The beneficial effects of pleiotropic drugs

By Syed Akbar
June 14, 2008
Hyderabad: Imagine a heart patient benefiting from a tablet he takes for relief from
nagging headache. The tablet not only gives him relief from headache, but also dilutes his blood to the extent of preventing further cardiac attacks.
Or a person suffering from some neurological problem finds that the wrinkles on her face have vanished and she looks younger, after a doctor prescribed her Botolinium Toxin, also known as Botox. The drug was originally intended for neurological conditions like stiff neck, but is now being increasingly used for cosmetology, uplifting face and as an anti-ageing drug that reduces wrinkles.
What more does a patient ask for? Take a cheap tablet for some known small problem and get relief from a major health problem yet to be discovered. Many drugs have side effects. Some of them are good and some of them are quite bad. Drugs with multiple effects, either beneficial or harmful, are called pleiotropic medicines. In short, pleiotropic effects of a drug are actions other than those for which the medicine was specifically developed. For instance, a medicine primarily meant for headache relief working against a cardiac problem without the knowledge of the patient.
Health experts say that pleiotropic effects may be harmful (toxicity), neutral (without any side-effects) or beneficial. Such drugs come cheap and are quite affordable even for the economically poorer sections. Take the case of the simple drug called aspirin. Everybody knows that it’s available off the counter in a medical shop and provides the much-needed relief from headaches and other body aches. Aspirin was originally used as an analgesic (pain reliever) agent by doctors across the world. In-depth research has shown that aspirin has benefits unimaginable, such as helping patients who suffered a stroke. It works in patients with a history of heart attack and peripheral vascular diseases.
Says senior physician Dr Aftab Ahmed, “the list of such drugs is quite long. The active agent in these drugs works in more than one ways. Thus it benefits the patient in several ways. Some drugs have negative effects too and it is quite common. But the drugs with multiple beneficial effects really work in favour of the patient. Beta blockers are generally prescribed for BP control but they are also beneficial for heart failure, angina, and post myocardial infarction patients.”
Doctors worldwide prescribe statins for patients with high levels of cholesterol. Statins reduce cholesterol. They also improve the functioning of blood vessels. Statins are potent inhibitors of cholesterol biosynthesis.
In clinical trials, statins are beneficial in the primary and secondary Prevention of coronary heart disease. However, the overall benefits observed with statins appear to be greater than what might be expected from changes in lipid levels alone, suggesting effects beyond cholesterol lowering.
Statins also involve improving endothelial function, enhancing the stability of atherosclerotic plaques, decreasing oxidative stress and inflammation, and inhibiting the thrombogenic response. They are also beneficial with their extra-hepatic effects on the immune system and bones.
“Sildenafil popularly known as Viagra is basically a drug for impotency or erectile dysfunction, later on it was found to be useful in new born children too,” says Dr Manoj Agarwal, senior cardiologist, Apollo Health City, Hyderabad. The drug can be used for patients who have primary pulmonary hypertension. There are lots of patients suffering from this disease, it has no permanent cure. This drug helps to improve their quality of life.
“In new born nitric oxide is required to decrease the resistance in lungs known as pulmonary vascular resistance. However nitric oxide is expensive and most patients here can’t afford. A few years ago Sildenafil, nitric oxide donor was found very useful in new born children with heart disease. These children have high pulmonary artery pressure and this drug helped in reducing the suffering of the children. That way a drug originally intended for some other purpose has become a boon for these children,” argues Dr Manoj.
Suffering from malaria? Doctors prescribe chloroquine. You get rid of the dangerous malaria thanks to chloroquine dose. And you are also relieved of your nagging joint pains, arthritis, amoebic liver abscess, photosensitive skin lesions, in case you are suffering from all or any one of them. Chloroquine has properties beyond curing malaria. Diabetics, particularly women, have much to cheer about metformin, the
commonly prescribed drug for diabetes. Metformin has got benefits for women with polycystic ovary disease associated with infertility and overweight.
Viagra is now increasingly prescribed for patients with pulmonary Hypertension. ACE inhibitors, originally for BP control, but is also useful for heart failure, diabetic kidney diseases and post MI Patients.
The next time one goes to a medical shop, one need not be shy of asking for Viagra. For, it has benefits other than those popularly known or advertised by drug manufacturers.

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Pleiotropic (drugs with multiple benefits):
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1. Aspirin: originally an analgesic; useful to stroke, heart attack, peripheral vascular disease patients.
2. Beta blockers: Generally prescribed for BP control; also beneficial for heart failure, angina, and post myocardial infarction patients.
3. Statins: reduce cholesterol; also improve the functioning of blood vessels.
4. Chloroquine: anti-malarial drug; used for joint pains, arthritis, amoebic liver abscess, photosensitive skin lesions etc.
5. Botolinium Toxin or Botox: neurological conditions like stiff neck; beneficial for cosmetology, uplifting face, as an anti ageing drug, reduces wrinkles.
6. Metformin: anti-diabetes; benefits for women with polycystic ovary disease associated with infertility and overweight.
7. Viagra: erectile dysfunction; used for patients with pulmonary hypertension; this reduces pulmonary hypertension and symptoms associated with it.
8. ACE inhibitors: BP control; also useful for heart failure, diabetic kidney diseases, post MI patients etc.