the use of innovative clinical trial designs, minimal risk research methods, increased understanding of developmental pharmacology, multidisciplinary research teams, increased clinical pharmacology expertise and training, collaborative research networks, and critical legislative changes. This progress has not been observed to a similar degree for pregnant women. These two populations, however, share similar drug development challenges and, therefore, lessons learned in pediatric clinical trials can be leveraged to advance drug development in pregnant women.

Delphi survey of international pharmacology experts: an attempt to derive international recommendations for use of medicine in breastfeeding women.

There are currently no common guidelines used by health professionals to aid decision-making around the use of medicines during breastfeeding. Several specialized books, Web sites, and drug information services exist; however, all use slightly different criteria to derive their "safety hierarchy." The aim of this study was to build consensus among international experts in pharmacology and breastfeeding to develop an agreed-upon classification system for safety of medicine use in breastfeeding women. A three-round Web-based Delphi qualitative research design was used. Seventeen experts in pharmacy/pharmacology and breastfeeding identified 15 key parameters that are used to inform decisions about medicines and breastfeeding. The most important parameters about the infant were the age and health of the child, and those of the medicine were the safety profile and experience of use in infants. The experts had a clear understanding of the complexity of decision-making when prescribing for breastfeeding women. Although the current number or letter classification systems do not incorporate important considerations such as infant age, a longer "descriptive text" incorporating all considerations may be impractical in busy clinical practice. Although clinicians and lay people would appreciate a simple classification scheme, in practice, decision-making about the safety of medicines for breastfeeding women is complex.

Consensus recommendations for systematic evaluation of drug-drug interaction evidence for clinical decision support.

Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. The aim of this study was to provide recommendations for systematic evaluation of evidence for DDIs from the scientific literature, drug product labeling, and regulatory documents. A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 18 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar 12 times from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. We developed expert consensus answers to the following three key questions. (i) What is the best approach to evaluate DDI evidence? (ii) What evidence is required for a DDI to be applicable to an entire class of drugs? (iii) How should a structured evaluation process be vetted and validated? Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug compendia and clinical decision support systems in which these recommendations are implemented should be able to provide higher-quality information about DDIs.

New Approach for the Development of Improved Traditional Medicine: Case of a Preparation of an Oral Hypoglycemic Medicine from Laportea ovalifolia (Schumach. & Thonn.) Chew. (Urticaceae).

A majority of Africans rely on traditional medicine as the primary form of health care. Yet most traditional medicine products have a short shelf life, especially for water-based formulations such as macerations, infusions and decoctions. Indeed, many of these water extracts become unfit for human consumption after five to seven days of conservation either because of the degradation or toxicity of active components, and/or the growth of pathogenic organisms. The purpose of this study was to describe and apply a new approach for the development of an improved traditional medicine (ITM) that is cheap, very efficient, not toxic, and easy to produce, and that can be conserved for a longer time without a significant loss of activity. Hence, Laportea ovalifolia was selected from an ethnobotanical prospection in all regions of Cameroon, and was used to prepare an oral hypoglycemic product. This preparation required 9 steps focused on the characterization of the plant species, and the standardization of the ethnopharmacological preparation by a multidisciplinary team of scientists with expertise in botany, ecology, pharmacognosy and pharmacology. Resultantly, four galenic formulations of hypoglycemic medications were produced. A relationship between these four formulations was described as follow: One spoon of oral suspension (10 ml)=one sachet of powder=2 tablets=3 capsules. Hence, our research provides new insight into a drug discovery approach that could alleviate the major problems affecting traditional medicine and enhance its effectiveness in addressing health care in developing and undeveloped countries.