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Thin Layer Chromatographic Method for Detection of Conventional Drug Adulterants in Herbal Products. SEPARATIONS 2022. [DOI: 10.3390/separations10010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Commercially available conventional drugs have been used to adulterate herbal products. Considering the rapid growth of herbal products’ market, it is essential to screen herbal products for the presence of conventional drugs. Simple analytical methods are needed for the rapid screening of conventional drugs that are likely to be adulterated in herbal products. Thin layer chromatography (TLC) methods for screening twelve conventional drugs in herbal products have been developed and applied. The analytes were extracted from herbal products using acetonitrile:methanol:acetic acid:water (4:4:1:1, v/v). Solvent mixture of dichloromethane:ethyl acetate:methanol (75:15:10, v/v) separated well trimethoprim, sildenafil, paracetamol, and sulfamethoxazole while pyrimethamine, metronidazole, and sulfadoxine were well separated by dichloromethane:ethyl acetate:methanol (77.5:12.5:10, v/v). In addition, acetyl salicylic acid, ibuprofen, diclofenac, quinine, and lumefantrine were well separated by ethyl acetate:methanol:30% ammonia (75:22.5:2.5, v/v). Chromatographic separations were found to be highly reproducible, and more than 10 samples can be analysed in one run. The method was applied in the screening of 229 herbal products. Consequently, 24.0% of the samples contained one adulterant, while 21.4% contained at least two adulterants. All conventional drugs detected in herbal products were not mentioned on the labels and therefore the consumers are kept unaware of their side effects and health problems. Further studies for confirming and quantitatively determining the adulterants in a wide range of products as well as a systematic toxicological analysis of the adulterants in herbal products are recommended.
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Veatch-Blohm ME, Chicas I, Margolis K, Vanderminden R, Gochie M, Lila K. Screening for consistency and contamination within and between bottles of 29 herbal supplements. PLoS One 2021; 16:e0260463. [PMID: 34813619 PMCID: PMC8610273 DOI: 10.1371/journal.pone.0260463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/09/2021] [Indexed: 11/19/2022] Open
Abstract
In the United States the marketing of dietary supplements, of which the majority are herbal supplements, is currently a multibillion-dollar industry involving use from over half of the adult population. Due to their frequency of use and the lack of regulation of herbal supplements by the Food and Drug Administration (FDA) it is important for the health and safety of consumers to know about consistency of supplements and any possible contamination by harmful products, such as heavy metals or microorganisms. The purpose of the study was to determine consistency and contamination within and between bottles of common herbal supplements. Duplicate bottles of 29 herbal supplements were tested for consistency for antioxidant activity, phenolic concentration and flavonoid concentration under methanolic and water extraction. The supplements were also analyzed for the presence of metals and fungal contaminants. For all of the supplements tested there was high variability around the mean in antioxidant activity, phenolic concentrations and flavonoid concentrations, with coefficients of variation (CV) ranging from 0-120. Zinc was found in almost 90% of the supplements, nickel in about half of the supplements and lead in none of the supplements. Approximately 60% of the supplements contained fungal isolates. Although the majority of the fungi that were found in the supplements are generally not hazardous to human health, many of them could be problematic to sensitive groups, such as immunocompromised individuals. The data, which demonstrates contamination and a lack of consistency, in conjunction with previous studies on supplement contamination, strengthen the case that the FDA should regulate over-the-counter herbal supplements the same way that they regulate food and drugs. Until such time it is crucial that consumers are informed that many of the supplements that they take may lack the standardization that would reduce the chance of contamination and lead to consistency from one pill to the next.
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Affiliation(s)
- Maren E. Veatch-Blohm
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Iris Chicas
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Kathryn Margolis
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Rachael Vanderminden
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Marisa Gochie
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Khusmanie Lila
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
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Suparmi S, Wahidin D, Rietjens IMCM. Risk characterisation of constituents present in jamu to promote its safe use. Crit Rev Toxicol 2021; 51:183-191. [PMID: 34032188 DOI: 10.1080/10408444.2021.1912708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Safety in use of jamu consumption, as part of traditional medicine from Indonesia, is dependent on the complete and adequate assessment of potential hazards and risks of the botanicals and botanical constituents included. This includes especially hazards and risks related to the presence in jamu of active pharmaceutical ingredients (APIs) as well as of constituents that are genotoxic and carcinogenic. The present review presents an overview of the current state-of-the art on these hazards and risks based on case reports on adulteration, and the actual detection of genotoxic and carcinogenic ingredients of concern in jamu. Based on the overview thus obtained, it appears that drug-adulteration presents important hazards responsible for potential adverse effects, due to overdosing. The potential hazards of exposure to APIs mainly relate to the presence of constituents that may cause liver damage, renal impairment, kidney failure, steroid dependence or genotoxicity and carcinogenicity. For these APIs, a risk characterisation was performed based on comparison of health-based guidance values (HBGVs) and exposure, while for the genotoxic carcinogens the margin of exposure (MOE) approach was used. Results of this risk characterisation should be used by risk managers to impose specification for constituents of health concern to protect consumers. It is concluded that to manage the risks identified and further improve the safety in use of jamu, a collaboration between farmers, manufacturer/producers, academia, government, health professionals, and consumers is indicated.
