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Golla VM, Kalyan M, Gholap U, Padhy HP, Ramachandran RK, Samanthula G. Discerning the stability behaviour of mavacamten availing liquid chromatography-mass spectrometry and nuclear magnetic resonance spectroscopy: In silico toxicity and mutagenicity prediction of degradation products. J Mass Spectrom 2024; 59:e5007. [PMID: 38445805 DOI: 10.1002/jms.5007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 03/07/2024]
Abstract
The present study aimed to separate, identify, and characterise the degradation products formed when mavacamten is exposed to stress degradation as well as the stability of the drug in various environments and also to understand its degradation chemistry. Prediction of in silico toxicity and mutagenicity was aimed at the observed degradation products. Stress degradation along with stability studies and degradation kinetics were performed on mavacamten, and separation of degradation products was carried out by high-performance liquid chromatography. Tandem mass spectrometry studies were executed to characterise the structures of degradation products using product ion fragments. Orthogonally, nuclear magnetic resonance experiments were conducted to elucidate the structures having ambiguity in characterising them. Deductive Estimation of Risk from Existing Knowledge and Structure Activity Relationship Analysis using Hypotheses software were used to establish in silico toxicity and mutagenic profiles of mavacamten and its degradation products. Two degradation products of mavacamten found in acidic hydrolytic stress conditions were separated, identified, characterised, and proposed as 1-isopropylpyrimidine-2,4,6(1H,3H,5H)-trione and 1-phenylethanamine. Mavacamten was found to be stable under different pH and gastrointestinal conditions. The degradation kinetics of mavacamten under 1 N acidic condition followed zero-order kinetics, and it was degraded completely within 6 h. In silico toxicity and mutagenicity studies revealed that 1-phenylethanamine can be a skin sensitiser. A high-performance liquid chromatography method was developed for the separation of degradation products of mavacamten and characterised by liquid chromatography-tandem mass spectrometry and nuclear magnetic resonance. During the manufacturing and storage of drug product, precautions need to be taken when dealing with acidic solutions as the drug is prone to hydrolysis in acidic conditions. The formation of 1-phenylethanamine under these conditions is to be monitored as it is a skin sensitiser.
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Affiliation(s)
- Vijaya Madhyanapu Golla
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research, Hyderabad, India
| | - Mallika Kalyan
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research, Hyderabad, India
| | - Upasana Gholap
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research, Hyderabad, India
| | - Hara Prasad Padhy
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research, Hyderabad, India
| | - Roshitha K Ramachandran
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research, Hyderabad, India
| | - Gananadhamu Samanthula
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research, Hyderabad, India
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Annema PA, Derijks HJ, Bouvy ML, van Marum RJ. Impact of Drug Recalls on Patients in The Netherlands: A 5-Year Retrospective Data Analysis. Clin Pharmacol Ther 2024. [PMID: 38390768 DOI: 10.1002/cpt.3220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
Drug recalls occur frequently and have the potential to impact considerable numbers of patients and healthcare providers. However, in the absence of a comprehensive overview the extent of conducted recalls and their impact on patients remains unknown. To address this, we developed a comprehensive overview of drug recalls affecting patients. We compiled this overview based on the drug recall registrations from the Jeroen Bosch Hospital (JBZ), the University Medical Center Utrecht (UMCU), and the Royal Dutch Pharmacists Association (KNMP). A retrospective data analysis was conducted to identify drug recalls that affected patients. Specifically, we defined these as drug recalls that required patients to actively switch their drug to a different batch or brand of the same drug or to switch to a drug within the same or a different class of drugs. To quantify the impact, we used real-world drug dispensing data. Between January 1, 2017, and December 31, 2021, we identified 48 drug recalls that necessitated patients to make active changes to their medications an estimated 855,000 times. Most of the affected patients (292,000) were required to switch to a different brand of the same drug, whereas in 95,000 cases patients had to switch to a drug from another drug class. Our study suggests that a significant number of patients are affected by drug recalls. Future efforts are needed to elucidate patients' experiences and preferences regarding drug recalls, which could provide valuable insights to aid decision-making by relevant (national) authorities concerning drug recalls.
