Advances in Pharmacology and Therapeutics Journal

A Review of Liver Damage Caused by Statins

Alireza Bagheri — 2025-08-31

Introduction: Statins, or HMG-CoA reductase inhibitors, are among the most widely used drugs for controlling hyperlipidemia and cardiovascular diseases. They are generally considered low-risk, but sometimes, it has been reported that they can damage liver tissue with cholestatic damage or liver parenchyma. The current review addresses statins-induced liver injury, focusing on clinical presentation, diagnostic approach, and disease management.

Methods: For English-language studies, a comprehensive search using keywords selected according to the MeSH model, including "drug-induced liver injury, statin, cholestatic liver injury, cellular liver injury, and cholestasis," was conducted in PubMed, Scopus, and Google Scholar databases.

Results: Studies show that mild liver dysfunction, characterized by an increase in aminotransferases, may occur in about three percent of patients, while severe liver damage is rare and usually reversible with discontinuation of the causative statin. In suspected liver damage caused by statins, a comprehensive evaluation can be performed by taking a detailed medical history and performing laboratory investigations, including imaging studies and valid assays such as the Roussel Uclaf Causality Assessment Method (RUCAM).

Conclusion: Statins used to lower blood lipids can lead to liver damage, mainly cholestatic or hepatocyte damage. It is important to pay attention to the health of the liver while taking this drug class, and the final diagnosis of the occurrence of this complication is based on a comprehensive evaluation, monitoring of liver function, and awareness of drug interactions. More research is needed to determine strategies to reduce risk.

Effects of L- Carnitine Supplementation on Nitric Oxide Levels in Pemphigus Vulgaris Patients: A Randomized, Double-Blind Clinical Trial

Zahra Fakhri — 2025-08-31

Background and objective: Blisters on the human skin and mucous membranes are a hallmark of the extremely rare autoimmune disease known as Pemphigus vulgaris (PV). Elevated levels of reactive oxygen species (ROS) are linked to this condition. Nitric oxide (NO), produced by endothelial cells, is a key signaling molecule that contributes to vascular function and can act as an antioxidant by neutralizing reactive oxygen species in specific biological contexts. A substance that resembles a vitamin, L-carnitine, positively influences antioxidant levels. This study aimed to investigate the impact of L-carnitine supplementation on serum nitric oxide levels in patients with Pemphigus vulgaris.

Method and materials: This clinical trial included a total of 46 patients with Pemphigus Vulgaris, aged between 30 and 65 years. Participants were randomly divided into two groups: one receiving L-carnitine (n = 23) and the other a placebo (n = 23). Each group took either 2000 mg of L-carnitine or placebo tablets daily. The intervention was conducted over 8 weeks, with serum L-carnitine and nitric oxide (NO) levels assessed both before and after the intervention.

Results: At baseline, the intervention and control groups did not differ statistically significantly in terms of age, weight, height, and BMI (p > 0.05). By the end of the study, patients in the L-Carnitine group showed a significant increase in serum L-Carnitine levels (from 74.56±36.36 to 97.49±41.27, p<0.001) and in nitric oxide (NO) concentration (from 202.37±14.59 to 242.98±20.63, p=0.006) In contrast, the placebo group did not show any significant changes in either parameter (p>0.05).

Conclusion: A daily intake of 2 g of L-carnitine for 8 weeks in patients with PV has positive effects on reducing oxidative stress and increasing serum nitric oxide levels.