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Affiliation(s)
- Suparmi Suparmi
- Division of Toxicology, Wageningen University and Research, Wageningen, The Netherlands.,Department of Biology, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
| | - Dasep Wahidin
- Badan Pengawas Obat dan Makanan RI, Jakarta, Indonesia
| | - Ivonne M C M Rietjens
- Division of Toxicology, Wageningen University and Research, Wageningen, The Netherlands
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Washaya N, Evans A, Muloiwa R, Smith P, Buys H. The prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. BMC Pediatr 2021; 21:42. [PMID: 33461521 PMCID: PMC7812651 DOI: 10.1186/s12887-021-02500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Paediatric poisoning is a common presentation to emergency departments worldwide. There is a paucity of data on the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS), in the management of paediatric poisoning in low-and middle-income countries (LMICs). In high-income countries, most studies are retrospective, and few include children. Objective The study describes the prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Methods Children admitted with suspected poisoning between 1 January 2017 and 31 December 2017, were recruited. All patients had a urine and/or blood sample sent for LC-MS/MS toxicology. Data collected included demographic data, clinical features, investigations, management, outcome and social interventions. Results One hundred fifty-two children, with median age of 39 (IQR 25–61) months were enrolled of which 128 (84%) were poisoning cases. Of the 128 poisoning cases, 88 (69%) presented with a history of ingesting a known substance, 16 (12%) an unknown substance and 24 (19%) were cases of occult poisoning. LC-MS/MS was able to identify a substance in 92% of the cases of occult poisoning. In those who had presented with a seemingly known substance, LC-MS/MS found a different substance in 15 cases. LC-MS/MS was also able to detect multiple drugs in 40 patients. Of the poisoning cases, six (5%) cases were attempted homicide cases and 5 (4%) cases were attempted suicide cases. No children died. Individualized social interventions were instituted in poisoning cases. Emergency placement safety reasons was required in 6 children. Conclusion When the limitations are known, LC-MS/MS is useful in identifying cases of occult poisoning, identifying patients who have ingested multiple substances and/or an unknown substance and when targeted towards child protection. As LC-MS/MS is an expensive test, it should be used judiciously in LMICs.
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Affiliation(s)
- Norbertta Washaya
- Division of Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alicia Evans
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Peter Smith
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
| | - Heloise Buys
- Division of Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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5
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A strategy to identify and quantify closely related adulterant herbal materials by mass spectrometry-based partial least squares regression. Anal Chim Acta 2017; 977:28-35. [DOI: 10.1016/j.aca.2017.04.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/31/2017] [Accepted: 04/18/2017] [Indexed: 01/24/2023]
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6
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Barnes BR. Child lead poisoning in South Africa: implications for psychological research. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317714106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lead is a toxic heavy metal that is associated with lowered intelligence quotient scores, behavioural problems, and physical health impairments in children. Current consensus is that there is no safe level of child lead exposure and that even low doses of lead can have negative effects. Several reviews conducted in South Africa have revealed the sources and potential risk factors associated with child lead poisoning. However, no South African reviews have focused on the quality of studies focusing on child lead poisoning and psychological outcomes (intelligence, cognitive, and behavioural outcomes). This study reviews epidemiological studies of child lead poisoning with a particular focus on the association between child lead poisoning and psychological outcomes in South Africa over a 30-year time span (1986–2016). The review pays particular attention to study design, measurement, sampling, and confounding variables. Nine studies that measured child lead poisoning were included in the review. Just two of the nine studies (one cross-sectional and one follow-up) measured psychological outcomes and neither study adequately adjusted for confounding. In all studies, sampling was purposive and lead exposure indicators were suited to short-term acute exposure. There is, therefore, insufficient evidence to determine the magnitude of the association between child lead poisoning and psychological outcomes in South Africa. More rigorous epidemiological studies are needed to strengthen the evidence base. The article also highlights opportunities for psychological research in intervention studies and studies that are framed by an environmental justice agenda.
