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Vikram HP, Kumar TP, Kumar G, Beeraka NM, Deka R, Suhail SM, Jat S, Bannimath N, Padmanabhan G, Chandan RS, Kumar P, Gurupadayya B. Nitrosamines crisis in pharmaceuticals - Insights on toxicological implications, root causes and risk assessment: A systematic review. J Pharm Anal 2024; 14:100919. [PMID: 38799236 PMCID: PMC11126534 DOI: 10.1016/j.jpha.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 05/29/2024] Open
Abstract
The presence of N-nitroso compounds, particularly N-nitrosamines, in pharmaceutical products has raised global safety concerns due to their significant genotoxic and mutagenic effects. This systematic review investigates their toxicity in active pharmaceutical ingredients (APIs), drug products, and pharmaceutical excipients, along with novel analytical strategies for detection, root cause analysis, reformulation strategies, and regulatory guidelines for nitrosamines. This review emphasizes the molecular toxicity of N-nitroso compounds, focusing on genotoxic, mutagenic, carcinogenic, and other physiological effects. Additionally, it addresses the ongoing nitrosamine crisis, the development of nitrosamine-free products, and the importance of sensitive detection methods and precise risk evaluation. This comprehensive overview will aid molecular biologists, analytical scientists, formulation scientists in research and development sector, and researchers involved in management of nitrosamine-induced toxicity and promoting safer pharmaceutical products.
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Affiliation(s)
- Hemanth P.R. Vikram
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy Mysuru, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, 570015, India
- Xenone Healthcare Pvt. Ltd., New Delhi, 110076, India
| | - Tegginamath Pramod Kumar
- Department of Pharmaceutics, JSS College of Pharmacy Mysuru, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, 570015, India
| | - Gunjan Kumar
- Xenone Healthcare Pvt. Ltd., New Delhi, 110076, India
| | - Narasimha M. Beeraka
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119991, Russian Federation
- Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research (RIPER), Ananthapuramu, 515721, India
- Herman B. Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Rajashree Deka
- Animal Physiology and Biochemistry Laboratory, Department of Zoology, Gauhati University, Guwahati, 781014, India
| | - Sheik Mohammed Suhail
- Department of Pharmacology, JSS College of Pharmacy Mysuru, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, 570015, India
| | - Sandeep Jat
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari, 781101, India
| | - Namitha Bannimath
- Department of Pharmacology, University of Galway, Galway, H91 TK33, Ireland
| | - Gayatiri Padmanabhan
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy Mysuru, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, 570015, India
| | - Ravandur S. Chandan
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy Mysuru, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, 570015, India
| | - Pramod Kumar
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari, 781101, India
| | - Bannimath Gurupadayya
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy Mysuru, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, 570015, India
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Buschmann H, Handler N, Holzgrabe U. The quality of drugs and drug products - Always guaranteed? J Pharm Biomed Anal 2024; 239:115880. [PMID: 38103416 DOI: 10.1016/j.jpba.2023.115880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/17/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
To ensure the efficacy, safety, and quality of drugs, several national and international guidelines and regulatory requirements exist. The most important international regulatory framework for quality is the collection of the guidelines ICH Q1-Q14 (International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use), which form the basis for the development and approval of medicinal products. Additionally, international and national pharmacopoeias and national regulatory authorities like Food and Drug Administration (FDA) and European Directory for the Quality of Medicines and HealthCare (EDQM) have to be considered during the lifecycle of a drug. Further, regular updates and optimization of processes and methods together with periodic audits and inspections of the manufacturing plants help to ensure compliance with the complex regulatory requirements for medicinal products. Although the pharmaceutical world seems to be very well regulated and controlled, several drug recalls per year have to be announced and conducted to remove defect products from the market and protect the patient from any potential health risk. This review article provides an overview of the most common reasons for such recalls presenting several historical and current cases with a detailed discussion of root causes. A specific focus lies on quality issues like drug degradation, impurity and nitrosamine contamination, lack of drug stability, occurrence and transformation of polymorphs, contamination with particulates and foreign matters, amongst others. The role of APIs, excipients and packaging will be discussed as well as the analytical challenges to detect, control and mitigate such quality issues. A final chapter will discuss the current situation and an outlook on emerging topics and future challenges for drug quality.
