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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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2
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Shakleya D, Asmelash B, Alayoubi A, Abrigo N, Mohammad A, Wang J, Zhang J, Yang J, Marzan TA, Li D, Shaklah M, Alsharif FM, Desai S, Faustino PJ, Ashraf M, O'Connor T, Vera M, Raw A, Sayeed VA, Keire D. Bumetanide as a Model NDSRI Substrate: N-nitrosobumetanide Impurity Formation and its Inhibition in Bumetanide Tablets. J Pharm Sci 2023; 112:3075-3087. [PMID: 37364772 DOI: 10.1016/j.xphs.2023.06.013] [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: 05/16/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Nitrosamine compounds are classified as potential human carcinogens, the origin of these impurities can be broadly classified in two categories, nitrosamine impurity found in drug products that are not associated with the Active Pharmaceutical Ingredient (API), such as N-nitrosodimethylamine (NDMA) or nitrosamine impurities associated with the API, such as nitrosamine drug substance-related impurities (NDSRIs). The mechanistic pathway for the formation of these two classes of impurities can be different and the approach to mitigate the risk should be tailored to address the specific concern. In the last couple of years number of NDSRIs have been reported for different drug products. Though, not the only contributing factor for the formation of NDSIRs, it is widely accepted that the presence of residual a nitrites/nitrates in the components used in the manufacturing of the drug products can be the primary contributor to the formation of NDSRIs. Approaches to mitigate the formation of NDSRIs in drug products include the use of antioxidants or pH modifiers in the formulation. The primary objective of this work was to evaluate the role of different inhibitors (antioxidants) and pH modifiers in tablet formulations prepared in-house using bumetanide (BMT) as a model drug to mitigate the formation of N-nitrosobumetanide (NBMT). A multi-factor study design was created, and several bumetanide formulations were prepared by wet granulation with and without sodium nitrite spike (100 ppm) and different antioxidants (ascorbic acid, ferulic acid or caffeic acid) at three concentrations (0.1%, 0.5% or 1% of the total tablet weight). Formulations with acidic and basic pH were also prepared using 0.1 N hydrochloric acid and 0.1 N sodium bicarbonate, respectively. The formulations were subjected to different storage (temperature and humidity) conditions over 6 months and stability data was collected. The rank order of N-nitrosobumetanide inhibition was highest with alkaline pH formulations, followed by formulations with ascorbic acid, caffeic acid or ferulic acid present. In summary, we hypothesize that maintaining a basic pH or the addition of an antioxidant in the drug product can mitigate the conversion of nitrite to nitrosating agent and thus reduce the formation of bumetanide nitrosamines.
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Affiliation(s)
- Diaa Shakleya
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Bethel Asmelash
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of lifecycle Drug product, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Alaadin Alayoubi
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Nicolas Abrigo
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Adil Mohammad
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Jiang Wang
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Jinhui Zhang
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Jingyue Yang
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Tim Andres Marzan
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - David Li
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Maha Shaklah
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Fahd M Alsharif
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Saaniya Desai
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Patrick J Faustino
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Muhammad Ashraf
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Thomas O'Connor
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Matthew Vera
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of lifecycle Drug product, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Andre Raw
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of lifecycle Drug product, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Vilayat A Sayeed
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of lifecycle Drug product, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - David Keire
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
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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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Yang J, Kakarla R, Marzan T, Sherwin B, George M, Bennett J, Basutto J, Su Y, Ollerenshaw J, Morin J, Rebière H, Maggio AF, Kermaïdic A, Gervela E, Brenier C, Civade C, Chauvey D, Duperray F, Wollein U, Conti M, Tromp J, Meyer S, Wanko R, Wierer M, Bertrand M, Rodriguez J, Sommers C, Keire D. Performance Characteristics of Mass Spectrometry-Based Analytical Procedures for Quantitation of Nitrosamines in Pharmaceuticals: Insights from an Inter-laboratory Study. J Pharm Sci 2023; 112:2685-2695. [PMID: 37524228 DOI: 10.1016/j.xphs.2023.07.022] [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: 04/14/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
With the discovery of carcinogenic nitrosamine impurities in pharmaceuticals in 2018 and subsequent regulatory requirements for risk assessment for nitrosamine formation during pharmaceutical manufacturing processes, storage or from contaminated supply chains, effective testing of nitrosamines has become essential to ensure the quality of drug substances and products. Mass spectrometry has been widely applied to detect and quantify trace amounts of nitrosamines in pharmaceuticals. As part of an effort by regulatory authorities to assess the measurement variation in the determination of nitrosamines, an inter-laboratory study was performed by the laboratories from six regulatory agencies with each of the participants using their own analytical procedures to determine the amounts of nitrosamines in a set of identical samples. The results demonstrated that accurate and precise quantitation of trace level nitrosamines can be achieved across multiple analytical procedures and provided insight into the performance characteristics of mass spectrometry-based analytical procedures in terms of accuracy, repeatability and reproducibility.