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Affiliation(s)
- Brendon R Barnes
- Department of Psychology, University of Johannesburg, South Africa
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Tankeu S, Vermaak I, Chen W, Sandasi M, Viljoen A. Differentiation between two "fang ji" herbal medicines, Stephania tetrandra and the nephrotoxic Aristolochia fangchi, using hyperspectral imaging. PHYTOCHEMISTRY 2016; 122:213-222. [PMID: 26632529 DOI: 10.1016/j.phytochem.2015.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 05/14/2023]
Abstract
Stephania tetrandra ("hang fang ji") and Aristolochia fangchi ("guang fang ji") are two different plant species used in Traditional Chinese Medicine (TCM). Both are commonly referred to as "fang ji" and S. tetrandra is mistakenly substituted and adulterated with the nephrotoxic A. fangchi as they have several morphological similarities. A. fangchi contains aristolochic acid, a carcinogen that causes urothelial carcinoma as well as aristolochic acid nephropathy (AAN). In Belgium, 128 cases of AAN was reported while in China, a further 116 cases with end-stage renal disease were noted. Toxicity issues associated with species substitution and adulteration necessitate the development of reliable methods for the quality assessment of herbal medicines. Hyperspectral imaging in combination with partial least squares discriminant analysis (PLS-DA) is suggested as an effective method to distinguish between S. tetrandra and A. fangchi root powder. Hyperspectral images were obtained in the wavelength region of 920-2514nm. Reduction of the dimensionality of the data was done by selecting the discrimination information range (964-1774nm). A discrimination model with a coefficient of determination (R(2)) of 0.9 and a root mean square error of prediction (RMSEP) of 0.23 was created. The constructed model successfully identified A. fangchi and S. tetrandra samples inserted into the model as an external validation set. In addition, adulteration detection was investigated by preparing incremental adulteration mixtures of S. tetrandra with A. fangchi (10-90%). Hyperspectral imaging showed the ability to accurately predict adulteration as low as 10%. It is evident that hyperspectral imaging has tremendous potential in the development of visual quality control methods which may prevent cases of aristolochic acid nephropathy in the future.
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Affiliation(s)
- Sidonie Tankeu
- Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
| | - Ilze Vermaak
- Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa; SAMRC Herbal Drugs Research Unit, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa.
| | - Weiyang Chen
- Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
| | - Maxleene Sandasi
- Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
| | - Alvaro Viljoen
- Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa; SAMRC Herbal Drugs Research Unit, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
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8
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Petri RP, Walter JA, Wright J. Integrative Health and Healing Practices Specifically for Service Members: Self-Care Techniques. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard P. Petri
- United States Army, Chairman, NATO HFM-195 Task Force, Integrative Medicine Interventions for Military Personnel, El Paso, TX
| | | | - Jon Wright
- Summer Intern, Volunteer, Samueli Institute, Alexandria, VA
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9
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Park HJ, Cho SH, Lee JH, Hwang IS, Han KM, Yoon CY, Cho S, Kim WS. Screening for Corticosteroid Adulterants in Korean Herbal Medicines. J Forensic Sci 2015; 61:226-9. [DOI: 10.1111/1556-4029.12906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/17/2014] [Accepted: 01/12/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Hyoung-Joon Park
- Advanced Analysis Team; Toxicological Evaluation and Research Department; National Institute of Food and Drug Safety Evaluation; Ministry of Food and Drug Safety; Cheongju-si Chungcheongbuk-do 363-700 Korea
| | - So-Hyun Cho
- Advanced Analysis Team; Toxicological Evaluation and Research Department; National Institute of Food and Drug Safety Evaluation; Ministry of Food and Drug Safety; Cheongju-si Chungcheongbuk-do 363-700 Korea
| | - Ji Hyun Lee
- Advanced Analysis Team; Toxicological Evaluation and Research Department; National Institute of Food and Drug Safety Evaluation; Ministry of Food and Drug Safety; Cheongju-si Chungcheongbuk-do 363-700 Korea