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Affiliation(s)
- Helmut Buschmann
- RD&C Research, Development & Consulting GmbH, Neuwaldegger Strasse 35/2/3, Vienna 1170, Austria
| | - Norbert Handler
- RD&C Research, Development & Consulting GmbH, Neuwaldegger Strasse 35/2/3, Vienna 1170, Austria
| | - Ulrike Holzgrabe
- University of Wuerzburg, Institute of Pharmacy and Food Chemistry, Am Hubland, Wuerzburg 97074, Germany.
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Frydrych A, Jurowski K. The comprehensive prediction of carcinogenic potency and tumorigenic dose (TD 50) for two problematic N-nitrosamines in food: NMAMPA and NMAMBA using toxicology in silico methods. Chem Biol Interact 2024; 389:110864. [PMID: 38199258 DOI: 10.1016/j.cbi.2024.110864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/12/2024]
Abstract
The identification and toxicological assessment of potential carcinogens is of paramount importance for public health and safety. This study aimed to predict the carcinogenic potency and tumorigenic dose (TD50) for two problematic N-nitrosamines (N-NAs) commonly found in food: N-2-methylpropyl-N-1-methylacetonylnitrosamine (NMAMPA, CAS: 93755-83-0) and N-3-Methylbutyl-N-1-methylacetonylnitrosamine (NMAMBA, CAS: 71016-15-4). To achieve this goal, in silico toxicology methods were employed due to their practical applications and potential in risk assessment. The justification for conducting these studies was incoherent results published by the European Food Safety Authority (EFSA). For this purpose, we applied various in silico tools, including qualitative methods (ToxTree, ProTox II and CarcinoPred-EL) and quantitative methods (QSAR Toolbox and LAZAR) were applied to predict the carcinogenic potency. These tools leverage computational approaches to analyze chemical structures for finding toxicophores and generating predictions, making them efficient alternatives to traditional in vivo experiments. The results obtained indicated that N-NAs are carcinogenic compounds, and quantitative data was obtained in the form of estimated doses of TD50 for the compounds tested.
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Affiliation(s)
- Adrian Frydrych
- Laboratory of Innovative Toxicological Research and Analyzes, Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959, Rzeszów, Poland
| | - Kamil Jurowski
- Laboratory of Innovative Toxicological Research and Analyzes, Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959, Rzeszów, Poland; Department of Regulatory and Forensic Toxicology, Institute of Medical Expertises in Łódź, ul. Aleksandrowska 67/93, 91-205, Łódź, Poland.
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Planinšek Parfant T, Skube T, Roškar R. A robust analytical method for simultaneous quantification of 13 low-molecular-weight N-Nitrosamines in various pharmaceuticals based on solid phase extraction and liquid chromatography coupled to high-resolution mass spectrometry. Eur J Pharm Sci 2024; 192:106633. [PMID: 37951317 DOI: 10.1016/j.ejps.2023.106633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023]
Abstract
Recently, the potentially highly carcinogenic N-nitrosamines (NAs) have become the focus of pharmaceutical regulatory authorities, the pharmaceutical industry and researchers because trace amounts have been detected in some drug products (DPs), resulting in drug supply shortages. In the absence of sufficient analytical methods for the determination of multiple regulated low-molecular-weight NAs in various DPs, a robust, selective, sensitive and accurate method based on sample preparation by solid phase extraction, followed by liquid chromatography high-resolution mass spectrometry for the simultaneous analysis of 13 regulated low-molecular-weight NAs was developed. The best results for the cleanup were obtained using Strata X-C SPE cartridge. The proposed method was successfully validated according to the USP general chapter 〈1469〉, demonstrating its excellent linearity, accuracy and precision in wide analytical ranges, adjusted to NAs acceptable intake limits. The achieved limits of quantitation correspond to 30 % or less of the acceptable intake limits. The developed analytical method was applied to 16 commercially available DPs containing one to three active pharmaceutical ingredients with different physicochemical properties. Only N-Nitrosodimethylamine was detected in DPs containing ranitidine at levels exceeding the regulatory AI limits by 37.6 - 57.4-fold. In addition, the robustness of the method was confirmed on a considerable number of DPs containing different active ingredients, demonstrating the suitability of the analytical method for routine quality control of different DPs, thus mitigate the risk to human health.
