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The US Food and Drug Administration published guidance about the control of nitrosamine impurities in medicines. [32] [33] Health Canada published guidance about nitrosamine impurities in medications [34] and a list of established acceptable intake limits of nitrosamine impurities in medications. [35]
Since then, FDA has determined that other types of nitrosamine compounds, e.g., N-Nitrosodiethylamine (NDEA), are present at unacceptable levels in APIs from multiple API producers of valsartan and other drugs in the ARB class." [72] In 2018, the FDA issued guidance to the industry on how to assess and control the impurities. [73]
In cigarette smoke, NNN has been found in levels between 2.2 and 6.6 parts per million (ppm). The FDA has put limits of nitrosamines in other consumable products (such as cured meats) at levels below 10 parts per billion (ppb). [14]
Generally, people should not be exposed to a lifetime risk of cancer exceeding 1 in 100,000 from nitrosamines in their medicines. [12] EU regulators first became aware of nitrosamines in medicines in mid-2018, and took regulatory actions, including recalling medicines and stopping the use of active substances from certain manufacturers. [12]
In August 2020, the U.S. Food and Drug Administration (FDA) became aware of nitrosamine impurities in certain samples of rifapentine. [11] The FDA and manufacturers are investigating the origin of these impurities in rifapentine, and the agency is developing testing methods for regulators and industry to detect the 1-cyclopentyl-4 ...
The effects of nitroso compounds vary dramatically across the gastrointestinal tract, and with diet. Nitroso compounds present in stool do not induce nitrosamine formation, because stool has neutral pH. [7] [8] Stomach acid catalyzes nitrosamine compound formation and is the main location of the reaction during digestion. [9]
In August 2020, the European Medicines Agency (EMA) provided guidance to marketing authorization holders on how to avoid the presence of nitrosamine impurities in human medicines and asked them to review all chemical and biological human medicines for the possible presence of nitrosamines and to test the products at risk. [62]
Among the tobacco-specific nitrosamines, nicotine-derived nitrosamine ketone (NNK) and N-nitrosonornicotine (NNN) are the most carcinogenic. [1] Others include N ′-nitrosoanatabine (NAT) and N-nitrosoanabasine (NAB). NNK and its metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) are potent systemic lung carcinogens in rats ...