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Huhmann BA, Limbu YB. Fair Balance of Prescription Drug Information on Legitimate and Illegitimate Online Pharmacy Websites. PHARMACY 2024; 12:67. [PMID: 38668093 PMCID: PMC11054229 DOI: 10.3390/pharmacy12020067] [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: 02/25/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
Patients require important information when prescribed medications. For example, the U.S. Food and Drug Administration (FDA) requires that promotional information includes a fair balance of risks and benefits. This study evaluates how well legitimate online pharmacies (LOPs) and illegitimate online pharmacies (IOPs) comply with the spirit of the FDA's fair balance guidelines by examining the extent and equivalence of risk and benefit information on their websites. This study analyzed the content of 307 online pharmacy websites. Most (90.3%) communicated drug benefits, while 84.7% provided risks. Both risk and benefit information was moderately extensive. Presentation of risks and benefits differed between online pharmacy types. Compared to LOPs, IOPs were more likely to present risk information but also exaggerate benefits. Four in ten online pharmacies presented a fair balance of risks and benefits. However, LOPs (47.4%) were more likely to present a fair balance than IOPs (36.5%). Interestingly, IOPs were more likely to disclose instructions for use and overdose information than LOPs. These findings underscore the need for regulatory guidelines to encourage online pharmacies to present a fair balance of benefit and risk information. Also, pharmacists should develop online approaches to better fulfill their professional responsibility as drug information providers while maintaining their integrity and objectivity.
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Affiliation(s)
- Bruce A. Huhmann
- Department of Marketing, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Yam B. Limbu
- Department of Marketing, Montclair State University, Montclair, NJ 07043, USA;
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2
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Miller K, May U, Beecken WD, Hatzichristodoulou G, Böhm M, Fink S. Evidence for benefits and risks of tadalafil as a non-prescription medicine: review and evaluation using the Group Delphi technique to achieve consensus amongst clinical experts. Front Pharmacol 2023; 14:1254706. [PMID: 37876727 PMCID: PMC10590875 DOI: 10.3389/fphar.2023.1254706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023] Open
Abstract
An evidence-based consensus meeting was held with urologists, a pharmacist and a cardiologist to perform a structured benefit-risk analysis of reclassifying tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor for treatment of erectile dysfunction (ED), to be available without prescription in Germany. As per the Brass process endorsed by regulatory authorities, an evidence-based Brass value tree was developed, which identified the incremental benefits and risks that should be considered above the safety and efficacy evidence required for prescription medicines. During the Group Delphi consensus meeting, the expert panel rated the likelihood and clinical impact of each benefit and risk on a scale of 0 (none) to 3 (high). Overall attribute scores were calculated from the product of the mean likelihood and mean clinical impact scores giving a possible score of 0-9. The overall benefit attribute scores ranged from 2.8 to 5.4. The overall risk attribute scores ranged from 0.2 to 2.2 though most were 1.0 or less (3 or more is generally considered to be of concern). On balance, the independent meeting scored the benefits of reclassification of tadalafil higher than the risks and considered the risk mitigation strategies of the packaging label and patient information leaflet (PIL) sufficient.
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Affiliation(s)
- Kurt Miller
- Department of Urology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Uwe May
- Department of Health Economics and Pharmacoeconomics, Fresenius University of Applied Sciences, Wiesbaden, Germany
| | | | | | - Michael Böhm
- Department of Internal Medicine, University of the Saarland, Homburg Saar, Germany
| | - Stefan Fink
- State Pharmacists’ Association of Thuringia, Erfurt, Germany
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Pathak R, Gaur V, Sankrityayan H, Gogtay J. Tackling Counterfeit Drugs: The Challenges and Possibilities. Pharmaceut Med 2023:10.1007/s40290-023-00468-w. [PMID: 37188891 PMCID: PMC10184969 DOI: 10.1007/s40290-023-00468-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 05/17/2023]
Abstract
Drugs that have been manufactured or packaged fraudulently are referred to as counterfeit/fake/spurious/falsified drugs because they either lack active ingredients or have the incorrect dosages. Counterfeiting of drugs has become a global issue with which the whole world is grappling. The World Health Organization states the frightening figure in which almost 10.5% of the medications worldwide are either subpar or fake. Although developing and low-income countries are the targets of the large-scale drug counterfeiting activities, fake/substandard drugs are also making their way into developed nations including the USA, Canada, and European countries. Counterfeiting of drugs is leading to not only economic loss but is also playing its part in the morbidity and mortality of patients. The recent COVID-19 pandemic fuelled the demand for certain categories of medicines such as antipyretics, remdesivir, corticosteroids, vaccines, etc., thus increasing the demand and manufacture of subpar/fake medicines. This review articulates the current trends and global impact of drug counterfeiting, current and potential measures for its prevention and the role of different stakeholders in tackling the menace of drug counterfeiting.
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Affiliation(s)
- Ranjana Pathak
- Dr Reddy's Laboratory Ltd, Banjara Hills, 8-2-337, Road No. 3, Hyderabad, Telangana, 500034, India.
| | - Vaibhav Gaur
- Global Medical Affairs, Cipla Ltd, Mumbai, India
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Limbu YB, Huhmann BA. Illicit Online Pharmacies: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095748. [PMID: 37174265 PMCID: PMC10178756 DOI: 10.3390/ijerph20095748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
This scoping review presents the extent and nature of the body of literature on illicit online pharmacies (IOPs) and identifies research gaps. Using the five-step framework developed by Arksey and O'Malley, we searched PubMed, Web of Science, EMBASE, CINAHL, Science Direct and PsycInfo to retrieve relevant studies published in English in peer-reviewed journals. The search strategy identified forty-three articles that met the inclusion criteria. Ten themes were identified and categorized into five clusters: patient risk, healthcare providers, marketing and supply chain, public health and society, and policy and regulation. Research into these clusters has evolved over time and has focused increasingly on issues related to specific drugs rather than the overall phenomenon. Data collection has been dominated by convenience sampling, online searches, content analysis and surveys. Data analysis remains primarily descriptive. Gaps within the extant literature suggest an agenda for future research into regulation and enforcement; public health awareness and education; healthcare services; risks to patients and public health; patient-, price- and product-related issues; website design; social media promotion; and supply chains and logistics. We conclude that IOPs are vastly understudied and suggest an urgent need for further empirical and conclusive research.