| | - In Sun Hwang
- Advanced Analysis Team; Toxicological Evaluation and Research Department; National Institute of Food and Drug Safety Evaluation; Ministry of Food and Drug Safety; Cheongju-si Chungcheongbuk-do 363-700 Korea
| | - Kyoung Moon Han
- Advanced Analysis Team; Toxicological Evaluation and Research Department; National Institute of Food and Drug Safety Evaluation; Ministry of Food and Drug Safety; Cheongju-si Chungcheongbuk-do 363-700 Korea
| | - Chang-Yong Yoon
- Advanced Analysis Team; Toxicological Evaluation and Research Department; National Institute of Food and Drug Safety Evaluation; Ministry of Food and Drug Safety; Cheongju-si Chungcheongbuk-do 363-700 Korea
| | - Sooyeul Cho
- Advanced Analysis Team; Toxicological Evaluation and Research Department; National Institute of Food and Drug Safety Evaluation; Ministry of Food and Drug Safety; Cheongju-si Chungcheongbuk-do 363-700 Korea
| | - Woo Seong Kim
- Advanced Analysis Team; Toxicological Evaluation and Research Department; National Institute of Food and Drug Safety Evaluation; Ministry of Food and Drug Safety; Cheongju-si Chungcheongbuk-do 363-700 Korea
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Sharma S, Gupta M, Bhadauria R. Quality evaluation of commercially available Triphala powder: a renown dietary supplement of Indian system of medicines. QUALITY ASSURANCE AND SAFETY OF CROPS & FOODS 2015. [DOI: 10.3920/qas2014.0391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S. Sharma
- Jiwaji University, School of Studies in Botany, Mycology and Plant Pathology Laboratory, Gwalior (MP) 474011, India
- Amity University Madhya Pradesh, Amity Institute of Biotechnology, Gwalior 474005, India
| | - M. Gupta
- Jiwaji University, School of Studies in Botany, Mycology and Plant Pathology Laboratory, Gwalior (MP) 474011, India
| | - R. Bhadauria
- Jiwaji University, School of Studies in Botany, Mycology and Plant Pathology Laboratory, Gwalior (MP) 474011, India
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Rooney JS, McDowell A, Strachan CJ, Gordon KC. Evaluation of vibrational spectroscopic methods to identify and quantify multiple adulterants in herbal medicines. Talanta 2015; 138:77-85. [PMID: 25863375 DOI: 10.1016/j.talanta.2015.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 12/27/2022]
Abstract
To counter the growth of herbal medicines adulterated with pharmaceuticals crossing borders, rapid, inexpensive and non-destructive analytical techniques, that can handle complex matrices, are required. Since mid-infrared (MIR), near infrared (NIR) and Raman spectroscopic techniques meet these criteria, their performance in identifying adulterants in seized weightloss herbal medicines is definitively determined. Initially a validated high pressure liquid chromatography methodology was used for reference identification and quantification of the adulterants sibutramine H2O·HCl, fenfluramine HCl and phenolphthalein. Of 38 products, only sibutramine and phenolphthalein were detected by HPLC. The spectroscopic measurements showed Raman was ill-suited due to sample burning and emission while NIR lacked adulterant selectivity. Conversely, MIR demonstrated apt identification performance, which manifested as spectrally meaningful separation based on the presence and type of adulterant during principal component analysis (test set validated). Partial least squares regression models were constructed from the MIR training sets for sibutramine and phenolphthalein - both models fitted the training set data well. Average test set prediction errors were 0.8% for sibutramine and 2.2% for phenolphthalein over the respective concentration ranges of 1.7-11.7% and 0.9-34.4%. MIR is apposite for the screening of anorectic and laxative adulterants and is the most viable technique for wider adulterant screening in herbal medicines.
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Affiliation(s)
- Jeremy S Rooney
- Department of Chemistry, MacDiarmid Institute, Dodd-Walls Centre, University of Otago, Dunedin 9016, New Zealand
| | - Arlene McDowell
- School of Pharmacy, University of Otago, Dunedin 9016, New Zealand
| | - Clare J Strachan
- School of Pharmacy, University of Otago, Dunedin 9016, New Zealand; Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, 00790 Helsinki, Finland
| | - Keith C Gordon
- Department of Chemistry, MacDiarmid Institute, Dodd-Walls Centre, University of Otago, Dunedin 9016, New Zealand.