Exosome Therapy for Cancer Treatment: Drug Delivery Tools

Seyed Hossein Khaleghinejad — 2025-08-31

Exosomes are vesicles that naturally transport molecules between cells and have emerged as promising systems for cancer therapy. Exosomes have a lipid bilayer membrane on their surface that contains glycoproteins, tetraspanins, and receptors. DNA and microRNA (miRNA) are enclosed inside the exosomes. Due to their ability to deliver drugs, proteins, and miRNAs, they offer a selective, stable alternative to traditional cancer treatments, which often have severe side effects. Exosomes can be engineered to target cancer cells more effectively, reducing tumor growth and enhancing immune responses. The method for isolating them is broken down into three main parts: (1) initial steps before isolation that involve obtaining fluids containing exosomes, focusing on protocols for organ explants and cell cultures; (2) The actual process of exosome isolation, which includes various gradient options; and (3) procedures conducted after isolation to assess the purity and quantity of the exosomal fraction. However, challenges like production efficiency and standardization still need to be overcome. Artificial exosomes, which combine the benefits of natural and synthetic systems, are being developed to meet these needs. Future research could focus on optimizing exosome engineering techniques and exploring their applications in various cancer therapies.

Clinicopathological Features of Fungal Infections in COVID-19 Patients: A Retrospective Study in Yazd, Iran

Maryam Vajihinejad — 2025-08-31

Patients with COVID-19 due to unspecified medical treatment, hospitalization in the intensive care unit, need for invasive or non-invasive ventilation, prescription of broad-spectrum antibiotics, use of corticosteroids, and suffering from other underlying diseases, especially diabetes, are opportunistic to fungal infection. This study investigated the clinicopathology of fungal infections in patients with COVID-19 in samples sent to the pathology department of Shahid Sadoughi Hospital in Yazd, Iran, from 2020 to 2022.

Methods: This is an analytical cross-sectional study. The information related to patients with COVID-19 and fungal infections who were referred to the pathology department of Shahid Sadoughi Hospital in Yazd, Iran, from March 2020 to March 2022 was analyzed. Age, gender, clinical manifestations, type of fungal infection, site of involvement, mortality, duration of hospitalization and hospitalization department, need for mechanical ventilation, and clinical symptoms were extracted from patients’ files and recorded in a researcher-made questionnaire. The data were statistically analyzed using SPSS version 26.

Results: In this study, fungal infections were confirmed in 53 patients with COVID-19 based on pathological diagnosis. Among them, 30 (56.6%) were men and 23 (43.4%) were women. The average age of the patients was 54.26 ± 18.07 years. In the pathological examination of fungal samples, 50 (94.3%) cases of mucormycosis, 2 (3.8%) cases of Aspergillus, and 1 (1.9%) case of simultaneous mucormycosis and Aspergillus were reported. Fungal infections involved the nasal cavity in 31 (58.5%) cases and paranasal sinuses in 18 (34%) cases. After the treatment period, the patients were discharged, and 14 (26.4%) patients died.

Conclusion: We concluded that fungal infections following COVID-19 infection are associated with serious complications and a high mortality rate; therefore, it is recommended that patients who are liable to suffer from fungal infections avoid overtreatment and treat them more carefully for COVID-19 to prevent possible fungal infection

Evaluation of the Effectiveness of Ivermectin in Combination With Standard Treatment in Suspected COVID-19 Patients: A Double-Blind Randomized Clinical Trial

Zohreh Akhoundi Meybodi — 2025-08-31

Background: The 2019 coronavirus is a highly contagious viral disease that causes acute respiratory syndrome and has a catastrophic impact on the world's demographics. Ivermectin may be associated with inhibition of nuclear transport, a mechanism that may be effective against SARS-CoV-2. In this study, we investigated the effectiveness of ivermectin in combination with standard treatment in suspected or probable COVID-19 patients.

Materials and Methods: This study was a prospective and double-blind randomized controlled clinical trial. This study was conducted on 50 patients aged 18 to 60 (25 in the intervention group and 25 in the control group) suspected of having COVID-19 based on clinical symptoms, blood oxygen percentage, and COVID PCR, who are candidates for outpatient treatment. Patients are randomly divided into two intervention groups, including ivermectin and standard treatment, and a control group, including placebo and standard treatment. Standard treatment includes 500 mg acetaminophen tablets and diphenhydramine syrup. The patients in the ivermectin group used oral ivermectin at a dose of 200 µg/kg once a day for two days in addition to the standard treatment. The patients were contacted on the first, third, seventh, and fourteenth days, and the symptoms were asked according to the questionnaire. In this study, the data was statistically analyzed using SPSS 22 software.