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Affiliation(s)
- Yam B Limbu
- Feliciano School of Business, Montclair State University, 1 Normal Ave., Montclair, NJ 07043, USA
| | - Bruce A Huhmann
- Department of Marketing, Virginia Commonwealth University, Richmond, VA 23284, USA
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Harwacki J, Pisklak DM, Szeleszczuk L. Solid state 13C NMR spectroscopy as a tool for identification of counterfeit Viagra tablets and guide for develop new identification approach of falsified product. Int J Pharm 2023; 636:122837. [PMID: 36921742 DOI: 10.1016/j.ijpharm.2023.122837] [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: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
Counterfeit drugs are a global problem that is directly related to the safety and effectiveness of pharmacotherapy. The black market for counterfeit products is constantly growing and related to the wide availability through online shopping. Therefore, there is a constant need to develop analytical methods that would allow for the unambiguous identification of counterfeit products from the original ones. One of such techniques is solid-state NMR spectroscopy, which allows for direct registration and analysis of spectra of multicomponent solid forms of pharmaceutical formulations. The paper explores the possibility of using this technique in the identification of counterfeit Viagra tablets. In this study, solid-state NMR has been used to detect the non-pharmacopoeial cellulose present in the samples of counterfeit Viagra tablets. Besides, the NMR results allowed to develop a rapid dying technique that can be used to distinguish between the counterfeit and original drug. It has been shown that solid-state NMR spectroscopy allows for numerous analyses such as identification of counterfeit products, assessment of the composition of analyte, estimation of qualitative differences between the original and falsified product, and the development of simple analytical methods based on tablets composition differences.
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Affiliation(s)
- Jakub Harwacki
- Medical University of Warsaw, Faculty of Pharmacy, Department of Organic and Physical Chemistry, Stefana Banacha 1, 02-097 Warsaw, Poland.
| | - Dariusz Maciej Pisklak
- Medical University of Warsaw, Faculty of Pharmacy, Department of Organic and Physical Chemistry, Stefana Banacha 1, 02-097 Warsaw, Poland.
| | - Lukasz Szeleszczuk
- Medical University of Warsaw, Faculty of Pharmacy, Department of Organic and Physical Chemistry, Stefana Banacha 1, 02-097 Warsaw, Poland.
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Long CS, Kumaran H, Goh KW, Bakrin FS, Ming LC, Rehman IU, Dhaliwal JS, Hadi MA, Sim YW, Tan CS. Online Pharmacies Selling Prescription Drugs: Systematic Review. PHARMACY 2022; 10:pharmacy10020042. [PMID: 35448701 PMCID: PMC9031186 DOI: 10.3390/pharmacy10020042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: The patronage of online pharmacies is rapidly growing, driven by the convenience and cheaper costs of purchasing prescription drugs electronically, especially under the lockdown situation. However, there are issues regarding the quality of the prescription drugs sold online and the legitimacy of online pharmacies. The use of prescription drugs without the supervision of a licensed health care practitioner may potentially harm consumers. Objectives: This systematic review was conducted to improve the body of knowledge on three main aspects of online pharmacies: (1) type and characteristics of the online pharmacies selling drugs; (2) the quality of pharmaceutical drugs purchased online; and (3) the characteristics of consumers of online pharmacies. Methods: Based on a pre-defined search strategy, PubMed and Scopus were utilised to search articles written in the English language published between January 2009 and February 2020. Studies focusing on the sale of prescription drugs were included. The terms used for the literature search were “online pharmacy”, “internet pharmacy”, “e-pharmacy”, “prescription”, “quality”, “medication safety”, and “counterfeit medicine”. These terms were used alone and in combination with Boolean operators. The institutional webpages including the World Health Organization (WHO) and the United States Food and Drug Administration (USFDA) were also examined for any additional studies. No methodological limitations in terms of study design were applied. A standardised data collection form was used to compile the data. Results: Based on the inclusion and exclusion criteria, a total of 46 articles were eligible and included in the final analysis. There were 27 articles on types and characteristic of online pharmacies, 13 articles on the quality of prescription drugs sold from online pharmacies, and 11 articles on consumers purchasing prescription drugs from online pharmacies. Readers should note that five articles discussed both the types and characteristics of online pharmacies, and the quality of the drugs sold from the outlets. The response rate (products received out of the number of orders) ranged from 20% to 100%, whereas the proportion of consumers buying prescription drugs online ranged from 2.3% to 13%. Reasons for online purchase of prescription drugs include the difficulty of obtaining a prescription for certain medications such as opioid analgesics, cheaper cost, since the costs associated with seeing a physician to obtain a prescription are reduced, and the need to obtain drugs such as opioid analgesics and benzodiazepine for misuse. Conclusions: Almost half of the online pharmacies are not properly regulated and fraudulent issues were uncovered. To address this issue, stricter regulation by World Health Organization and implementation should be carried out together with frequent monitoring of the licensure system and pharmacy verification on every online pharmacy, this would reduce the number of illegal or illegitimate online pharmacy.
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Affiliation(s)
- Chiau Soon Long
- Faculty of Computing and Engineering, Quest International University, Ipoh 30250, Malaysia;
| | - Harshily Kumaran
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia; (H.K.); (F.S.B.)
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai 71800, Malaysia;
| | - Faizah Safina Bakrin
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia; (H.K.); (F.S.B.)
| | - Long Chiau Ming
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei; (L.C.M.); (J.S.D.)
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan 23200, Pakistan;
| | - Jagjit Singh Dhaliwal
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei; (L.C.M.); (J.S.D.)
| | - Muhammad Abdul Hadi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Yee Wai Sim
- Faculty of Computing and Engineering, Quest International University, Ipoh 30250, Malaysia;
- Correspondence: (Y.W.S.); (C.S.T.)
| | - Ching Siang Tan
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia; (H.K.); (F.S.B.)
- Correspondence: (Y.W.S.); (C.S.T.)
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Ming Kenneth Ho H, Xiong Z, Ying Wong H, Buanz A. The Era of Fake Medicines: Investigating counterfeit medicinal products for erectile dysfunction disguised asherbal supplements. Int J Pharm 2022; 617:121592. [PMID: 35182703 DOI: 10.1016/j.ijpharm.2022.121592] [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: 01/03/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
Sales of substandard and falsified medical products (SF) are rising rapidly everywhere around the globe. The wide and easy access to these products is an alarming issue to the global health systems and undermined the health of patients, especially with the thrive of online commerce. To tackle this threat to public health, new ways to access these products should be identified and detection technologies should be strengthened. The overarching aim of this study was to investigate if herbal supplements sold online claiming to be natural alternatives to Viagra® were amongst these SF medical products and how effective different analytical techniques are in providing information about these products. 3 products which claimed to be herbal supplements for men sexual performance were purchased from an e-commerce platform. Two products were received as unregistered generic sildenafil citrate tablets manufactured in India (and thus different to the products information on the website) while one product was received in the same packaging as shown on the website, claiming to be an herbal product. Nevertheless, all products were proven to contain sildenafil citrate, the active pharmaceutical ingredients in Viagra® after the comprehensive analytical tests. The results elucidated that the quality standards for the unregistered generic sildenafil citrate tablets were fulfilled according to the British Pharmacopeia, but the falsified product failed the quality tests and contained approximately 200 mg sildenafil citrate, which is equivalent to 2-fold of the daily maximum dose. Furthermore, physical characterisations, including powder x-ray diffraction and thermal analysis were performed and revealed that the polymorphic forms of sildenafil citrate were different, demonstrating the importance of employing thermal analysis in addition to the conventional analysis techniques for the substandard and falsified medical products. These techniques provided valuable insights into the physical form of the active ingredient in these products. What is more, the ease with which these SF products were obtained and confirmed to be misleading consumers emphasises the need for tighter regulation for e-commerce websites in line with those enforced on online pharmacies.