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12
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Moreira APL, Martini M, de Carvalho LM. Capillary electrophoretic methods for the screening and determination of pharmacologic adulterants in herbal-based pharmaceutical formulations. Electrophoresis 2014; 35:3212-30. [DOI: 10.1002/elps.201400059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Ana Paula L. Moreira
- Graduate Programme in Pharmaceutical Sciences; Federal University of Santa Maria (UFSM); Santa Maria RS Brazil
| | - Mariele Martini
- Graduate Programme in Chemistry; Federal University of Santa Maria (UFSM); Santa Maria RS Brazil
- Department of Chemistry; Federal University of Santa Maria (UFSM); Santa Maria RS Brazil
| | - Leandro M. de Carvalho
- Graduate Programme in Pharmaceutical Sciences; Federal University of Santa Maria (UFSM); Santa Maria RS Brazil
- Graduate Programme in Chemistry; Federal University of Santa Maria (UFSM); Santa Maria RS Brazil
- Department of Chemistry; Federal University of Santa Maria (UFSM); Santa Maria RS Brazil
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13
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Gardiner P, Adams D, Filippelli AC, Nasser H, Saper R, White L, Vohra S. A systematic review of the reporting of adverse events associated with medical herb use among children. Glob Adv Health Med 2014; 2:46-55. [PMID: 24416663 PMCID: PMC3833530 DOI: 10.7453/gahmj.2012.071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Information about the safety of herbal medicine often comes from case reports published in the medical literature, thus necessitating good quality reporting of these adverse events. The purpose of this study was to perform a systematic review of the comprehensiveness of reporting of published case reports of adverse events associated with herb use in the pediatric population. METHODS Electronic literature search included 7 databases and a manual search of retrieved articles from inception through 2010. We included published case reports and case series that reported an adverse event associated with exposure to an herbal product by children under the age of 18 years old. We used descriptive statistics. Based on the International Society of Epidemiology's "Guidelines for Submitting Adverse Events Reports for Publication," we developed and assigned a guideline adherence score (0-17) to each case report. RESULTS Ninety-six unique journal papers were identified and represented 128 cases. Of the 128 cases, 37% occurred in children under 2 years old, 38% between the ages of 2 and 8 years old, and 23% between the ages of 9 and 18 years old. Twenty-nine percent of cases were the result of an intentional ingestion while 36% were from an unintentional ingestion. Fifty-two percent of cases documented the Latin binomial of the herb ingredients; 41% documented plant part. Thirty-two percent of the cases reported laboratory testing of the herb, 20% documented the manufacturer of the product, and 22% percent included an assessment of the potential concomitant therapies that could have been influential in the adverse events. Mean guideline adherence score was 12.5 (range 6-17). CONCLUSIONS There is considerable need for improvement in reporting adverse events in children following herb use. Without better quality reporting, adverse event reports cannot be interpreted reliably and do not contribute in a meaningful way to guiding recommendations for medicinal herb use.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, Boston Medical Center, Massachusetts, United States
| | - Denise Adams
- CARE Program, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Amanda C Filippelli
- Department of Family Medicine, Boston Medical Center, Massachusetts, United States
| | - Hafsa Nasser
- CARE Program, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Robert Saper
- Department of Family Medicine, Boston Medical Center, Massachusetts, United States
| | - Laura White
- Department of Biostatistics, Boston University School of Public Health, United States
| | - Sunita Vohra
- CARE Program, Department of Pediatrics, University of Alberta, Edmonton, Canada
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Feng Y, Lei D, Hu C. Rapid identification of illegal synthetic adulterants in herbal anti-diabetic medicines using near infrared spectroscopy. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2014; 125:363-374. [PMID: 24566115 DOI: 10.1016/j.saa.2014.01.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 01/23/2014] [Accepted: 01/26/2014] [Indexed: 06/03/2023]
Abstract
We created a rapid detection procedure for identifying herbal medicines illegally adulterated with synthetic drugs using near infrared spectroscopy. This procedure includes a reverse correlation coefficient method (RCCM) and comparison of characteristic peaks. Moreover, we made improvements to the RCCM based on new strategies for threshold settings. Any tested herbal medicine must meet two criteria to be identified with our procedure as adulterated. First, the correlation coefficient between the tested sample and the reference must be greater than the RCCM threshold. Next, the NIR spectrum of the tested sample must contain the same characteristic peaks as the reference. In this study, four pure synthetic anti-diabetic drugs (i.e., metformin, gliclazide, glibenclamide and glimepiride), 174 batches of laboratory samples and 127 batches of herbal anti-diabetic medicines were used to construct and validate the procedure. The accuracy of this procedure was greater than 80%. Our data suggest that this protocol is a rapid screening tool to identify synthetic drug adulterants in herbal medicines on the market.
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Affiliation(s)
- Yanchun Feng
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Deqing Lei
- Shaoyang Institute for Drug Control of Hunan, Shaoyang 422000, China
| | - Changqin Hu
- National Institutes for Food and Drug Control, Beijing 100050, China.
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Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. Eur J Clin Pharmacol 2012; 69:295-307. [PMID: 22843016 DOI: 10.1007/s00228-012-1353-z] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 07/10/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of this overview of systematic reviews is to summarise and critically evaluate the evidence from systematic reviews of the adulteration and contamination of herbal medicinal products (HMPs). METHODS Five electronic databases were searched to identify all relevant systematic reviews. RESULTS Twenty-six systematic reviews met our inclusion criteria. The most commonly HMPs were adulterated or contaminated with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic heavy metals and/or prescription drugs. The most severe adverse effects caused by these adulterations were agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death. Adulteration and contamination of HMPs were most commonly noted for traditional Indian and Chinese remedies, respectively. CONCLUSIONS Collectively these data suggest that there are reasons for concerns with regards to the quality of HMPs. Adulteration and contamination of HMPs can cause serious adverse effects. More stringent quality control and its enforcement seem to be necessary to avoid health risks.