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Affiliation(s)
- Jingyue Yang
- Office of Testing and Research, Center of Drug Evaluation and Research, US Food and Drug Administration, Saint Louis, MO 63110, USA
| | - Raghavi Kakarla
- Office of Testing and Research, Center of Drug Evaluation and Research, US Food and Drug Administration, Saint Louis, MO 63110, USA
| | - Tim Marzan
- Office of Testing and Research, Center of Drug Evaluation and Research, US Food and Drug Administration, Saint Louis, MO 63110, USA
| | - Bill Sherwin
- TGA Laboratories, 136 Narrabundah Lane, Symonston, Canberra, A.C.T 2606, Australia
| | - Mark George
- TGA Laboratories, 136 Narrabundah Lane, Symonston, Canberra, A.C.T 2606, Australia
| | - Justine Bennett
- TGA Laboratories, 136 Narrabundah Lane, Symonston, Canberra, A.C.T 2606, Australia
| | - Jose Basutto
- TGA Laboratories, 136 Narrabundah Lane, Symonston, Canberra, A.C.T 2606, Australia
| | - Yi Su
- Health Products Laboratory Program, Regulatory Operations and Enforcement Branch, Department of Health, Government of Canada, 2301 Midland Ave, Toronto ON, M1P 4R7, Canada
| | - Jason Ollerenshaw
- Health Products Laboratory Program, Regulatory Operations and Enforcement Branch, Department of Health, Government of Canada, 2301 Midland Ave, Toronto ON, M1P 4R7, Canada
| | - Justin Morin
- Health Products Laboratory Program, Regulatory Operations and Enforcement Branch, Department of Health, Government of Canada, 2301 Midland Ave, Toronto ON, M1P 4R7, Canada
| | - Hervé Rebière
- French National Agency for the Safety of Medicines and Health Products (ANSM), Laboratory Controls Division; 635 Rue de la Garenne, 34740 Vendargues, France
| | - Annie-Francoise Maggio
- French National Agency for the Safety of Medicines and Health Products (ANSM), Laboratory Controls Division; 635 Rue de la Garenne, 34740 Vendargues, France
| | - Audrey Kermaïdic
- French National Agency for the Safety of Medicines and Health Products (ANSM), Laboratory Controls Division; 635 Rue de la Garenne, 34740 Vendargues, France
| | - Elodie Gervela
- French National Agency for the Safety of Medicines and Health Products (ANSM), Laboratory Controls Division; 635 Rue de la Garenne, 34740 Vendargues, France
| | - Charlotte Brenier
- French National Agency for the Safety of Medicines and Health Products (ANSM), Laboratory Controls Division; 635 Rue de la Garenne, 34740 Vendargues, France
| | - Corinne Civade
- French National Agency for the Safety of Medicines and Health Products (ANSM), Laboratory Controls Division; 635 Rue de la Garenne, 34740 Vendargues, France
| | - Denis Chauvey
- French National Agency for the Safety of Medicines and Health Products (ANSM), Laboratory Controls Division; 635 Rue de la Garenne, 34740 Vendargues, France
| | - Françoise Duperray
- French National Agency for the Safety of Medicines and Health Products (ANSM), Laboratory Controls Division; 635 Rue de la Garenne, 34740 Vendargues, France
| | - Uwe Wollein
- Department of Pharmacy (OMCL), Bavarian Health and Food Safety Authority, Veterinaerstr. 2 85764 Oberschleissheim, Germany
| | - Massimiliano Conti
- Schweizerisches Heilmittelinstitut (Biol. & Pharm.), OMCL Swissmedic, Hallerstrasse 7, 3012, Bern, Switzerland
| | - Jan Tromp
- Schweizerisches Heilmittelinstitut (Biol. & Pharm.), OMCL Swissmedic, Hallerstrasse 7, 3012, Bern, Switzerland
| | - Simon Meyer