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Affiliation(s)
- Hei Ming Kenneth Ho
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Zhaoan Xiong
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Hui Ying Wong
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Asma Buanz
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK.
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Aronson JK, Ferner RE, Richards GC. Deaths attributed to the use of medications purchased online. BMJ Evid Based Med 2022; 27:60-64. [PMID: 34933931 DOI: 10.1136/bmjebm-2021-111759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Jeffrey K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robin E Ferner
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Section of Clinical Pharmacology, University College London Hospitals, London, UK
| | - Georgia C Richards
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, UK
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Sansone A, Cuzin B, Jannini EA. Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions. Sex Med 2021; 9:100437. [PMID: 34619517 PMCID: PMC8766274 DOI: 10.1016/j.esxm.2021.100437] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction The counterfeit phenomenon is a largely under-reported issue, with potentially large burden for healthcare. The market for counterfeit drugs used in sexual medicine, most notably type 5 phosphodiesterase inhibitors (PDE5i), is rapidly growing. Aims To report the health risks associated with the use of counterfeit medications, the reasons driving their use, and the strategies enacted to contain this phenomenon. Methods A systematic scoping review of the literature regarding counterfeit PDE5i was carried between January and June 2021, then updated in August 2021. Main Outcome Measure We primarily aimed to clarify the main drivers for counterfeit PDE5i use, the health risks associated, and the currently available strategies to fight counterfeiters. Results One hundred thirty-one records were considered for the present scoping review. Production of fake PDE5i is highly lucrative and the lacking awareness of the potential health risks makes it a largely exploitable market by counterfeiters. Adulteration with other drugs, microbial contamination and unreliable dosages make counterfeit medications a cause of worry also outside of the sexual medicine scope. Several laboratory techniques have been devised to identify and quantify the presence of other compounds in counterfeit medications. Strategies aimed at improving awareness, providing antitampering packaging and producing non-falsifiable products, such as the orodispersible formulations, are also described. Clinical implications Improving our understanding of the PDE5i counterfeit phenomenon can be helpful to promote awareness of this issue and to improve patient care. Strengths & Limitations Despite the systematic approach, few clinical studies were retrieved, and data concerning the prevalence of counterfeit PDE5i use is not available on a global scale. Conclusion The counterfeit phenomenon is a steadily growing issue, with PDE5i being the most counterfeited medication with potentially large harmful effects on unaware consumers. Sansone A, Cuzin B, and Jannini EA. Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions. Sex Med 2021;9:100437.
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Affiliation(s)
- Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Béatrice Cuzin
- Division of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Sweileh WM. Substandard and falsified medical products: bibliometric analysis and mapping of scientific research. Global Health 2021; 17:114. [PMID: 34556126 PMCID: PMC8460181 DOI: 10.1186/s12992-021-00766-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/14/2021] [Indexed: 12/11/2022] Open
Abstract
Objective Substandard and falsified (SF) medical products are a global public health threat. The presence and spread of SF drugs negatively affect (1) patients’ safety and health outcomes, (2) national economy, (3) public trust in the healthcare system, and (4) the international fight against serious health challenges such as malaria and antimicrobial resistance. The objective of the current study was to investigate and provide a snapshot analysis of the evolution and developmental patterns of global research publications on SF products. Methods A bibliometric approach was adopted using terms such as fake, falsified, counterfeit, substandard, and others. No language restriction was made. The study period was from 1900 up to 2020. The search strategy was validated and implemented using Scopus database. Results The search strategy retrieved 978 documents authored by 2861 researchers from 100 different countries and published in 421 different journals. The retrieved documents received 11,237 citations (11.5 citations per document) with an H-index of 53. The 978 documents retrieved from Scopus were published from 1961 to 2020, giving an average of 16.6 publications per year. The present study indicated that research on SF medical products: (a) has experienced a steep growth from 2001 to 2012 followed by a steady-state growth; (b) was disseminated in a wide range of journals, mainly in the fields of the pharmaceutical industry, analytical chemistry, public health, infectious diseases, and internal medicine; (c) was published by scholars with diverse and distant geographical backgrounds; (d) was mainly produced in the United States, United Kingdom, and Germany; (d) has fragmented research networks and a limited number of researchers per network; (e) has limited cross-country collaboration except for that between the US and the UK in one hand and countries in the Mekong region in the other hand; (f) emphasized on medications related to malaria and sexual stimulants; and (g) received relatively inadequate funding. Conclusions Research on SF medical products is important and should remain a priority to ensure good quality of medications. Research activity in the field needs to be encouraged in world regions such as Africa and the Middle East where drug regulations are unsatisfactory and cross-border trade of illegal medications is common. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00766-5.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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11
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Screening sexual performance enhancing compounds and their analogues in counterfeit and illicit erectile dysfunction drugs by high-performance liquid chromatography and liquid chromatography-tandem mass spectrometry. J Forensic Leg Med 2021; 82:102224. [PMID: 34371245 DOI: 10.1016/j.jflm.2021.102224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 11/20/2022]
Abstract
The growth of the counterfeit and illicit drugs market is attributable in part to phosphodiesterase type-5 inhibitor (PDE-5is) medications for erectile dysfunction (ED). PDE-5is and their analogues are being increasingly supplied as counterfeit and illicit drugs marketed to enhance sexual performance. Herein, we screened and confirmed a total of 181 such counterfeit and illicit drugs used to date to enhance sexual performance by high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Out of 181 samples, PDE-5is and their analogues were detected in 156 samples, with 49.4% containing two or more components in a single sample. Sildenafil, tadalafil, and miscellaneous group were detected a rates of 64.1%, 34.4%, and 1.5% times and concentrations of 0.04-496 mg/g, 0.02-147 mg/g, and 0.54-16.4 mg/g, respectively with multiple compound groups also detected in single samples. Overdosing on these drugs can lead to adverse effects, the toxicities of combined administrations have not been researched, and administering multiple components in a single sample can be fatal. We recommend that counterfeit and illicit drugs for enhancing sexual performance be continuously controlled and supervised for the protection of public health, and more studies into toxicity and side effects are required.