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Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. Eur J Clin Pharmacol 2012. [PMID: 22843016 DOI: 10.10007/s00228-012-1353-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this overview of systematic reviews is to summarise and critically evaluate the evidence from systematic reviews of the adulteration and contamination of herbal medicinal products (HMPs). METHODS Five electronic databases were searched to identify all relevant systematic reviews. RESULTS Twenty-six systematic reviews met our inclusion criteria. The most commonly HMPs were adulterated or contaminated with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic heavy metals and/or prescription drugs. The most severe adverse effects caused by these adulterations were agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death. Adulteration and contamination of HMPs were most commonly noted for traditional Indian and Chinese remedies, respectively. CONCLUSIONS Collectively these data suggest that there are reasons for concerns with regards to the quality of HMPs. Adulteration and contamination of HMPs can cause serious adverse effects. More stringent quality control and its enforcement seem to be necessary to avoid health risks.
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Zhang CY, Chang DL, Chen SL. Simultaneous Determination of Five Nonsteroidal Anti-Inflammatory Drugs and Two Glucocorticoids in Adulterated Traditional Herbal Medicines for the Treatment of Rheumatism. ANAL LETT 2011. [DOI: 10.1080/00032719.2010.526268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Savaliya AA, Prasad B, Raijada DK, Singh S. Detection and characterization of synthetic steroidal and non-steroidal anti-inflammatory drugs in Indian ayurvedic/herbal products using LC-MS/TOF. Drug Test Anal 2011; 1:372-81. [PMID: 20355217 DOI: 10.1002/dta.75] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is claimed that ayurvedic/herbal healthcare products (AHPs) are safe because of their natural origin. However, several reports exist of adulteration of AHPs with synthetic drugs. In this study, a generalized strategy was developed using LC-MS/TOF for the detection and verification of steroidal and anti-inflammatory drugs in 58 AHPs collected from various parts of India. The strategy involved recording of mass spectral information for standard drugs-including ionization mode (ESI/APCI - ve or + ve), mass spectrum, accurate mass, identification of qualifier fragments (two), extracted ion chromatograms (EICs), isotopic pattern and determination of UV max (nm)-through UV-PDA studies. Adulteration was then detected in AHPs primarily through comparison of EICs at accurate m/z for molecular ion peaks and R(T) matching with the standard. It was confirmed by spiking with the standards, and matching mass spectrum, accurate mass, R(T) of qualifier fragments, isotopic pattern and UV spectrum of the standards with the adulterant peaks in AHPs. Dexamethasone and diclofenac were detected as adulterants in ten AHPs whereas one AHP tested positive for piroxicam and another for dexamethasone. All the adulterated products were sold by the healthcare practitioners, while no product marketed by manufacturers or chemist shops had this problem. The study showed that LC-MS/TOF-based screening could be used as a rapid approach to monitor adulteration of steroids and anti-inflammatory drugs in AHPs.
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Affiliation(s)
- Akash A Savaliya
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research, Sector 67, S.A.S. Nagar, Mohali 160 062, Punjab, India
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Wang J, Chen B, Yao S. Analysis of six synthetic adulterants in herbal weight-reducing dietary supplements by LC electrospray ionization-MS. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2008; 25:822-30. [PMID: 18569001 DOI: 10.1080/02652030801946553] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS) method was developed for the simultaneous determination of six synthetic adulterants, namely fenfluramine, phenolphthalein, N-di-desmethyl sibutramine, N-mono-desmethyl sibutramine, sibutramine, and orlistat. The method was applied to the analysis of herbal weight-reducing dietary supplements. Chromatographic separation of the analytes on a C(8) reversed-phase column was achieved using a gradient elution of solvent A: acetonitrile and solvent B: aqueous 20 mM ammonium formate solution. Sildenafil was utilized as an internal standard for quantification. The MS detector was operated in positive electrospray ionization mode. Selected-ion monitoring (SIM) was carried out for m/z 232, 319, 252, 266, 280, 496, and 475 for fenfluramine, phenolphthalein, N-di-desmethyl sibutramine, N-mono-desmethyl sibutramine, sibutramine, orlistat, and sildenafil, respectively. The method was validated for accuracy, precision, linearity, and selectivity. The limits of detection for the six synthetic adulterants ranged from 0.0018 to 0.73 microg g(-1). The proposed method was used for a small survey of 22 dietary supplements of which eleven samples were adulterated with phenolphthalein, N-mono-desmethyl sibutramine, and sibutramine at levels from 0.212 to 96.2 mg g(-1).
