Long-term detection of clenbuterol in human scalp hair by gas chromatography-high-resolution mass spectrometry

Adverse events of clenbuterol among athletes: a systematic review of case reports and case series

Clenbuterol is a potent beta-2 agonist widely misused by professional athletes and bodybuilders. Information on clenbuterol associated adverse events is present in case reports and case series, though it may not be readily available. This systematic review aimed to critically evaluate the evidence of adverse events associated with clenbuterol among athletes. The search strategy was in accordance with PRISMA guidelines. Databases such as PubMed, Science Direct, Scopus, and Google Scholar were searched from 1990 to October 2021 to find out the relevant case reports and case series. There were 23 included studies. Using a suitable scale, the included studies' methodological quality analysis was evaluated. In total, 24 athletes experienced adverse events. Oral ingestion of clenbuterol was the most preferred route among them. The daily administered dose of clenbuterol was ranging from 20 µg to 30 mg. Major adverse events experienced by athletes were supraventricular tachycardia, atrial fibrillation, hypotension, chest pain, myocardial injury, myocarditis, myocardial ischemia, myocardial infarction, cardiomyopathy, hepatomegaly, hyperglycemia, and death. The cardiac-related complications were the most commonly occurring adverse events. Clenbuterol is notorious to produce life-threatening adverse events including death. Lack of evidence regarding the performance-enhancing effects of clenbuterol combined with its serious toxicities questions the usefulness of this drug in athletes.

Magnetic separation of clenbuterol based on competitive immunoassay and evaluation by surface-enhanced Raman spectroscopy

The elimination of β-agonist has attracted considerable interest due to its harmfulness to human health when it existed in pork.

Analytical methods for the detection of clenbuterol

Clenbuterol is therapeutically used for the treatment of pulmonary diseases such as bronchial asthma or for tocolytic reasons. In cattle feeding as well as in sports it is illicitly misused due to its anabolic properties to promote muscle growth. Sample preparation procedures and analytical techniques used for the detection of clenbuterol are manifold and vary with the objectives of the investigation. Methods for its detection in biological specimens, drug preparations, the environment, food and feed products are reported. They are mainly based on immunochemical, chromatographic and mass spectrometric techniques, or on capillary electrophoresis. Sample preparation primarily includes liquid-liquid extraction and solid-phase extraction. Depending on the aim of the method clenbuterol can be determined in single- or multi-analyte methods. In biological and environmental samples concentrations are generally low due to the potency of the drug. Thus, highly sensitive procedures are required for expedient analyses.

Liquid chromatography/electrospray ionization tandem mass spectrometric screening and confirmation methods for beta2-agonists in human or equine urine

Electrospray ionization (ESI) mass spectra of 19 common beta(2)-agonists were investigated in terms of fragmentation pattern and dissociation behavior of the analytes, proving the origin of fragment ions and indicating mechanisms of charge-driven and charge-remote fragmentation. Based on these data, liquid chromatographic/ESI tandem mass spectrometric (LC/ESI-MS/MS) screening and confirmation methods were developed for doping control purposes. These procedures employ established sample preparation steps including either acidic or enzymatic hydrolysis, alkaline extraction and, in the case of equine urine specimens, acidic re-extraction of the analytes. In addition, a degradation product of formoterol caused by acidic hydrolysis during sample preparation could be identified and utilized as target compound in screening and also confirmation methods. The screening procedures cover 18 or 19beta(2)-agonists, the estimated limits of detection of which for equine and human urine samples vary between 2 and 100 ng ml(-1) and between 2 and 50 ng ml(-1), respectively. A single LC/MS/MS analysis can be performed in 9 min.

Use of alternative specimens: drugs of abuse in saliva and doping agents in hair

It is generally accepted that chemical testing of biologic fluids is the most objective means of diagnosis of drug use. The presence of a drug analyte in a biologic specimen can be used to document exposure. The standard for drug testing in toxicology is an immunoassay screen conducted on a urine sample, followed by confirmation by gas chromatography with mass spectrometric detection. In recent years, remarkable advances in sensitive analytic techniques have enabled the analysis of drugs in unconventional biologic specimens such as saliva or hair. The aim of this review is to document the current status of drugs of abuse testing in saliva and some doping agents in hair. The influence on drug concentration of the procedure of saliva sampling is described. Screening procedures along with specific methods are reviewed for the determination of amphetamines, cannabis, cocaine, and opiates in saliva. Before an extensive review on the detection of anabolics, corticosteroids, and beta-adrenergic stimulants in hair, the place of this specimen in doping control is discussed, with a focus on the potential problems of this new technology.

Clenbuterol ingestion causing prolonged tachycardia, hypokalemia, and hypophosphatemia with confirmation by quantitative levels

BACKGROUND

Clenbuterol is a long acting beta2-adrenergic agonist used in the treatment of pulmonary disorders. Acute clenbuterol toxicity resembles that of other beta2-adrenergic agonists. Most previously reported cases of clenbuterol toxicity describe patients who ate livestock illicitly treated with clenbuterol.