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Affiliation(s)
- Pieter A Annema
- Department of Pharmacy and Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Amsterdam University Medical Center location Vrije Universiteit Amsterdam, Elderly Care Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Hieronymus J Derijks
- Department of Pharmacy and Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Rob J van Marum
- Department of Pharmacy and Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Amsterdam University Medical Center location Vrije Universiteit Amsterdam, Elderly Care Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
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Pozsgai K, Szűcs G, Kőnig-Péter A, Balázs O, Vajda P, Botz L, Vida RG. Analysis of pharmacovigilance databases for spontaneous reports of adverse drug reactions related to substandard and falsified medical products: A descriptive study. Front Pharmacol 2022; 13:964399. [PMID: 36147337 PMCID: PMC9485933 DOI: 10.3389/fphar.2022.964399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: The public health threat of substandard and falsified medicines has been well known in the last two decades, and several studies focusing on the identification of products affected and preventing consumption have been published. However, the number of these products reaching patients and causing health consequences and adverse drug reactions is not a well-researched area.Objectives: Our aim was to identify and describe the characteristics of cases that are related to adverse drug reactions potentially originating from counterfeit medication using publicly available pharmacovigilance data.Methods: A descriptive study was performed based on pharmacovigilance data retrieved from Individual Case Safety Reports (ICSRs) identified in the European Medicines Agency’s EudraVigilance and FDA Adverse Event Reporting System (FAERS) databases in April 2022 using selected MedDRA preferred terms: counterfeit product administered, product counterfeit, product label counterfeit, product packaging counterfeit, suspected counterfeit product, adulterated product, product tampering, and suspected product tampering. ICSRs were analyzed by age and gender, by year of reporting, region of origin, reporter’s profession, and severity of the outcome. The disproportionality method was used to calculate pharmacovigilance signal measures.Results: A total of 5,253 cases in the FAERS and 1,049 cases in the EudraVigilance database were identified, generally affecting middle-aged men with a mean age of 51.055 (±19.62) in the FAERS and 64.18% of the cases between 18 and 65 years, while the male to female ratios were 1.18 and 1.5. In the FAERS database, we identified 138 signals with 95% confidence interval including sildenafil (n = 314; PRR, 12.99; ROR, 13.04; RRR, 11.97), tadalafil (n = 200; PRR, 11.51; ROR, 11.55; RRR, 10.94), and oxycodone (n = 190; PRR, 2.47; ROR, 2.14; RRR, 2.47). While in the EV data 31, led by vardenafil (n = 16, PRR = 167.19; 101.71–274.84; 95% CI, RRR = 164.66; 100.17–270.66; 95% CI, ROR = 169.47; 103.09–278.60; 95% CI, p < 0.001), entecavir (n = 46, PRR = 161.26, RRR = 154.24, ROR = 163.32, p < 0.001), and tenofovir (n = 20, PRR = 142.10, RRR = 139.42, ROR = 143.74, p < 0.001).Conclusion: The application of pharmacovigilance datasets to identify potential counterfeit medicine ADRs can be a valuable tool in recognition of potential risk groups of consumers and the affected active pharmaceutical ingredients and products. However, the further development and standardization of ADR reporting, pharmacovigilance database analysis, and prospective and real-time collection of potential patients with health consequences are warranted in the future.
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Affiliation(s)
- Kevin Pozsgai
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Gergő Szűcs
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Anikó Kőnig-Péter
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Orsolya Balázs
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Péter Vajda
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Lajos Botz
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Róbert György Vida
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
- *Correspondence: Róbert György Vida,
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Shergill RS, Farlow A, Perez F, Patel BA. 3D-printed electrochemical pestle and mortar for identification of falsified pharmaceutical tablets. Mikrochim Acta 2022; 189:100. [DOI: 10.1007/s00604-022-05202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/25/2022] [Indexed: 12/21/2022]
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Ahmed J, Modica de Mohac L, Mackey TK, Raimi-Abraham BT. A critical review on the availability of substandard and falsified medicines online: Incidence, challenges and perspectives. The Journal of Medicine Access 2022; 6:23992026221074548. [PMID: 36204527 PMCID: PMC9413502 DOI: 10.1177/23992026221074548] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Simultaneous expansion of the Internet and increased globalisation of the
pharmaceutical industry have meant medication can be accessed transnationally
from both legal and illicit sources. This has coincided with the rise of
substandard and falsified medicines (SFMs) online. These products fail to meet
regulatory or quality standards and/or are constituted with substandard
ingredients, causing undesired pharmacological effects, including possible
injury and death. This review aimed to identify original research studies that
examined characteristics of SFM online sales, attitudes towards purchasing
medicines online and strategies to address this drug safety challenge. Keywords
of ‘Substandard’ and ‘Falsified’/‘Counterfeit’ and ‘Medicines’/‘Drugs’ and
‘Online’/‘Internet’ were searched using Web of Knowledge and PubMed databases.
Resulting literature, which satisfied the study’s inclusion criteria, was
included in the review, and the findings from each paper were assessed. From an
initial 185 literature articles, 7 were eligible according to the inclusion
criteria to be reviewed. These articles identified studies testing SFMs
purchased online, surveys of attitudes and knowledge about SFMs online, and
website content analysis to detect illegal online sales. Challenges identified
were lack of knowledge and awareness among consumers and physicians, in addition
to the use of direct-to-consumer-advertising, via Internet platforms and social
media, providing easy access to SFMs. Despite this, medicine authentication
technology, website verification approaches and new detection methods were
identified as potential solutions specific to online SFM sales. To address
online sales of SFMs, more robust research, greater awareness/educational
programmes, analytical detection methods and more stringent online global
governance are required.
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Affiliation(s)
- Jamee Ahmed
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Science, King’s College London, London, UK
| | - Laura Modica de Mohac
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Science, King’s College London, London, UK
| | - Tim K Mackey
- Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
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Abstract
There has been a recent surge in the amount of substandard and falsified clopidogrel. Pharmacopeial based assays using high performance liquid chromatography and mass spectroscopy are widely used for the measurement of clopidogrel but are not accessible in low to middle income countries. Therefore, our study explored four different techniques (mid-infrared spectroscopy, thin layer chromatography, ultraviolet visible spectroscopy, and differential pulse voltammetry), which could be used in low to middle income countries. Differential pulse voltammetry showed the best performance for accurate and precise determination of clopidogrel in the presence of excipients. Clopidogrel tablets were fully crushed and sonicated in buffer for 30 seconds prior to differential pulse voltammetry measurements using a 3 mm glassy carbon electrode. Measurements were made without removing the excipients and the limit of detection was 0.08 mg ml-1 and the sensitivity was 15.7 μA mg ml-1. When conducting a blinded study, differential pulse voltammetry was able to identify varying types of substandard and falsified samples. Our findings highlight that voltammetry could be a vital analytical technique for the determination of substandard and falsified medicines in low- and middle-income countries.
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Affiliation(s)
| | - Petra Kristova
- School of Applied Sciences, University of Brighton, Brighton, East Sussex, UK.
| | - Bhavik Anil Patel
- School of Applied Sciences, University of Brighton, Brighton, East Sussex, UK.
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