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Affiliation(s)
- J Wang
- Key Laboratory of Chemical Biology and Traditional Chinese Medicine Research, Ministry of Education, Hunan Normal University, Changsha, China
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Street RA, Stirk WA, Van Staden J. South African traditional medicinal plant trade-Challenges in regulating quality, safety and efficacy. JOURNAL OF ETHNOPHARMACOLOGY 2008; 119:705-710. [PMID: 18638533 DOI: 10.1016/j.jep.2008.06.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/18/2008] [Accepted: 06/19/2008] [Indexed: 05/26/2023]
Abstract
Based on the long history of medicinal plant use, users of traditional medicines accept that they are safe for human consumption. However, the absence of regulation of the medicinal plant trade in aspects such as collection, processing and storage provides no such guarantee. Environmental pollution, misidentification and adulteration provides further grounds for concern. The potential adverse effects of South African traditional medicines are not well documented. There are only a few investigations of mutagenic properties and heavy metal contamination. In the absence of regulatory controls, the safety and quality of medicinal plants vary considerably. The current comprehension and future challenges regarding quality, safety and efficacy of South African traditional medicine are discussed.
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Affiliation(s)
- R A Street
- Research Centre for Plant Growth and Development, School of Biological and Conservation Sciences, University of KwaZulu-Natal Pietermaritzburg, Private Bag X01, Scottsville 3209, South Africa
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Gardiner P, Phillips RS, Kemper KJ, Legedza A, Henlon S, Woolf AD. Dietary supplements: inpatient policies in US children's hospitals. Pediatrics 2008; 121:e775-81. [PMID: 18381505 DOI: 10.1542/peds.2007-1898] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Variations in hospital policies and practices regarding the use of vitamins, minerals, herbs, and other dietary supplements could compromise patient safety and quality of care. We undertook this study to describe pediatric hospital policies regarding dietary supplements. METHODS We administered a cross-sectional survey of a sample of National Association of Children Hospitals and Related Institutions members. Pharmacy personnel were asked about the following: written policies addressing dietary supplements; how such policies are made; and responsibilities for storage, administration, documentation, and checking for potential interactions. We created a 10-point hospital policy and practices quality score to assess the quality of each policy. RESULTS Of the 186 eligible National Association of Children Hospitals and Related Institutions hospitals, 109 responded (59%). Forty-four percent reported having written policies on vitamins and minerals, herbs, and other dietary supplements. Few hospitals had herbs (2%) or other dietary supplements (38%) on formulary. However, most (81%) allowed patients to use their home supply of dietary supplements under defined circumstances, and 64% allowed staff to make recommendations about dietary supplement use. In 70% of hospitals, nurses stored and administered the home supply of dietary supplements. Less than half (46%) required documentation of a check for drug or dietary supplements interactions. One third (32%) had surgical preoperative recommendations regarding dietary supplements. Only 11% of 109 hospitals satisfied the 10 criteria necessary for a perfect hospital policy and practices quality score indicative of quality practices regarding patient use of dietary supplements. CONCLUSION Even among those hospitals that have written policies about dietary supplements, there is a wide range in policy quality, which may compromise the safety of patients.
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Affiliation(s)
- Paula Gardiner
- Osher Institute, Harvard Medical School, Boston, Massachusetts, USA.
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Gabardi S, Munz K, Ulbricht C. A review of dietary supplement-induced renal dysfunction. Clin J Am Soc Nephrol 2007; 2:757-65. [PMID: 17699493 DOI: 10.2215/cjn.00500107] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Complementary and alternative medicine (CAM) is a multibillion-dollar industry. Almost half of the American population uses some form of CAM, with many using them in addition to prescription medications. Most patients fail to inform their health care providers of their CAM use, and physicians rarely inquire. Annually, thousands of dietary supplement-induced adverse events are reported to Poison Control Centers nationwide. CAM manufacturers are not responsible for proving safety and efficacy, because the Food and Drug Administration does not regulate them. However, concern exists surrounding the safety of CAM. A literature search using MEDLINE and EMBASE was undertaken to explore the impact of CAM on renal function. English-language studies and case reports were selected for inclusion but were limited to those that consisted of human subjects, both adult and pediatric. This review provides details on dietary supplements that have been associated with renal dysfunction and focuses on 17 dietary supplements that have been associated with direct renal injury, CAM-induced immune-mediated nephrotoxicity, nephrolithiasis, rhabdomyolysis with acute renal injury, and hepatorenal syndrome. It is concluded that it is imperative that use of dietary supplements be monitored closely in all patients. Health care practitioners must take an active role in identifying patients who are using CAM and provide appropriate patient education.