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Affiliation(s)
| | - Taja Skube
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, 1000 Ljubljana, Slovenia
| | - Robert Roškar
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, 1000 Ljubljana, Slovenia.
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Ishizaki A, Ozawa K, Kataoka H. Simultaneous analysis of carcinogenic N-nitrosamine impurities in metformin tablets using on-line in-tube solid-phase microextraction coupled with liquid chromatography-tandem mass spectrometry. J Chromatogr A 2023; 1710:464416. [PMID: 37804578 DOI: 10.1016/j.chroma.2023.464416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
Contamination of active pharmaceutical ingredients (APIs) and pharmaceutical preparations with carcinogenic N-nitrosamines has led to recalls of these products and supply shortages to patients. The present study describes the development of a highly sensitive method for simultaneous analysis of seven N-nitrosamines using on-line in-tube solid-phase microextraction (IT-SPME) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) to determine their actual contamination in metformin tablets. Using a Carboxen 1006 PLOT capillary as the extraction device for IT-SPME, these compounds were efficiently extracted and concentrated 6‒24-fold by subjecting 40 µL of sample to 25 repeated draw/eject cycles at a rate of 0.2 mL/min. The seven N-nitrosamines were separated within 11 min by gradient elution with 0.1 % formic acid solution and acetonitrile as the mobile phase using a CAPCELL PAK C18 MGII column and detected by multiple reaction monitoring in positive ion mode. The calibration curve showed linearity in the range 0.2‒50 ng/mL and detection limits (S/N = 3) in the range 3‒112 pg/mL. The intra-day and inter-day precisions were less than 5.5 % and 7.0 % (n = 6), respectively, with accuracies ranging from 93‒117 %. Following ultrasonic extraction with water, centrifugation and filtration of the supernatant liquid through a membrane filter, the N-nitrosamine impurities in metformin tablets could be analyzed by IT-SPME/LC‒MS/MS. Their limits of quantification (S/N = 10) were 0.1‒5.1 pg/mg API and recoveries ranged from 87‒102 %. Analysis of eight metformin tablets from eight manufacturers showed that 5.8‒7.5 pg/mg N-nitrosodimethylamine were present in three tablets, with no other N-nitrosamines detected in any of the eight tablets. This method may be useful in testing for N-nitrosamine impurities in pharmaceutical preparations.
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Affiliation(s)
- Atsushi Ishizaki
- School of Pharmacy, Shujitsu University, Nishigawara, Okayama 703-8516, Japan
| | - Kazutaka Ozawa
- School of Pharmacy, Shujitsu University, Nishigawara, Okayama 703-8516, Japan
| | - Hiroyuki Kataoka
- School of Pharmacy, Shujitsu University, Nishigawara, Okayama 703-8516, Japan.
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Corrêa PCRP, Chatkin JM. Could APO-varenicline and cytisine be solutions for the shortage of varenicline in Brazil? J Bras Pneumol 2023; 49:e20230185. [PMID: 37283405 PMCID: PMC10578940 DOI: 10.36416/1806-3756/e20230185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
| | - José Miguel Chatkin
- . Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
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