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Gurney K, Hobbs LJ, Adams NJ, Bailey JV. The Sextherapylondon interactive website for sexual difficulties: content, design and rationale. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2019.1703929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Gurney
- Clinical Psychologist and Psychosexologist, Chelsea and Westminster NHS Trust, Sexual Health Service, London, UK
| | - Lorna J. Hobbs
- Clinical Psychologist, e-Health Unit, University College London, Royal Free Hospital, London, UK
| | - Naomi J. Adams
- Consultant Clinical Psychologist, Central and North West London NHS Trust, Sexual Health Services, Mortimer Market Centre, London, UK
| | - Julia V. Bailey
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
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Zhao H, Berdahl C, Bresee C, Moradzadeh A, Houman J, Kim H, Eilber K, Pevnick J, Anger JT. Priapism from Recreational Intracavernosal Injections in a High-Risk Metropolitan Community. J Sex Med 2019; 16:1650-1654. [PMID: 31501058 DOI: 10.1016/j.jsxm.2019.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Recreational use of intracavernosal injections (ICIs) is a high-risk behavior that involves sharing of these agents by men without physician regulation. AIM To characterize the etiologies and outcomes of priapism at a Los Angeles metropolitan medical center to better understand patterns of usage of recreational ICIs and the public health implications of such practices. METHODS With institutional review board approval, we retrospectively reviewed all cases of priapism presenting to the emergency room of a Los Angeles tertiary medical center from 2010 to 2018. We compared outcomes between patients who presented with priapism after recreational ICI and patients who presented with other etiologies. MAIN OUTCOME MEASURE We describe patient characteristics, etiologies, and treatments of priapism at our institution. RESULTS We identified 169 priapism encounters by 143 unique patients. Recreational ICIs accounted for 82 of the 169 priapism encounters (49%). Patients who used recreational injections were younger than those who presented with other etiologies (43.5 years vs 47.5 years; P = .048) and had delayed presentations (median, 12 hours vs 8 hours; P < .0001). There was no statistical difference across groups in the proportion of patients requiring operative intervention (14.6% of recreational ICI users vs 16.1% of all other patients; P = .23). A total of 36 out of 72 patients who used recreational ICIs (50%) were HIV+. CLINICAL IMPLICATIONS Our study adds to the relatively sparse literature on priapism outcomes. We identify and describe a high-risk population that uses recreational intracavernosal injections. STRENGTHS & LIMITATIONS To our knowledge, this is the largest series of priapism encounters. However, the data are retrospective from a single institution, and there is a lack of long-term follow up. CONCLUSION A large proportion of priapism visits at our institution were attributed to recreational use of ICIs. This is a high-risk patient population that may not be aware of the risks of recreational ICIs and the consequences of priapism. Further effort should be made to increase public and physician awareness of this harmful practice. Zhao H, Berdahl C, Bresee C, et al. Priapism from Recreational Intracavernosal Injections in a High-Risk Metropolitan Community. J Sex Med 2019;16:1650-1654.
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Affiliation(s)
- Hanson Zhao
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carl Berdahl
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Catherine Bresee
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ariel Moradzadeh
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Justin Houman
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Howard Kim
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Karyn Eilber
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joshua Pevnick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer T Anger
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
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Romolo FS, Salvini A, Zelaschi F, Oddone M, Odoardi S, Mestria S, Strano Rossi S. Instrumental neutron activation analysis (INAA) and liquid chromatography (LC) coupled to high resolution mass spectrometry (HRMS) characterisation of sildenafil based products seized on the Italian illegal market. Forensic Sci Int Synerg 2019; 1:126-136. [PMID: 32411964 PMCID: PMC7221474 DOI: 10.1016/j.fsisyn.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/21/2022]
Abstract
The commerce of illegal and counterfeit medicinal products on internet is a serious criminal problem. Drugs for erectile dysfunction such as phosphodiesterase type 5 inhibitor are the most commonly counterfeited medicines in Europe. The search of possible toxic chemical substances in seized products is needed. Moreover, the profiling of the material can be the source of relevant forensic information. For the first time a combined approach based on liquid chromatography (LC) coupled to high resolution mass spectrometry (HRMS) and instrumental neutron activation analysis (INAA) is proposed and tested, allowing characterisation of both authentic and illegal pharmaceuticals containing sildenafil seized in Italy. LC-HRMS allowed the detection and identification of unknown impurities not reported on labels in illegal products and the quantitation of the sildenafil. INAA showed to be suitable to provide both qualitative and quantitative information for forensic purposes on 23 elements, allowing discrimination between legal and illegal products.