- Schweizerisches Heilmittelinstitut (Biol. & Pharm.), OMCL Swissmedic, Hallerstrasse 7, 3012, Bern, Switzerland
| | - Richard Wanko
- Biological Standardisation, OMCL Network & HealthCare Department (DBO), EDQM - Council of Europe - Conseil de l'Europe, 7 Allée Kastner CS 30026 F- 67081 Strasbourg, France
| | - Michael Wierer
- Biological Standardisation, OMCL Network & HealthCare Department (DBO), EDQM - Council of Europe - Conseil de l'Europe, 7 Allée Kastner CS 30026 F- 67081 Strasbourg, France
| | - Marie Bertrand
- Biological Standardisation, OMCL Network & HealthCare Department (DBO), EDQM - Council of Europe - Conseil de l'Europe, 7 Allée Kastner CS 30026 F- 67081 Strasbourg, France
| | - Jason Rodriguez
- Office of Testing and Research, Center of Drug Evaluation and Research, US Food and Drug Administration, Saint Louis, MO 63110, USA
| | - Cynthia Sommers
- Office of Testing and Research, Center of Drug Evaluation and Research, US Food and Drug Administration, Saint Louis, MO 63110, USA
| | - David Keire
- Office of Testing and Research, Center of Drug Evaluation and Research, US Food and Drug Administration, Saint Louis, MO 63110, USA.
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Arafat M, Sakkal M, Yuvaraju P, Esmaeil A, Poulose V, Aburuz S. Effect of Excipients on the Quality of Drug Formulation and Immediate Release of Generic Metformin HCl Tablets. Pharmaceuticals (Basel) 2023; 16:ph16040539. [PMID: 37111296 PMCID: PMC10146418 DOI: 10.3390/ph16040539] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
Generic medications are bioequivalent to brand-name medications, but the quality and purity of generic medications are still debatable. The aim of this study was to compare the generic product of metformin (MET) to its branded counterpart using pure MET powder as a reference. Quality control tablet assessment and in vitro evaluation of drug release were carried out in various pH media. Additionally, several analytical methods and thermal techniques were used, namely differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), X-ray diffraction (XRD), scanning electron microscopy (SEM), Fourier-transform infrared (FTIR), and confocal Raman microscopy. The results showed a significant difference between the two products. In terms of friability assessment, mean resistance force, and tablet disintegration, the generic MET product showed significant weight loss, higher mean resistance force, longer disintegration time, and a slower rate of drug release. In addition, DSC and TGA showed that the generic product had the lowest melting point and the least weight loss compared to the branded product and pure powder. XRD and SEM demonstrated some changes in the crystallinity structure of the molecule particles for the generic product. Additionally, FTIR and confocal Raman revealed the same peaks and band shifts in all samples, but with differences in the intensity for the generic tablet only. The observed differences could be due to the use of different excipients in the generic product. The possibility of forming a eutectic mixture between the polymeric excipient and metformin in the generic tablet was presumed, which might be attributed to alterations in the physicochemical properties of the drug molecule in the generic product. In conclusion, using different excipients might have a significant effect on the physicochemical properties of drugs in generic formulations, leading to significant changes in drug release behavior.