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Affiliation(s)
- Steven Gabardi
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA 02115-6110, USA.
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van den Bout-van den Beukel CJP, Koopmans PP, van der Ven AJAM, De Smet PAGM, Burger DM. Possible drug-metabolism interactions of medicinal herbs with antiretroviral agents. Drug Metab Rev 2006; 38:477-514. [PMID: 16877262 DOI: 10.1080/03602530600754065] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Herbal medicines are widely used by HIV patients. Several herbal medicines have been shown to interact with antiretroviral drugs, which might lead to drug failure. We have aimed to provide an overview of the modulating effects of Western and African herbal medicines on antiretroviral drug-metabolizing and transporting enzymes, focusing on potential herb-antiretroviral drug interactions. Echinacea, garlic, ginkgo, milk thistle, and St. John's wort have the potential to cause significant interactions. In vitro and in vivo animal studies also indicated other herbs with a potential for interactions; however, most evidence is based on in vitro studies. Further pharmacokinetic studies to unveil potential Western and especially African herb-antiretroviral drug interactions are urgently required, and the clinical significance of these interactions should be assessed.
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Jung J, Hermanns-Clausen M, Weinmann W. Anorectic sibutramine detected in a Chinese herbal drug for weight loss. Forensic Sci Int 2006; 161:221-2. [PMID: 16870382 DOI: 10.1016/j.forsciint.2006.02.052] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 01/28/2006] [Accepted: 02/12/2006] [Indexed: 10/24/2022]
Abstract
In the presented case, a young healthy woman had ordered a Chinese herbal medicine, called "LiDa Dai Dai Hua Jiao Nang", via internet. She took this product for approximately 1 week, but on the second day she developed severe headache, vertigo and sensation of numbness. After discontinuing medication, symptoms disappeared within 2 days. For identification of the ingredients, a urine sample as well as a sample of the "LiDa" capsule were analysed by GC-MS and HPLC-DAD. One major ingredient was detected in urine as well as in the "LiDa" capsule and was identified as sibutramine. Quantification by HPLC-DAD yielded 27.4 mg sibutramine base, which is approximately two times the amount of the highest authorized single dose available on the pharmaceutical market in Germany. This case demonstrates a common problem with herbal medicines, where adulterations with synthetic therapeutic substances can lead to severe side effects and/or potentially fatal interactions with conventional medicines.
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Affiliation(s)
- Julia Jung
- Institute of Forensic Medicine, Forensic Toxicology, University Hospital Freiburg, Germany.
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Bogusz MJ, Hassan H, Al-Enazi E, Ibrahim Z, Al-Tufail M. Application of LC-ESI-MS-MS for detection of synthetic adulterants in herbal remedies. J Pharm Biomed Anal 2006; 41:554-64. [PMID: 16427237 DOI: 10.1016/j.jpba.2005.12.015] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Revised: 12/05/2005] [Accepted: 12/07/2005] [Indexed: 11/28/2022]
Abstract
Adulteration of allegedly "natural herbal medicines" with undeclared synthetic drugs is a common and dangerous phenomenon of alternative medicine. The purpose of the study was to develop a procedure for detection of most common synthetic adulterants in herbal remedies, using high-pressure liquid chromatography-electrospray tandem mass spectrometry (LC-ESI-MS-MS). Eighty drugs belonging to various pharmacological classes were included in the study. For most drugs two transitions were monitored, using protonated or deprotonated molecules as precursor ions. The drugs were isolated from herbal remedies using simple methanol extraction. Chromatographic separation was done in gradient of acetonitrile-10 mM ammonium formate buffer (pH 3.0). Drugs tested were grouped in suites, comprising analgesic drugs, antibiotics, antidiabetic drugs, antiepileptic drugs, aphrodisiacs, hormones and anabolic drugs, psychotropic drugs, and weight reducing compounds. These suites were used according to the declared benefits of examined preparations. Limits of detection ranged from 5 pg to 1 ng per injected sample. Drug-free herbal remedy spiked with eight various pharmaceuticals occurring in adulterated herbal preparations was used for internal proficiency testing. The recoveries of spiked drugs ranged from 63 to 100%. The procedure was applied in everyday casework. Several undeclared drugs were identified in "herbal" remedies, like e.g. sildenafil, tadalafil, testosterone, or glibenclamide. Pharmacological properties of detected drugs always corresponded with the claims of the "natural" remedies. The method presents a valuable extension of standard GC-MS screening used for this purpose.
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Affiliation(s)
- Maciej J Bogusz
- Department of Pathology and Laboratory Medicide, King Faisal Specialist Hospital and Research Centre, 11211 Riyadh, P.O. Box 3354, MBC 10, Saudi Arabia.
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