NDMA structure

Last year (August 2018) I wrote how there was adulteration of valsartan, a drug for hypertension in the ARB (angiotensin receptor blocker) class. This resulted from a Chinese manufacturer allowing the feed-stock chemical valsartan to be adulterated during manufacture with a toxic chemical N-Nitrosodimethylamine, usually known as NDMA. This potential carcinogen has gained notoriety in recent years by showing up as a groundwater contaminant from fracking. You probably have read of it. Tiny amounts are not an issue, but continued use certainly is.

Plot thickens and expands

Since last year, there has been a continuing series of announcements about other hypertensive drugs adulterated with NDMA, all in the ARB or ACE (angiotension converting enzyme inhibitor) classes. Patients regularly get notices that their prescriptions are contaminated. Fortunately, at any given time only some drugs in either class, and really some production batches of those drugs, are contaminated. While there is no imminent danger from this contamination, certainly one should change promptly to drugs that are free of NDMA.

What to do?

Your pharmacy is your first recourse. They know what drug batch you received and whether it was contaminated. In addition, they know (and are already likely trying) to obtain the same medication from a clean source to minimize the disruptions to their customers (you). In the event there is no identical drug (e.g, valsartan) available to them, they will know what comparable drugs they can get in the ARB or ACE class that are uncontaminated. You yourself should find out from the pharmacy and they (or you) then let us know what is available and we will choose an appropriate substitute for you.

If you get that information promptly from your pharmacy, we can act quickly and mitigate this unfortunate and recurring problem. To date we have had no instance where an appropriate substitute antihypertensive medication in those classes (ARB or ACE) was not available.

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