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Affiliation(s)
- Mosab Arafat
- College of Pharmacy, Al Ain University, Al Ain P.O. Box 64141, United Arab Emirates
| | - Molham Sakkal
- College of Pharmacy, Al Ain University, Al Ain P.O. Box 64141, United Arab Emirates
| | - Priya Yuvaraju
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Anna Esmaeil
- Pharmalink and Medicina Group of Pharmacies, Abu Dhabi P.O. Box 41412, United Arab Emirates
| | - Vijo Poulose
- Department of Chemistry, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Salahdein Aburuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan
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Fahrer J, Christmann M. DNA Alkylation Damage by Nitrosamines and Relevant DNA Repair Pathways. Int J Mol Sci 2023; 24:ijms24054684. [PMID: 36902118 PMCID: PMC10003415 DOI: 10.3390/ijms24054684] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Nitrosamines occur widespread in food, drinking water, cosmetics, as well as tobacco smoke and can arise endogenously. More recently, nitrosamines have been detected as impurities in various drugs. This is of particular concern as nitrosamines are alkylating agents that are genotoxic and carcinogenic. We first summarize the current knowledge on the different sources and chemical nature of alkylating agents with a focus on relevant nitrosamines. Subsequently, we present the major DNA alkylation adducts induced by nitrosamines upon their metabolic activation by CYP450 monooxygenases. We then describe the DNA repair pathways engaged by the various DNA alkylation adducts, which include base excision repair, direct damage reversal by MGMT and ALKBH, as well as nucleotide excision repair. Their roles in the protection against the genotoxic and carcinogenic effects of nitrosamines are highlighted. Finally, we address DNA translesion synthesis as a DNA damage tolerance mechanism relevant to DNA alkylation adducts.
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Affiliation(s)
- Jörg Fahrer
- Division of Food Chemistry and Toxicology, Department of Chemistry, RPTU Kaiserslautern-Landau, Erwin-Schrödinger Strasse 52, D-67663 Kaiserslautern, Germany
- Correspondence: (J.F.); (M.C.); Tel.: +496312052974 (J.F.); Tel: +496131179066 (M.C.)
| | - Markus Christmann
- Department of Toxicology, University Medical Center Mainz, Obere Zahlbacher Strasse 67, D-55131 Mainz, Germany
- Correspondence: (J.F.); (M.C.); Tel.: +496312052974 (J.F.); Tel: +496131179066 (M.C.)
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Charoo NA, Dharani S, Khan MA, Rahman Z. Nitroso Impurities in Drug Products: An Overview of Risk Assessment, Regulatory Milieu, and Control Strategy. AAPS PharmSciTech 2023; 24:60. [PMID: 36759424 DOI: 10.1208/s12249-023-02523-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Many nitrosamines have been recognized to be carcinogenic for many decades. Despite the fact that several nitrosamine precursors are frequently used in the manufacturing of pharmaceutical products, their potential presence in pharmaceutical products has previously been overlooked due to a lack of understanding on how they form during the manufacturing process. From the risk assessment, it is clear that nitrosamines or their precursors may be present in any component of the finished dosage form. As a risk mitigation strategy, components with a high potential to form nitrosamine should be avoided. In the absence of suitable alternatives, sufficient measures to maintain nitrosamines below acceptable intake levels must be applied. Excipient manufacturing pathways must be extensively studied in order to identify probable excipient components that may contribute to nitrosamine formation. The manufacturers must not solely rely on pharmacopeial specifications for APIs and excipients, rather, they should also develop and implement additional strategies to control nitrosamine impurities. The formulation can be supplemented with nitrosating inhibitors, such as vitamin C, to stop the generation of nitrosamine. The purpose of this review is to identify key risk factors with regard to nitrosamine formation in pharmaceutical dosage forms and provide an effective control strategy to contain them below acceptable daily intake limits.
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Affiliation(s)
- Naseem A Charoo
- Succor Pharma Solutions, Laboratory Complex, 216, Dubai Science Park, Dubai, UAE
| | - Sathish Dharani
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX, 77843, USA
| | - Mansoor A Khan
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX, 77843, USA
| | - Ziyaur Rahman
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX, 77843, USA.