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Affiliation(s)
| | - Andrea Salvini
- Laboratory of Applied Nuclear Energy, University of Pavia, Italy
- Radiochemistry Area – Chemistry Department, Università di Pavia, Italy
| | - Fabio Zelaschi
- Laboratory of Applied Nuclear Energy, University of Pavia, Italy
- Radiochemistry Area – Chemistry Department, Università di Pavia, Italy
| | - Massimo Oddone
- Laboratory of Applied Nuclear Energy, University of Pavia, Italy
- Radiochemistry Area – Chemistry Department, Università di Pavia, Italy
| | - Sara Odoardi
- Forensic Toxicology Laboratory, Institute of Public Health, F. Policlinico Gemelli IRCCS Roma - Università Cattolica del Sacro Cuore, Italy
| | - Serena Mestria
- Forensic Toxicology Laboratory, Institute of Public Health, F. Policlinico Gemelli IRCCS Roma - Università Cattolica del Sacro Cuore, Italy
| | - Sabina Strano Rossi
- Forensic Toxicology Laboratory, Institute of Public Health, F. Policlinico Gemelli IRCCS Roma - Università Cattolica del Sacro Cuore, Italy
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15
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Jang I, Lee JU, Lee JM, Kim BH, Moon B, Hong J, Oh HB. LC–MS/MS Software for Screening Unknown Erectile Dysfunction Drugs and Analogues: Artificial Neural Network Classification, Peak-Count Scoring, Simple Similarity Search, and Hybrid Similarity Search Algorithms. Anal Chem 2019; 91:9119-9128. [DOI: 10.1021/acs.analchem.9b01643] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Inae Jang
- Department of Chemistry, Sogang University, Seoul 04107, Republic of Korea
| | - Jae-ung Lee
- Department of Chemistry, Sogang University, Seoul 04107, Republic of Korea
| | - Jung-min Lee
- Department of Chemistry, Sogang University, Seoul 04107, Republic of Korea
| | - Beom Hee Kim
- College of Pharmacy, Kyunghee University, Seoul 02447, Republic of Korea
| | - Bongjin Moon
- Department of Chemistry, Sogang University, Seoul 04107, Republic of Korea
| | - Jongki Hong
- College of Pharmacy, Kyunghee University, Seoul 02447, Republic of Korea
| | - Han Bin Oh
- Department of Chemistry, Sogang University, Seoul 04107, Republic of Korea
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16
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Baydaroglu E, Eschwège P, Hubert J, El Osta R. Les génériques d’inhibiteur de la 5 phosphodiestérase améliorent-ils l’observance au traitement en raison d’un coût moindre ? Prog Urol 2019; 29:326-331. [DOI: 10.1016/j.purol.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/03/2019] [Accepted: 04/23/2019] [Indexed: 01/20/2023]
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17
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Assemat G, Balayssac S, Gerdova A, Gilard V, Caillet C, Williamson D, Malet-Martino M. Benchtop low-field 1H Nuclear Magnetic Resonance for detecting falsified medicines. Talanta 2018; 196:163-173. [PMID: 30683346 DOI: 10.1016/j.talanta.2018.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 12/16/2022]
Abstract
Falsified medicines represent a serious threat to public health. Among the different measures to effectively combat this scourge, analytical methods play a key role in their detection and removal from the market before they reach patients. The present study evaluates for the first time the potential of a benchtop low-field (LF) Nuclear Magnetic Resonance (NMR) spectrometer for uncovering drug falsification by focusing on the analysis of fifteen erectile dysfunction and nine antimalarial medicines, the most commonly reported falsified medicines in developed and developing countries respectively. After a simple and rapid sample preparation and ≈ 5 min of spectrum recording, LF 1H NMR allows to conclude on the quality of the medicine: presence or absence of the expected active pharmaceutical ingredient (API), presence of unexpected API, absence of any API. Some 2D experiments are also described but although conclusive they are hampered by the duration of the experiments. The LF 1H NMR assay, based on the internal standard method, is validated by the determination of its accuracy, repeatability, limits of detection (LOD) and quantification (LOQ), and by comparison of the data obtained on some medicines after 45 min of spectrum recording to those measured with high-field 1H NMR. Because of its saving capabilities (cost, space, user experience), LF 1H NMR spectroscopy might become a routine screening tool in laboratories in charge of detecting falsified medicines.
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Affiliation(s)
- Gaëtan Assemat
- Groupe de RMN Biomédicale, Laboratoire SPCMIB (UMR CNRS 5068), Université Paul Sabatier, Université de Toulouse, 118 route de Narbonne, 31062 Toulouse cedex, France
| | - Stéphane Balayssac
- Groupe de RMN Biomédicale, Laboratoire SPCMIB (UMR CNRS 5068), Université Paul Sabatier, Université de Toulouse, 118 route de Narbonne, 31062 Toulouse cedex, France
| | - Anna Gerdova
- Oxford Instruments Industrial Analysis, Tubney Woods, Abingdon, Oxfordshire OX13 5QX, United Kingdom
| | - Véronique Gilard
- Groupe de RMN Biomédicale, Laboratoire SPCMIB (UMR CNRS 5068), Université Paul Sabatier, Université de Toulouse, 118 route de Narbonne, 31062 Toulouse cedex, France
| | - Céline Caillet
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao PDR and Infectious Diseases Data Observatory, Centre for Tropical Medicine & Global Health, University of Oxford, UK
| | - David Williamson
- Oxford Instruments Industrial Analysis, Tubney Woods, Abingdon, Oxfordshire OX13 5QX, United Kingdom
| | - Myriam Malet-Martino
- Groupe de RMN Biomédicale, Laboratoire SPCMIB (UMR CNRS 5068), Université Paul Sabatier, Université de Toulouse, 118 route de Narbonne, 31062 Toulouse cedex, France.
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18
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Rebiere H, Guinot P, Chauvey D, Brenier C. Fighting falsified medicines: The analytical approach. J Pharm Biomed Anal 2017; 142:286-306. [PMID: 28531832 DOI: 10.1016/j.jpba.2017.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 01/27/2023]
Abstract
Given the harm to human health, the fight against falsified medicines has become a priority issue that involves numerous actors. Analytical laboratories contribute by performing analyses to chemically characterise falsified samples and assess their hazards for patients. A wide range of techniques can be used to obtain individual information on the organic and inorganic composition, the presence of an active substance or impurities, or the crystalline arrangement of the formulation's compound. After a presentation of these individual techniques, this review puts forward a methodology to combine them. In order to illustrate this approach, examples from the scientific literature (products used for erectile dysfunction treatment, weight loss and malaria) are placed in the centre of the proposed methodology. Combining analytical techniques allows the analyst to conclude on the falsification of a sample, on its compliance in terms of pharmaceutical quality and finally on the safety for patients.
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Affiliation(s)
- Hervé Rebiere
- French National Agency for Medicines and Health Products Safety, 635 Rue de la Garenne, 34740 Vendargues, France.
| | - Pauline Guinot
- French National Agency for Medicines and Health Products Safety, 635 Rue de la Garenne, 34740 Vendargues, France
| | - Denis Chauvey
- French National Agency for Medicines and Health Products Safety, 635 Rue de la Garenne, 34740 Vendargues, France
| | - Charlotte Brenier
- French National Agency for Medicines and Health Products Safety, 635 Rue de la Garenne, 34740 Vendargues, France
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Kim EH, Seo HS, Ki NY, Park NH, Lee W, Do JA, Park S, Baek SY, Moon B, Oh HB, Hong J. Reliable screening and confirmation of 156 multi-class illegal adulterants in dietary supplements based on extracted common ion chromatograms by ultra-high-performance liquid chromatography-quadrupole/time of flight-mass spectrometry. J Chromatogr A 2017; 1491:43-56. [DOI: 10.1016/j.chroma.2017.02.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 01/08/2023]
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20
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Chiang J, Yafi FA, Dorsey PJ, Hellstrom WJG. The dangers of sexual enhancement supplements and counterfeit drugs to "treat" erectile dysfunction. Transl Androl Urol 2017; 6:12-19. [PMID: 28217446 PMCID: PMC5313300 DOI: 10.21037/tau.2016.10.04] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Counterfeit phosphodiesterase-5 inhibitors (PDE-5i) are an increasing problem. Already in widespread use, the market for PDE-5i is steadily growing as the population ages. Counterfeiters are taking advantage of this growing market by developing illicit and counterfeit PDE-5i products. Many factors are contributing to the rapid growth of the illicit market, such as the low risk of prosecution, potentially high financial reward, and ease of distribution via Internet pharmacies. Consumers of illicit PDE-5i often do not realize they are using counterfeit products and placing themselves at an unnecessary health risk. Others seek to bypass the legitimate healthcare system due to either embarrassment of the underlying condition or desire for cheaper alternatives. However, taking illicit PDE-5i may harm consumers directly, as many illicit products contain detrimental contaminants and inaccurate amounts of the active ingredient without the appropriate warnings. Bypassing the legitimate healthcare system also endangers consumers indirectly, as erectile dysfunction (ED) is often associated with other medical comorbidities that patients should be screened for. Furthermore, PDE-5i can have potentially dangerous interactions with other pharmaceuticals that are rarely warned against with counterfeit PDE-5i. This communication reviews the literature regarding counterfeit PDE-5i, and summarizes both the scope and dangers of the illicit PDE-5i market.
