THE EFFECTS OF VITAMIN C AND GRAPE FRUIT JUICE SUPPLEMENTS ON THE POTENCY AND EFFICACY OF SOME SELECTED ANTI-MALARIAL DRUGS

Abstract

Combination therapy (CT) is now advocated for the treatment of malaria, especially the artemisinin based CT. Malaria is one of the most serious health challenges facing the world today. It is a disease caused by plasmodium, which could be cured effectively by the use of combination therapeutic drugs called anti-malarial drugs. The effects of vitamin C and grape vine supplements on the potency and efficacy of some selected anti-malarial drugs-combination therapy (Armact, Coartem, Waipa and Fansider) were investigated. A total of 80 patients (adults) infected with malaria parasites were used. The result showed that the concomitant administration of the drugs with grape fruit juices did not alter the efficacy and potency of the drugs, while vitamin C altered the efficacy and potency of the drugs. Therefore, the concomitant administration of these anti-malarial drugs (combination therapies) with vitamin C supplement should be avoided during the period of malaria treatment for the effectiveness of such drugs. [PUBLICATION ABSTRACT]

Headnote

ABSTRACT

Combination therapy (CT) is now advocated for the treatment of malaria, especially the artemisinin based CT. Malaria is one of the most serious health challenges facing the world today. It is a disease caused by plasmodium, which could be cured effectively by the use of combination therapeutic drugs called anti-malarial drugs. The effects of vitamin C and grape vine supplements on the potency and efficacy of some selected anti-malarial drugs-combination therapy (Armact, Coartem, Waipa and Fansider) were investigated. A total of 80 patients (adults) infected with malaria parasites were used. The result showed that the concomitant administration of the drugs with grape fruit juices did not alter the efficacy and potency of the drugs, while vitamin C altered the efficacy and potency of the drugs. Therefore, the concomitant administration of these anti-malarial drugs (combination therapies) with vitamin C supplement should be avoided during the period of malaria treatment for the effectiveness of such drugs.

Keywords: Anti-malarial, malaria, Combination therapy, Grape fruit juice and Vitamin C

INTRODUCTION

Anti-malarials also known as Anti-malarial medications are designed to prevent or cure malaria. Such drugs may be used for some treatment of malaria in individuals with suspected or confirmed infection, prevention of infection in individuals visiting a malariaendemic region who have no immunity (Malaria prophylaxis) and Routine intermittent treatment of certain groups in endemic regions (Intermittent preventive therapy) (Bukirwa, 2006).

Early diagnosis and prompt treatment is one of the principal technical components of the global strategy to control malaria (WHO 2006).The effectiveness of this intervention is highly dependent on anti-malarial drugs, which should not only be safe and effective, but also available, affordable and acceptable to the population at risk. The rational use of an effective anti-malarial drug not only reduces the risk of severe disease and death and shortens the duration of the illness, but also contributes to slowing down the development of the parasite's resistance to anti-malarial drugs (Wiseman, 2006). The emergence and rapid spread of P. falciparum resistance to commonly used anti-malarial drugs, poses a serious challenge to the effectiveness of early diagnosis and prompt treatment as a priority strategy within current malaria control efforts (Shanks, 2006).

The potential value of malaria therapy using combinations of drugs was identified as a strategic and viable option in improving efficacy and delaying development and selection of resistant parasites (Yeka, 2005). The concept of combination therapy is based on the synergistic or additive potential of two or more drugs, to improve therapeutic efficacy and also delay the development of resistance to the individual components of the combination. Current practice in treating cases of malaria is based around the concept of combination therapy, since this offers several advantages - reduced risk of treatment failure, reduced risk of developing resistance, enhanced convenience and reduced side-effects. Prompt parasitological confirmation by microscopy or alternatively by RDTs is recommended in all patients suspected of malaria, before the treatment is started (WHO, 2010). Treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible (WHO, 2010).

Combination therapy (CT) with antimalarial drugs is the simultaneous use of two or more blood schizontocidal drugs with independent modes of action and different biochemical targets in the parasite. In the context of this definition, multiple-drug therapies that include a non-anti-malarial drug to enhance the anti-malarial effect of a blood schizontocidal drug are not considered combination therapy (Yeka, 2005). The costs of anti-malarial combination therapies are over ten times more expensive than those of the traditional drugs currently used in Africa as monotherapy. Thus a change to and implementation of combination therapy would involve higher direct and indirect costs to health services, necessitating substantial financial support through sustained international public/private support, as these higher costs would be out of reach for many developing nations, especially in sub-Saharan Africa (Russell, 2008).