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Tuesuwan B, Vongsutilers V. Current Threat of Nitrosamines in Pharmaceuticals and Scientific Strategies for Risk Mitigation. J Pharm Sci 2023; 112:1192-1209. [PMID: 36739905 DOI: 10.1016/j.xphs.2023.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
The current global situation of nitrosamine contamination has expanded from angiotensin-II receptor blockers (ARBs) to wide range of medicines as the risk of contamination via the drug substances, formulation, manufacturing process, and packaging is possible for many drug products. The understanding of chemistry, toxicology, and root causes of nitrosamines are mandatory to effectively evaluate and mitigate the risks associated with the contaminated mutagen. Lessons learnt and scientific findings from previously identified root causes are good examples on how to perform effective risk assessments and establish control strategies. Addressing the risk of nitrosamine contamination in pharmaceuticals requires significant knowledge and considerable resources to collect the necessary information for risk evaluation. Examples of the resources required include a reliable laboratory facility, reference material, highly specific and sensitive instrumentation able handle trace levels of contamination, data management, and the most limited resource - time. Therefore, the supporting tools to assist with risk assessment e.g., shared databases for drug and excipients in concern, screening models for the determination of nitrosamine formation potential, and an in silico model to help with toxicity estimation, have proven to be beneficial to tackle the risk and concern of nitrosamine contamination in pharmaceuticals.
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Affiliation(s)
- Bodin Tuesuwan
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Vorasit Vongsutilers
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand.
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Schmidtsdorff S, Neumann J, Schmidt AH, Parr MK. Prevalence of nitrosamine contaminants in drug samples: Has the crisis been overcome? Arch Pharm (Weinheim) 2023; 356:e2200484. [PMID: 36461687 DOI: 10.1002/ardp.202200484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 12/04/2022]
Abstract
Various drug samples (N = 249; drug substances, tablets, capsules, solutions, crèmes, and more) from the European pharmaceutical market were collected since 2019 and analyzed for 16 nitrosamines (NAs). In 2.0% of the cases, NAs were detected. These findings included four active pharmaceutical ingredients already known for potential NA contamination: losartan (N-nitrosodimethylamine [NDMA] and N-nitrosodiethylamine, simultaneously), valsartan (NDMA), metformin (NDMA) and ranitidine (NDMA). The fifth new finding, which has not been reported yet, discovered contamination of a molsidomine tablet sample with N-nitrosomorpholine (NMor). The tablet contained 144% of the toxicological allowable intake for NMor. NMor was included in our screening from the beginning and is currently the focus of regulatory authorities, but was added to the guidelines only last year. Thus, it may not have been the focus of regulatory investigations for too long. Our results indicate that the majority of drug products in the market are nonhazardous in terms of patient safety and drug purity. Unfortunately, the list of individual affected products keeps growing constantly and new NA cases, such as molsidomine or nitrosated drug substances (nitrosamine drug substance-related impurities [NDSRI]), continue to emerge. We therefore expect nitrosamine screenings to remain a high priority.
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Affiliation(s)
- Sebastian Schmidtsdorff
- Chromicent GmbH, Berlin, Germany.,Department of Biology, Chemistry and Pharmacy, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Jonas Neumann
- Chromicent GmbH, Berlin, Germany.,Department of Biology, Chemistry and Pharmacy, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | | | - Maria K Parr
- Department of Biology, Chemistry and Pharmacy, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
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10
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Holzgrabe U. Nitrosated Active Pharmaceutical Ingredients - Lessons Learned? J Pharm Sci 2023; 112:1210-1215. [PMID: 36720391 DOI: 10.1016/j.xphs.2023.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
The occurrence of N-nitrosodialkylamines in active pharmaceutical ingredients (APIs) and drug products in the last years was a kind of eye opener with regard to quality of drugs. We became aware of the fact that quality control tests described in the international pharmacopoeias might not be sufficient. The N-nitrosodialkylamines found were neither so-called (structurally) related substances, nor residual solvents or heavy metals; hence they were not limited by a compendial test, but by the ICH guideline M7 of mutagenic impurities. Additionally, nitrosamine drug-substance-related impurities (NDSRIs) were detected, mostly within the process of risk assessment required by regulatory authorities. Here, the APIs containing a vulnerable amino moiety had reacted with nitrites being a contaminant of an excipient. This review deals with the formation, toxicity, and mitigation of NDSRISs.
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Affiliation(s)
- U Holzgrabe
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg Am Hubland, 97074 Wuerzburg, Germany.
