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Jędrejko K, Catlin O, Stewart T, Anderson A, Muszyńska B, Catlin DH. Unauthorized ingredients in "nootropic" dietary supplements: A review of the history, pharmacology, prevalence, international regulations, and potential as doping agents. Drug Test Anal 2023. [PMID: 37357012 DOI: 10.1002/dta.3529] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 06/27/2023]
Abstract
The first nootropic prohibited in sport was fonturacetam (4-phenylpiracetam, carphedon) in 1998. Presented here 25 years later is a broad-scale consideration of the history, pharmacology, prevalence, regulations, and doping potential of nootropics viewed through a lens of 50 selected dietary supplements (DS) marketed as "cognitive enhancement," "brain health," "brain boosters," or "nootropics," with a focus on unauthorized ingredients. Nootropic DS have risen to prominence over the last decade often as multicomponent formulations of bioactive ingredients presenting compelling pharmacological questions and potential public health concerns. Many popular nootropics are unauthorized food or DS ingredients according to the European Commission including huperzine A, yohimbine, and dimethylaminoethanol; unapproved pharmaceuticals like phenibut or emoxypine (mexidol); previously registered drugs like meclofenoxate or reserpine; EU authorized pharmaceuticals like piracetam or vinpocetine; infamous doping agents like methylhexaneamine or dimethylbutylamine; and other investigational substances and peptides. Several are authorized DS ingredients in the United States resulting in significant global variability as to what qualifies as a legal nootropic. Prohibited stimulants or ß2-agonists commonly used in "pre-workout," "weight loss," or "thermogenic" DS such as octodrine, hordenine, or higenamine are often stacked with nootropic substances. While stimulants and ß2-agonists are defined as doping agents by the World Anti-Doping Agency (WADA), many nootropics are not, although some may qualify as non-approved substances or related substances under catch-all language in the WADA Prohibited List. Synergistic combinations, excessive dosing, or recently researched pharmacology may justify listing certain nootropics as doping agents or warrant additional attention in future regulations.
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Affiliation(s)
- Karol Jędrejko
- Faculty of Pharmacy, Department of Pharmaceutical Botany, Jagiellonian University Medical College, Kraków, Poland
| | - Oliver Catlin
- Banned Substances Control Group (BSCG), Los Angeles, California, USA
| | - Timothy Stewart
- Banned Substances Control Group (BSCG), Los Angeles, California, USA
| | - Ashley Anderson
- International Sports Pharmacists Network, Fort Collins, Colorado, USA
| | - Bożena Muszyńska
- Faculty of Pharmacy, Department of Pharmaceutical Botany, Jagiellonian University Medical College, Kraków, Poland
| | - Don H Catlin
- Banned Substances Control Group (BSCG), Los Angeles, California, USA
- Department of Medicine and Molecular and Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, California, USA
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Deconinck E, Vanhee C, Keizers P, Guinot P, Mihailova A, Syversen PV, Li-Ship G, Young S, Blazewicz A, Poplawska M, Al-Sayed JL, Stengelshøj Olsen L, El-Atma O, Leist R, Jönsson KH, Afxentiou M, Barrios MM, Diaz ID, Zemser M, Kozokin A, Hackl A, Portela MJ, Beerbaum N, Bertrand M. The occurrence of non-anatomical therapeutic chemical-international nonproprietary name molecules in suspected illegal or illegally traded health products in Europe: A retrospective and prospective study. Drug Test Anal 2021; 13:833-840. [PMID: 33453144 DOI: 10.1002/dta.3001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 11/11/2022]
Abstract
The General European Official Medicines Control Laboratory (OMCL) Network (GEON), co-ordinated by the European Directorate for the Quality of Medicines & HealthCare (EDQM), regularly organises market surveillance studies on specific categories of suspected illegal or illegally traded products. These studies are generally based on a combination of retrospective and prospective data collection over a defined period of time. This paper reports the results of the most recent study in this context with the focus on health products containing non-Anatomical Therapeutic Chemical-International Nonproprietary Name (ATC-INN) molecules. In total 1104 cases were reported by 16 countries for the period between January 2017 and the end of September 2019. The vast majority of these samples (83%) were collected from the illegal market, while only 3% originated from a legal source. For the rest of the samples, categorisation was not possible. Moreover, 69% of all the reported samples were presented as medicines, including sexual performance enhancers, sports performance enhancers, physical performance enhancers and cognitive enhancers or nootropic molecules that act on the central nervous system (CNS). Although the popularity of anabolics, PDE-5 inhibitors and CNS drugs in illegal products has already been reported, the study showed some new trends and challenges. Indeed, 11% of the samples contained molecules of biological origin, that is, research peptides, representing the second most reported category in this study. Furthermore, the study also clearly shows the increasing popularity of Selective Androgen Receptor Modulators and nootropics, two categories that need attention and should be further monitored.