CASE REPORT

We report a case of human clenbuterol toxicity confirmed and correlated with qualitative and quantitative serum clenbuterol assays. This poisoned patient, a 28-year-old woman, developed sustained sinus tachycardia at 140/min, hypokalemia (2.4 mEq/L, 2.4 mmol/L), hypophosphatemia (0.9 mg/dL, 0.29 mmol/L), and hypomagnesemia (1.52 mg/dL, 0.76 mmol/L) after ingesting a reportedly small quantity of clenbuterol. The patient received repeated doses of metoprolol to treat her cardiovascular stimulation and potassium chloride to treat her hypokalemia. She remained symptomatic for more than 20 hours after the ingestion. Analysis by enzyme-linked immunosorbent assay and liquid chromatography/mass spectrometry revealed a serum clenbuterol concentration of 2.93 mcg/L 3 hours after the ingestion and an undetectable serum concentration 20 hours after ingestion. It is noteworthy that at a serum concentration below the limit of detection by liquid chromatography/mass spectrometry, the patient remained symptomatic. Acute clenbuterol toxicity is rarely reported following illicit use in humans, and this is the first such case to provide confirmatory toxicological analysis.

Testing of the anabolic stanozolol in human hair by gas chromatography-negative ion chemical ionization mass spectrometry

A sensitive, specific and reproducible method for the quantitative determination of stanozolol in human hair has been developed. The sample preparation involved a decontamination step of the hair with methylene chloride and the sonication in methanol of 100 mg of powdered hair for 2 h. After elimination of the solvent, the hair sample was solubilized in 1 ml 1 M NaOH, 15 min at 95 degrees C, in the presence of 10 ng stanozolol-d3 used as internal standard. The homogenate was neutralized and extracted using consecutively a solid-phase (Isolute C18) and a liquid-liquid (pentane) extraction. After evaporation of the final organic phase, the dry extract was derivatized using 40 microl MBHFA-TMSI (1000:20, v/v), incubated for 5 min at 80 degrees C, followed by 10 microl of MBHFBA, incubated for 30 min at 80 degrees C. The derivatized extract was analyzed by a Hewlett-Packard GC-MS system with a 5989 B Engine operating in the negative chemical ionization mode of detection. Linearity of the detector response was observed for stanozolol concentrations ranging from 5 to 200 pg/mg with a correlation coefficient of 0.998. The assay was capable of detecting 2 pg of stanozolol per mg of hair when approximately 100 mg hair material was processed, with a quantification limit set at 5 pg/mg. Intra-day precision was 5.9% at 50 pg/mg and 7.8% at 25 pg/mg with extraction recoveries of 79.8 and 75.1%, respectively. The analysis of a 3-cm long hair strand, obtained from a young bodybuilder (27 year old) assuming to be a regular user of Winstrol (stanozolol, 2 mg), revealed the presence of stanozolol at the concentration of 15 pg/mg.

Test methods: anabolics

In the International Olympic Committee (IOC) accredited laboratories, specific methods have been developed to detect anabolic steroids in athletes' urine. The technique of choice to achieve this is gas-chromatography coupled with mass spectrometry (GC-MS). In order to improve the efficiency of anti-doping programmes, the laboratories have defined new analytical strategies. The final sensitivity of the analytical procedure can be improved by choosing new technologies for use in detection, such as tandem mass spectrometry (MS-MS) or high resolution mass spectrometry (HRMS). A better sample preparation using immuno-affinity chromatography (IAC) is also a good tool for improving sensitivity. These techniques are suitable for the detection of synthetic anabolic steroids whose structure is not found naturally in the human body. The more and more evident use, on a large scale, of substances chemically similar to the endogenous steroids obliges both the laboratory and the sports authorities to use the steroid profile of the athlete in comparison with reference ranges from a population or with intraindividual reference values.

Pharmacological criteria that can affect the detection of doping agents in hair

When positive drug results are reported, a common interpretive question posed is whether or not it is possible to put a quantitative finding into context. A standard answer to this inquiry is that a positive hair testing result can be interpreted as meaning that the donor has chronically or repetitively used the drug identified in the hair, but that chronic or repetitive are not defined in the same way for all individuals. The Society of Hair Testing published on June 16, 1999, a consensus opinion on the use of hair in doping situations. However, although accepted in most courts of justice, hair analysis is not yet recognised by the International Olympic Committee. To be considered as a valid specimen for doping control, some issues still need to be addressed. The scientific community has demonstrated significant concern over the proper role that hair drug testing should serve in toxicological applications. Among the unanswered questions, five are of critical importance: (1) What is the minimal amount of drug detectable in hair after administration? (2) What is the relationship between the amount of the drug used and the concentration of the drug or its metabolites in hair? (3) What is the influence of hair color? (4) Is there any racial bias in hair testing? (5) What is the influence of cosmetic treatments? The present report documents scientific findings on these questions, with particular attention to the applications of hair in doping control.