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Affiliation(s)
- Jason Chiang
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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21
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Le B, McAchran S, Paolone D, Gralnek D, Williams D, Bushman W. Assessing the Variability in Insurance Coverage Transparency for Male Sexual Health Conditions in the United States. Urology 2016; 102:126-129. [PMID: 28024968 DOI: 10.1016/j.urology.2016.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/07/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the degree of transparency of health insurance policies regarding coverage of male sexual health conditions, we examined the publicly available policy coverage documents of the largest U.S. medical insurance plans. METHODS We selected 2 index patients across the male sexual health spectrum: (1) a phosphodiesterase type 5 refractory erectile dysfunction (ED) patient requiring intracavernosal injection therapy or penile prosthesis and (2) a 50-year-old male patient with laboratory-confirmed, symptomatic hypogonadism requiring testosterone replacement therapy as defined by endocrine society criteria. We researched the policy documents regarding coverage for standard therapies. We used breast reconstruction after mastectomy as a control. RESULTS We queried the publicly available policy statements for 84 of the largest health-care plans in the United States. Whereas breast reconstruction policies are publicly available for 94% of the plans examined, policies of only 39% of the plans for advanced ED treatment options and 62% for hypogonadism are publicly available. Of the plans that had publicly accessible data for ED coverage, 85% viewed penile prosthesis and intracavernosal injection as medically necessary, whereas 91% viewed androgen replacement as medically necessary for our index patient. CONCLUSION There is a lack of transparency among medical insurers regarding coverage of ED and hypogonadism in stark contrast to reconstructive breast surgery.
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Affiliation(s)
- Brian Le
- Department of Urology, University of Wisconsin-Madison, Madison, WI.
| | - Sarah McAchran
- Department of Urology, University of Wisconsin-Madison, Madison, WI
| | - David Paolone
- Department of Urology, University of Wisconsin-Madison, Madison, WI
| | - Dan Gralnek
- Department of Urology, University of Wisconsin-Madison, Madison, WI
| | - Daniel Williams
- Department of Urology, University of Wisconsin-Madison, Madison, WI
| | - Wade Bushman
- Department of Urology, University of Wisconsin-Madison, Madison, WI
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22
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Orsolini L, Francesconi G, Papanti D, Giorgetti A, Schifano F. Profiling online recreational/prescription drugs' customers and overview of drug vending virtual marketplaces. Hum Psychopharmacol 2015. [PMID: 26216567 DOI: 10.1002/hup.2466] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Internet and social networking sites play a significant role in the marketing and distribution of recreational/prescription drugs without restrictions. We aimed here at reviewing data relating to the profile of the online drug customer and at describing drug vending websites. METHODS The PubMed, Google Scholar, and Scopus databases were searched here in order to elicit data on the socio-demographic characteristics of the recreational marketplaces/online pharmacies' customers and the determinants relating to online drug purchasing activities. RESULTS Typical online recreational drugs' customers seem to be Caucasian, men, in their 20s, highly educated, and using the web to impact as minimally as possible on their existing work/professional status. Conversely, people without any health insurance seemed to look at the web as a source of more affordable prescription medicines. Drug vending websites are typically presented here with a "no prescription required" approach, together with aggressive marketing strategies. CONCLUSIONS The online availability of recreational/prescriptions drugs remains a public health concern. A more precise understanding of online vending sites' customers may well facilitate the drafting and implementation of proper prevention campaigns aimed at counteracting the increasing levels of online drug acquisition and hence intake activities.
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Affiliation(s)
- Laura Orsolini
- United Hospitals, Academic Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, England
| | - Giulia Francesconi
- United Hospitals, Academic Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Duccio Papanti
- United Hospitals, Academic Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.,Medical School of Trieste, Italy
| | - Arianna Giorgetti
- School of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Fabrizio Schifano
- FRCPsych, Chair in Clinical Pharmacology and Therapeutics, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, England
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Nayyar GML, Attaran A, Clark JP, Culzoni MJ, Fernandez FM, Herrington JE, Kendall M, Newton PN, Breman JG. Responding to the pandemic of falsified medicines. Am J Trop Med Hyg 2015; 92:113-118. [PMID: 25897060 PMCID: PMC4455086 DOI: 10.4269/ajtmh.14-0393] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 03/25/2015] [Indexed: 11/30/2022] Open
Abstract
Over the past decade, the number of countries reporting falsified (fake, spurious/falsely labeled/counterfeit) medicines and the types and quantities of fraudulent drugs being distributed have increased greatly. The obstacles in combatting falsified pharmaceuticals include 1) lack of consensus on definitions, 2) paucity of reliable and scalable technology to detect fakes before they reach patients, 3) poor global and national leadership and accountability systems for combating this scourge, and 4) deficient manufacturing and regulatory challenges, especially in China and India where fake products often originate. The major needs to improve the quality of the world's medicines fall into three main areas: 1) research to develop and compare accurate and affordable tools to identify high-quality drugs at all levels of distribution; 2) an international convention and national legislation to facilitate production and utilization of high-quality drugs and protect all countries from the criminal and the negligent who make, distribute, and sell life-threatening products; and 3) a highly qualified, well-supported international science and public health organization that will establish standards, drug-quality surveillance, and training programs like the U.S. Food and Drug Administration. Such leadership would give authoritative guidance for countries in cooperation with national medical regulatory agencies, pharmaceutical companies, and international agencies, all of which have an urgent interest and investment in ensuring that patients throughout the world have access to good quality medicines. The organization would also advocate strongly for including targets for achieving good quality medicines in the United Nations Millennium Development Goals and Sustainable Development Goals.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Joel G. Breman
- Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Carey Business School, Baltimore, Maryland; Population Health and Global Development Policy, University of Ottawa, Ottawa, Ontario, Canada; Pfizer Global Security, Pfizer Pharmaceuticals, New York, New York; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Gillings Global Gateway, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Law, University of Ottawa, Ottawa, Ontario Canada; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine, Churchill Hospital, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland
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Lee S, Choi B, Kim J, In S, Baeck S, Oh SM, Chung KH. An LC-MS/MS method for the determination of five erectile dysfunction drugs and their selected metabolites in hair. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 978-979:1-10. [PMID: 25531864 DOI: 10.1016/j.jchromb.2014.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/07/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Abstract
The abuse of sildenafil and its analogous, accelerated by their inappropriate or illegal distribution, is a serious social issue globally. However, no studies have been conducted to monitor these drugs simultaneously in hair, which can provide valuable information on chronic drug use. In the present study, an LC-MS/MS method was developed for the simultaneous determination in hair of five erectile dysfunction drugs having a high risk for abuse (mirodenafil, sildenafil, tadalafil, udenafil and vardenafil) and their selected metabolites (SK3541, desmethylsildenafil, DA8164 and desethylvardenafil). The novel method was fully validated after optimizing matrix effects and extraction efficiency. The optimized sample preparation included acidic methanol extraction followed by solid phase extraction using C18 mixed mode strong cation exchange polymeric cartridges. The prepared samples were analyzed by LC-MS/MS with electrospray ion source in the positive ionization mode. The validation results proved the method to be selective, sensitive, accurate and precise, with acceptable linearity within calibration ranges. LODs ranged from 0.05 (DA8164) to 1 ng/10 mg hair (tadalafil). LOQs were 1 ng/10 mg hair except for DA8164 and vardenafil, of which they were 2.5 ng/10 mg hair. No significant variations were observed by different sources of matrices in both human and rat hair, except for tadalafil, for which a stable isotope-labeled internal standard was effective. The animal study suggested hair pigmentation was a major factor for the incorporation of the drugs and metabolites into hair. However, a wide variation of the sildenafil-to-desmethylsildenafil ratios was observed in human hair samples. The developed method will be very useful for monitoring the abuse of erectile dysfunction drugs for both legal and public health aspects.
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Affiliation(s)
- Sooyeun Lee
- College of Pharmacy, Keimyung University, 1095 Dalgubeoldaero, Dalseo-gu, Daegu 704-701, Republic of Korea
| | - Boyeon Choi
- College of Pharmacy, Keimyung University, 1095 Dalgubeoldaero, Dalseo-gu, Daegu 704-701, Republic of Korea
| | - Jihyun Kim
- National Forensic Service, 10 Ipchoon-ro, Wonju, Kangwon-do 220-170, Republic of Korea
| | - Sanghwan In
- National Forensic Service, 10 Ipchoon-ro, Wonju, Kangwon-do 220-170, Republic of Korea
| | - Seungkyung Baeck
- National Forensic Service, 10 Ipchoon-ro, Wonju, Kangwon-do 220-170, Republic of Korea
| | - Seung Min Oh
- Hoseo Toxicology Research Center, Hoseo University, 20 Hoseo-ro, 79 beon-gil, Asan, Chungcheongnam-do 336-795, Republic of Korea
| | - Kyu Hyuck Chung
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 440-746, Republic of Korea.
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Bertero E, Montorsi F. Safety of Sildenafil Citrate: Review of 67 Double‐Blind Placebo‐Controlled Trials and the Postmarketing Safety Database. J Sex Med 2014; 11:885-887. [DOI: 10.1111/jsm.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Data on the utilization of treatment modalities for ED in Taiwan in the era of PDE5 inhibitors. Int J Impot Res 2014; 26:141-5. [DOI: 10.1038/ijir.2013.53] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 09/09/2013] [Accepted: 12/20/2013] [Indexed: 11/08/2022]
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27
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Mohee A, Bretsztajn L, Storey A, Eardley I. Management of ED under the "severe distress" criteria in the NHS: a real-life study. J Sex Med 2014; 11:1056-1062. [PMID: 24382018 DOI: 10.1111/jsm.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The United Kingdom is unusual in that a significant proportion of patients with erectile dysfunction (ED) have their treatment fully reimbursed by the National Health Service (NHS). This may have consequences for the choice of treatment and for compliance with treatment. AIMS The aim of this study was to evaluate the use and cost implications of phosphodiesterase type 5 inhibitor in an NHS setting. METHODS Basic demographics and data on ED management for patients treated from January 2000 to April 2011 were obtained from a prospectively accrued database. We reviewed drug usage and costs as well as switching between drugs. Patients were given the choice of all available therapies and were followed up annually. MAIN OUTCOME MEASURES Switching, compliance, and costs of treating ED under the "severe distress" criteria in the NHS were reviewed for this study. RESULTS Two thousand one hundred fifty-nine patients qualified for reimbursed therapy. Two hundred twenty-six patients were excluded from further analysis owing to missing data. Patients were followed up on an annual basis. The mean patient age was 60.2 years (min 23, max 90), and the mean follow-up was 50.8 months (min 1, max 127). Six hundred ninety-six were started on sildenafil, 990 on tadalafil, 163 on vardenafil, and 84 on intracavernosal alprostadil. Eighteen percent of patients initially started on the scheme and stopped medication unilaterally. Of the patients, 12.3% changed their medication during follow-up. The cost of drugs increased year by year from £257,100 in 2007 to £352,519 in 2011. CONCLUSIONS Our real-life observational study shows that in our institution, dropout of therapy is unusual. We hypothesize that this reflects, in part, the reimbursement issue. We also found that switching between drugs was unusual, although there are several possible explanations for that. Although this is a successful system for the patients, the hospital, which bears the costs of medication, is finding this an increasing economic drain.