According to WHO guidelines 2010, artemisinin-based combination therapies (ACTs) are the recommended anti-malarial treatments for uncomplicated malaria caused by P. falciparium.

MATERIALS AND METHODS

Experimental animals

A total of 80 persons (40 males and 40 females) infected with malarial parasite residing in Umuguma in Owerri West local government area of Imo state, Nigeria were selected during the experiment after a general malarial test on all the individuals and their body weights were taken before and after drug administration (treatment).

Collection of blood sample

Methanol was used as a disinfectant to swab the thumb and a lancet was used to puncture it for blood collection. Two drops of blood was placed on free grease slide, a thick film was made and allowed to air-dry. The dried thick blood film slide was laid on a staining rack, Giemsa stained and allowed for 30-40 min, washed offwith clean water, drained and allowed to dry at room temperature. Then viewed under the microscope using 10x objective for focusing and 40x objective for identifying the Plasmodium involved. Blood samples of subjects were all confirmed to be malarial parasite infected via malarial parasite test as described by (Sibley, 2001). The research had the approval of the concerned institutional medicinal ethics boards.

Drugs and supplements administered

The drugs used were Armact (Artesunate and Amodiquine), Coartem (Artemether and Lumefantrine), both purchased from Novartis pharmaceutica. Waipa (Dihydroartemisinin and Piperaquine) and Fansider (Sulfadoxin and Pyrimethamine) both purchased from Swiss Pharma Nigeria limited. The supplements used were Vitamin C and Grape fruit juice.

RESULTS

The results of the test on the blood samples before and after administration of the antimalarial drugs to the patients are as follows:

DISCUSSION

As shown from the result of the effects of Armact only on Patients with Malarial Parasite presented in Table 1, after the administration of the drug, the malarial parasite in all the groups were absent. The absence of death in the oral administration of the Armact observed in the patients suggests that the drug is practically non-toxic acutely (Salawu et al., 2009) and Russell, (2008). This could also explain the safe use of the drug by the local people, who have been using it in the treatment of malaria, in the eastern part of Nigeria. From Table 1.1, after treating with Armact and Vitamin C, it was observed that the malarial parasite was present in all the groups. The administration of Armact and Grape fruit juice (Table 1.2) showed no malarial parasite presence in all the patients. We can infer that Grape fruit juice can play a significant role in anti-malarial activity which is similar to the report of Adesokan and Akanji, 2010.

Also, from Table 2, the administration of Coartem drug on patients infected with malarial parasite showed no evidence of these patients being infected. This suggests the findings of (Ajaiyeoba et al 2006) that the use of this drug for the treatment of malaria was due to the presence of alkaloids. The treatment of both Coartem and Vitamin C (Table 2.1) on patients infected with the Plasmodium showed the presence of malarial parasite in some patients. From Table 2.2, the administration of both Coartem and Grape fruit Juice on infected patients showed no evidence of the presence of malarial parasite.

The treatment with Waipa anti-malarial (Table 3) on infected patients showed no trace of malarial parasite. Also, this is similar to the effect of the extract reported by previous studies on Alstonia boonei (Iyiola et al., 2011). From Table 3.1, when both Waipa and Vitamin C were administered there was presence of malarial parasite unlike when both Waipa and grape fruit juice (Table 3.2) were administered.

Treatment with Fansider (Table 4) on patients infected with plasmodium showed no sign of malarial parasite. This study is similar to the reports of Idowu et al., (2010), and also may possess health promoting effects, at least under some circumstances (Basu et al., 2007). But, treatment with both Fansider and Vitamin C (Table 4.1) showed the presence of malarial parasite which is contrary to the result of the treatment with both fansider and Grape fruit juice in patients infected with malarial parasite.

CONCLUSION

Successful malaria control depends greatly on the treatment with efficacious anti-malarial drugs. The ability of the four drugs (Armact, Coartem, Waipa and Fansider) to reduce the presence of malarial parasite may be due to presence of phyto-chemically active components in the drugs which might be responsible for their therapeutic activity as anti-malarial drugs. Also, the use of Grape fruit juice with anti-malarial drugs (Combination therapy) has potential health promoting effects. Multiple-drug therapies that include a non-antimalarial drug like Vitamin C to enhance the anti-malarial effect of a blood schizontocidal drug are not considered combination therapy.

This finding supports the use of Grape fruit juice and anti-malarial drugs as a combination therapy which is safe and possess potent antimalarial activity as found in its ability to suppress Plasmodium infection in patients.

ACKNOWLEDGEMENT

The authors acknowledge the assistance from the World Bank and the federal Republic of Nigeria with the World Bank step B projects.

References

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