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Affiliation(s)
- Eric Deconinck
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Scientific Direction Chemical and Physical Health Risks, Service of Medicines and Health Products, Sciensano, Brussels, Belgium
| | - Celine Vanhee
- Scientific Direction Chemical and Physical Health Risks, Service of Medicines and Health Products, Sciensano, Brussels, Belgium
| | - Peter Keizers
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Department of Product Composition, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Pauline Guinot
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Laboratory Controls Division, French National Agency for Medicines and Health Products Safety, Vendargues, France
| | - Albena Mihailova
- Laboratory, Division Reliable Supply, Norwegian Medicines Agency, Oslo, Norway
| | - Per Vidar Syversen
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Laboratory, Division Reliable Supply, Norwegian Medicines Agency, Oslo, Norway
| | - Graziella Li-Ship
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Inspections, Enforcement and Standards Division, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Steven Young
- Inspections, Enforcement and Standards Division, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Agata Blazewicz
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Falsified Medicines and medical Devices Department, National Medicines Institute, Warsaw, Poland
| | - Magdalena Poplawska
- Falsified Medicines and medical Devices Department, National Medicines Institute, Warsaw, Poland
| | | | - Lone Stengelshøj Olsen
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Medicines Control and Inspection Division, Danish Medicines Agency, Copenhagen, Denmark
| | - Oliver El-Atma
- Medicinal Products, Chemical and Veterinary Investigation Office, Karlsruhe, Germany
| | - Roman Leist
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,OMCL, Swissmedic, Swiss Agency for Therapeutic Products, Bern, Switzerland
| | - Karl-Henrik Jönsson
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Laboratory Department, Swedish Medical Products Agency, Uppsala, Sweden
| | - Maria Afxentiou
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Forensic Chemistry and Toxicology Laboratory, State General Laboratory, Nicosia, Cyprus
| | - M Mendoza Barrios
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Chemical and Pharmaceutical Division, Medicines for Human Use Department, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - I Dorronsoro Diaz
- Chemical and Pharmaceutical Division, Medicines for Human Use Department, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Marina Zemser
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Institute of Standardization and Control of Pharmaceuticals, Ministry of Health Israel, Jerusalem, Israel
| | - Alla Kozokin
- Institute of Standardization and Control of Pharmaceuticals, Ministry of Health Israel, Jerusalem, Israel
| | - Andreas Hackl
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Institute Assessment & Analytics, Analytics of chemical-pharmaceutical Medicinal Products, AGES-Österreichische Agentur für Gesundheit und Ernährungssicherheit GmbH, Wien, Austria
| | - Maria-Jao Portela
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Direção de Comprovação da Qualidade, INFARMED-Autoridade Nacional do Medicamento e Produtos de Saúde, I.P., Lisbon, Portugal
| | - Nico Beerbaum
- Institut für Lebensmittel, Arzneimittel, Tierseuchen und Umwelt, Landeslabor Berlin-Brandenburg, Berlin, Germany
| | - Marie Bertrand
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France
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