Results: Comparison of NYHA (New York Heart Association) classes between the first day and the fourteenth day using the Wilcoxon test showed that the NYHA classes in the fourteenth group had a significant decrease compared to the first day, and the effect of the group was also significant (P≤0.05). Changes in cough frequency between the two groups during 14 days were statistically significant (P≤0.05). Changes in the frequency of shortness of breath between the two groups during 14 days were statistically significant (P≤0.05). Changes in the frequency of fever, headache, dizziness, myalgia, and the need to receive painkillers between the two groups during 14 days were not statistically significant. Changes in the frequency of nausea and vomiting between the two groups during 14 days were statistically significant (P≤0.05).

Conclusion: In the end, we concluded that using ivermectin in patients with mild to moderate clinical conditions of COVID-19 effectively improved the clinical symptoms of patients who were also receiving standard treatment, and patient's symptoms improved in a shorter period. These findings can help specialists choose multidrug treatment, including ivermectin, in treating respiratory diseases such as COVID-19.

Drugs Prescribing Pattern Among Patients with Cancer in Yazd, Iran (2020): A Cross-Sectional Study

Golnaz Afzal — 2025-08-31

Background: Evaluating chemotherapy prescription patterns is crucial due to the increasing use of nutritional supplements and adjuvants alongside chemotherapy, leading to heightened drug interactions and side effects.

Aim: This study aimed to assess chemotherapy prescription patterns, nutritional supplements, and adjuvant of patients with cancer in Yazd, Iran.

Materials: This cross-sectional study was performed on the prescriptions of all cancer patients referred to Shahid Chamran Teaching Pharmacy, affiliated with the Faculty of Pharmacy, Shahid Sadouqi University of Medical Sciences, Yazd, Iran, from September to October 2021. The prescribed chemotherapy drugs, generic chemotherapy drugs, essential drug list (EDL) chemotherapy drugs, injectable chemotherapy drugs, and supplement types in each prescription were recorded. SPSS Version 22 and various statistical tests were employed for analysis.

Results: On average, each prescription included 2.37 ± 1.22 prescribed chemotherapy drugs, 1.89 ± 1.28 chemotherapy drugs by generic name, 2.21 ± 1.29 chemotherapy drugs from EDL, and 1.99±1.39 injectable chemotherapy drugs. Monotherapy accounted for 29.4% of prescriptions; the remainder was combination chemotherapy. Oral drugs comprised 10.8%, while the rest were injectables. Cyclophosphamide had the highest frequency among chemotherapy drugs, while alkylating agents dominated. Dexamethasone and granisteron were the most common adjuvants. Major polypharmacy prevalence was significant (P-value = 0.001).

Conclusion: The average prescription included a significant number of drugs compared to international standards, with over half exhibiting major polypharmacy. Despite American guidelines discouraging supplement use, 20% of prescriptions included dietary supplements.

Frontotemporal Dementia and the Therapeutic Void: Bridging the Gap in Drug Development for FTD

Mohsen Zabihi — 2025-08-31

Frontotemporal dementia (FTD) is a progressive and early-onset neurodegenerative condition, and there are no approved disease-modifying therapies. Despite growing insight into its molecular pathology and the development of biomarkers and genetic stratification tools, drug development for FTD remains limited. Significant challenges include the clinical and pathological heterogeneity of the disease, difficulties in early diagnosis, and limited commercial incentives due to its relative rarity. This editorial highlights the urgent need for coordinated translational research efforts, international collaboration, and robust funding mechanisms to accelerate therapeutic innovation. While the scientific groundwork is promising, overcoming the current therapeutic void requires sustained and strategic global initiatives.

Therapeutic Concern: HSV-2 Resistance Following Long-Term Antiviral Use

Farzane Behnezhad — 2025-08-31

The Article Abstract is not available.