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11
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Horne S, Vera MD, Nagavelli LR, Sayeed VA, Heckman L, Johnson D, Berger D, Yip YY, Krahn CL, Sizukusa LO, Rocha NFM, Bream RN, Ludwig J, Keire DA, Condran G. Regulatory Experiences with Root Causes and Risk Factors for Nitrosamine Impurities in Pharmaceuticals. J Pharm Sci 2023; 112:1166-1182. [PMID: 36599405 DOI: 10.1016/j.xphs.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 01/02/2023]
Abstract
N-Nitrosamines (also referred to as nitrosamines) are a class of substances, many of which are highly potent mutagenic agents which have been classified as probable human carcinogens. Nitrosamine impurities have been a concern within the pharmaceutical industry and by regulatory authorities worldwide since June 2018, when regulators were informed of the presence of N-nitrosodimethylamine (NDMA) in the angiotensin-II receptor blocker (ARB) medicine, valsartan. Since that time, regulatory authorities have collaborated to share information and knowledge on issues related to nitrosamines with a goal of promoting convergence on technical issues and reducing and mitigating patient exposure to harmful nitrosamine impurities in human drug products. This paper shares current scientific information from a quality perspective on risk factors and potential root causes for nitrosamine impurities, as well as recommendations for risk mitigation and control strategies.
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Affiliation(s)
| | - Matthew D Vera
- US Food and Drug Administration (US FDA), Silver Spring, MD, 20993, USA
| | - Laxma R Nagavelli
- US Food and Drug Administration (US FDA), Silver Spring, MD, 20993, USA
| | - Vilayat A Sayeed
- US Food and Drug Administration (US FDA), Silver Spring, MD, 20993, USA
| | - Laurel Heckman
- US Food and Drug Administration (US FDA), Silver Spring, MD, 20993, USA
| | - Deborah Johnson
- US Food and Drug Administration (US FDA), Silver Spring, MD, 20993, USA
| | - Dan Berger
- US Food and Drug Administration (US FDA), Silver Spring, MD, 20993, USA
| | | | | | | | | | - Robert N Bream
- European Medicines Agency (EMA, EU), Amsterdam, the Netherlands
| | - Joachim Ludwig
- Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), Bonn, Germany
| | - David A Keire
- US Food and Drug Administration (US FDA), St Louis, MO, 63110, USA
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12
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Leigh Wood E, Tatke A, Viehmann A, Ashtiani M, Friedman RL, Kopcha M, Fisher AC. Dosage unit uniformity and dissolution testing of extended-release pharmaceutical products marketed in the U.S. Int J Pharm 2022; 625:122119. [PMID: 36029995 DOI: 10.1016/j.ijpharm.2022.122119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
An international sampling study yielded 69 samples of extended-release prescription pharmaceuticals for legal sale in the U.S. Samples included 29 lots of innovator and 40 lots of generic solid oral extended-release drugs manufactured at 16 different facilities and containing 6 different active ingredients. Dosage unit uniformity and dissolution were tested for each lot. All samples met the relevant testing criteria for dosage unit uniformity and dissolution. There were no indications that manufacturer or region impacted a product's acceptability for use by patients. The variability of attributes was used to calculate a process performance index (Ppk) for each facility. Higher Ppk values suggest less variability relative to specification limits. Only two manufacturers fell below a 4-sigma manufacturing benchmark Ppk of 1.33 for dosage unit uniformity: a European manufacturer of a brand drug and an Asian manufacturer of a generic drug. Conversely, all but four manufacturers fell below a 4-sigma benchmark for the minimum Ppk across their product's dissolution timepoints: generic drug manufacturers in India (two), the U.S., and Canada. Compared to the immediate-release products of a previous study, Ppks were generally lower for extended-release products. A retrospective analysis found that manufacturers performing below median Ppks submitted more Field Alert Reports after the end of the sampling period.
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Affiliation(s)
- Erin Leigh Wood
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD 20993, USA
| | - Akshaya Tatke
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD 20993, USA
| | - Alex Viehmann
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD 20993, USA
| | - Melika Ashtiani
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD 20993, USA
| | - Richard L Friedman
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD 20993, USA
| | - Michael Kopcha
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD 20993, USA
| | - Adam C Fisher
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD 20993, USA.
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