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Affiliation(s)
- Amar Mohee
- Urology Department, Lincoln WingSt James University HospitalThe Leeds Teaching Hospitals NHS TrustLeedsUK.
| | | | - Anne Storey
- The Leeds Teaching Hospitals NHS TrustLeedsUK
| | - Ian Eardley
- The Leeds Teaching Hospitals NHS TrustLeedsUK
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Mackey TK, Liang BA. Improving global health governance to combat counterfeit medicines: a proposal for a UNODC-WHO-Interpol trilateral mechanism. BMC Med 2013; 11:233. [PMID: 24228892 PMCID: PMC4225602 DOI: 10.1186/1741-7015-11-233] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Perhaps no greater challenge exists for public health, patient safety, and shared global health security, than fake/falsified/fraudulent, poor quality unregulated drugs, also commonly known as "counterfeit medicines", now endemic in the global drug supply chain. Counterfeit medicines are prevalent everywhere, from traditional healthcare settings to unregulated sectors, including the Internet. These dangerous medicines are expanding in both therapeutic and geographic scope, threatening patient lives, leading to antimicrobial resistance, and profiting criminal actors. DISCUSSION Despite clear global public health threats, surveillance for counterfeit medicines remains extremely limited, with available data pointing to an increasing global criminal trade that has yet to be addressed appropriately. Efforts by a variety of public and private sector entities, national governments, and international organizations have made inroads in combating this illicit trade, but are stymied by ineffectual governance and divergent interests. Specifically, recent efforts by the World Health Organization, the primary international public health agency, have failed to adequately incorporate the broad array of stakeholders necessary to combat the problem. This has left the task of combating counterfeit medicines to other organizations such as UN Office of Drugs and Crime and Interpol in order to fill this policy gap. SUMMARY To address the current failure of the international community to mobilize against the worldwide counterfeit medicines threat, we recommend the establishment of an enhanced global health governance trilateral mechanism between WHO, UNODC, and Interpol to leverage the respective strengths and resources of these organizations. This would allow these critical organizations, already engaged in the fight against counterfeit medicines, to focus on and coordinate their respective domains of transnational crime prevention, public health, and law enforcement field operations. Specifically, by forming a global partnership that focuses on combating the transnational criminal and patient safety elements of this pre-eminent global health problem, there can be progress against counterfeit drugs and their purveyors.
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Affiliation(s)
- Tim K Mackey
- Department of Anesthesiology, University of California, San Diego School of Medicine, 200 W, Arbor Drive, San Diego, CA 92103-8770, USA.
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Argiolas A, Melis MR. Neuropeptides and central control of sexual behaviour from the past to the present: a review. Prog Neurobiol 2013; 108:80-107. [PMID: 23851261 DOI: 10.1016/j.pneurobio.2013.06.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 06/28/2013] [Accepted: 06/29/2013] [Indexed: 12/23/2022]
Abstract
Of the numerous neuropeptides identified in the central nervous system, only a few are involved in the control of sexual behaviour. Among these, the most studied are oxytocin, adrenocorticotropin, α-melanocyte stimulating hormone and opioid peptides. While opioid peptides inhibit sexual performance, the others facilitate sexual behaviour in most of the species studied so far (rats, mice, monkeys and humans). However, evidence for a sexual role of gonadotropin-releasing hormone, corticotropin releasing factor, neuropeptide Y, galanin and galanin-like peptide, cholecystokinin, substance P, vasoactive intestinal peptide, vasopressin, angiotensin II, hypocretins/orexins and VGF-derived peptides are also available. Corticotropin releasing factor, neuropeptide Y, cholecystokinin, vasopressin and angiotensin II inhibit, while substance P, vasoactive intestinal peptide, hypocretins/orexins and some VGF-derived peptide facilitate sexual behaviour. Neuropeptides influence sexual behaviour by acting mainly in the hypothalamic nuclei (i.e., lateral hypothalamus, paraventricular nucleus, ventromedial nucleus, arcuate nucleus), in the medial preoptic area and in the spinal cord. However, it is often unclear whether neuropeptides influence the anticipatory phase (sexual arousal and/or motivation) or the consummatory phase (performance) of sexual behaviour, except in a few cases (e.g., opioid peptides and oxytocin). Unfortunately, scarce information has been added in the last 15 years on the neural mechanisms by which neuropeptides influence sexual behaviour, most studied neuropeptides apart. This may be due to a decreased interest of researchers on neuropeptides and sexual behaviour or on sexual behaviour in general. Such a decrease may be related to the discovery of orally effective, locally acting type V phosphodiesterase inhibitors for the therapy of erectile dysfunction.
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Affiliation(s)
- Antonio Argiolas
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy.
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Martin Morales A, Hatzichristou D, Ramon Lladós J, Pascual Renedo V, Pimenidou A. Community pharmacy detection of erectile dysfunction in men with risk factors or who seek treatment or advice but lack a valid prescription. J Sex Med 2013; 10:2303-11. [PMID: 23845082 DOI: 10.1111/jsm.12238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pharmacists may be the first health care contact consulted about erectile dysfunction (ED). AIM To assess pharmacists' ability to detect ED and encourage patients to seek medical evaluation. METHODS This observational study conducted in Greece and Spain included men without a valid prescription for an ED medication but with a history indicating ED risk and/or who consulted a pharmacist about ED. Pharmacists completed a questionnaire about the patient. Patients completed the Sexual Health Inventory for Men (SHIM); men with a score ≤21 (cutoff for ED) were educated (by case pharmacists) and referred and encouraged to see a physician (by case and control pharmacists). MAIN OUTCOME MEASURES Proportion of men with a SHIM score ≤21 and, of those, the proportion who visited a physician and credited the pharmacist for their visit. ANCOVA and chi-square test were used for continuous and categorical data, respectively. RESULTS Among the 451 men (mean ± SD age, 54.9 ± 12.9 years) questioned about ED, 90% had a risk factor (usually hypertension, hypercholesterolemia, or diabetes), 28% had a previous diagnosis, 36% sought internet information, 38% self-medicated, 10% took medication obtained outside the pharmacy setting, and the first health care professional approached was a pharmacist (50%), physician (18%), or nurse (1%) at a median of 6 (range, 0-360) months after symptom onset. The SHIM score was ≤21 in 348 (77%) men. A lower score (indicating increased ED severity) was associated with increased age and with benign prostate hyperplasia, depression, diabetes, or prostate cancer. In the minority of men contacted for follow-up, less than one-third had visited their physician, despite pharmacist encouragement. CONCLUSIONS Pharmacists are often the first health care contact regarding ED and are highly accurate in its detection. Further research is needed to optimize the pharmacist's role in early detection, education, and motivating patients to be evaluated by a physician.
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Martin AL, Huelin R, Wilson D, Foster TS, Mould JF. A Systematic Review Assessing the Economic Impact of Sildenafil Citrate (Viagra®) in the Treatment of Erectile Dysfunction. J Sex Med 2013; 10:1389-400. [DOI: 10.1111/jsm.12068] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jannini EA, Limoncin E, Ciocca G, Buehler S, Krychman M. Ethical Aspects of Sexual Medicine. Internet, Vibrators, and Other Sex Aids: Toys or Therapeutic Instruments? J Sex Med 2012. [DOI: 10.1111/jsm.12018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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