Tamsulosin Hydrochloride

Chemoprophylaxis to mitigate the severity of COVID-19 outbreaks in nursing homes is not yet available. We assessed the feasibility of remdesivir, nirmatrelvir/ritonavir, and molnupiravir as potential chemoprophylaxis for nursing home residents.

We conducted a national, cross-sectional study of residents of Department of Veterans Affairs (VA) Community Living Centers (CLCs) in 2021-2022.

Veterans living in 134 CLCs on 4 census dates: January 1, 2021, July 1, 2021, January 1, 2022, and July 1, 2022.

Estimated glomerular filtration rates (eGFRs) were used to determine the proportion of residents who would require dose adjustment for antiviral agents. Medications issued in the 14 days before the census date were assessed for potential drug-drug interactions (pDDIs) with remdesivir, nirmatrelvir/ritonavir, and molnupiravir. We determined the number of residents at risk for pDDI and characterized their possible severity and mitigating actions.

Remdesivir and molnupiravir would not have required dose adjustments based on renal insufficiency, but 29% of CLC residents had eGFR values that would require adjustment for nirmatrelvir/ritonavir. The proportion of CLC residents at risk for pDDIs for remdesivir, nirmatrelvir/ritonavir, and molnupiravir was <1%, 91%, and 0%, respectively. Atorvastatin, tamsulosin, and amlodipine were the most frequently prescribed medications with a pDDI to nirmatrelvir/ritonavir. Therapy modification was required to address pDDIs among 61% of CLC residents; an additional 29% were taking ≥1 medication with an absolute contraindication to nirmatrelvir/ritonavir.

Given their tolerability among people with renal insufficiency and limited pDDIs, remdesivir and molnupiravir are both potential chemoprophylactic agents for COVID-19 outbreaks in nursing homes. Availability as oral capsules increases the feasibility for molnupiravir. Further work is needed to assess their efficacy to mitigate COVID-19 outbreaks in nursing homes.

Urolithiasis, a disease of kidney stones, is a prevalent and recurrent condition characterized by the formation of hard mineral deposits in the urinary tract, leading to significant morbidity and a substantial healthcare burden worldwide. With recurrence rates ranging from 30 to 50% and a lifetime prevalence of 9–12% in industrialized populations, effective prevention and management strategies are crucial. Traditional approaches to urolithiasis, including pharmacological agents and surgical interventions, emphasize medical interventions and lifestyle changes; however, the persistent recurrence and impact on quality of life underscore the necessity for more comprehensive solutions. Recent advancements have focused on the potential of nutraceuticals, including herbal extracts, vitamins, and minerals, as adjuncts in the prevention and treatment of kidney stones. These agents may exert beneficial effects by inhibiting stone crystal formation, modulating urinary pH, reducing urinary calcium and oxalate excretion, enhancing diuresis, and supporting overall renal function. Moreover, these plant-based therapies may help alleviate symptoms such as pain and inflammation related to stone episodes. This systematic review synthesizes findings from 14 randomized controlled trials to assess the therapeutic impact and safety profile of various herbal interventions in patients with diagnosed kidney or ureteral stones. Thus, evidence from these recent clinical trials has increasingly supported the efficacy of single-herb and polyherbal formulations, such as Nigella sativa , Alhagi maurorum , Subap Plus, and Palasha Kshara, in modulating urinary risk factors and promoting stone expulsion. For instance, these trials demonstrated promising outcomes for several herbs: Portulaca oleracea significantly increased urinary citrate and reduced calcium, Traditional Persian Medicine-based Mofatet powder markedly reduced stone size and improved urinary parameters, Alhagi maurorum distillates and extracts showed comparable efficacy to hydrochlorothiazide in stone expulsion, and Nigella sativa performed as well as or better than tamsulosin in both pain relief and stone passage. Additional polyherbal remedies, such as Subap Plus, Palasha Kshara, and BNO 1040 extract, also yielded favourable results in improving stone clearance, easing symptoms, and potentially preventing recurrence. Notably, most studies reported good short-term tolerability and minimal adverse effects. Despite these promising findings, limitations in sample size, standardization of formulations, lack of comprehensive adverse events reporting, and need for long-term follow-up highlight the necessity for further rigorous trials.