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PubMed1991

Recurrent rhabdomyolysis in association with cocaine use.

As the popularity of cocaine increases in our society, so does the frequency and variety of medical complications associated with its use. A growing number of cases have implicated cocaine use in the development of rhabdomyolysis and its complication, acute renal failure. We have reported the first case of recurrent rhabdomyolysis and acute renal failure directly associated with cocaine use. Although adulterants might cause muscle damage, we believe cocaine should be added to the list of drugs that are capable of producing rhabdomyolysis.

Acute Kidney Injury↗
PubMed2000

Phenytoin poisoning after using Chinese proprietary medicines.

We report a case of poisoning resulting from the use of Chinese proprietary medicines (CPM) containing anticonvulsants phenytoin, carbamazepine and valproate. The manufacturer's information leaflets did not mention any of these prescription drugs. As a consequence, the patient was admitted comatose due to severe phenytoin poisoning. We are not aware of any reported case of severe poisoning due to CPM adulterated with anticonvulsants and this is possibly the first case.

Adult↗
PubMed1995

An investigation into the extent of possible dilution of specimens received for urinary drugs of abuse screening.

Recent American and Swedish studies have shown an increase in "false" negative results when analysing dilute urine specimens for drugs of abuse. In the light of these studies, it was decided to perform a pilot study to determine the extent of possible specimen adulteration and dilution in a random batch of 50 urine specimens presented to this laboratory, using creatinine, osmolality, pH and relative density. It was found that 20% of the specimens were outside the pH range associated with the optimum working of Syva EMIT Drugs of Abuse in Urine (DAU) immunoassay screening techniques, and that if the National Institute on Drug Abuse (NIDA) recognized dilution cut-off of 1.8 mmol/L for urine creatinine concentration is applied, 84% of the specimens surveyed here would need to be repeated to ensure accurate results. Because of these findings, it is recommended that routine creatinine and pH estimations should be performed on all specimens submitted for urinary drugs of abuse screening, or at least when unexpectedly negative results are obtained.

Creatinine↗
PubMed2002

GC/MS determination of pyrolysis products from diacetylmorphine and adulterants of street heroin samples.

The inhalation of heroin vapors after heating on aluminium foil ("chasing the dragon") is gaining popularity nowadays among heroin users seeking to avoid the risks of parenteral drug administration. The heroin-smoking procedure was simulated under laboratory conditions by heating the samples on aluminium foil at 250 to 400 degrees C and collecting the vapors in a condenser trap. A total of 72 pyrolysis products of diacetylmorphine, street heroin, residues from aluminium foils used to smoke street heroin, typical by-products, and adulterants were detected by gas chromatography/mass spectrometry (GC/MS). About half of these compounds could be identified. Diacetylmorphine (base and salt) undergoes substantial to complete degradation. Some typical street heroin constituents, like morphine, codeine, acetylcodeine, papaverine, and caffeine, are rather heat-stable. Other compounds, like noscapine and paracetamol, are pyrolyzed to a greater extent. The principal chemical reactions leading to the formation of pyrolysis products are desacetylation, transacetylation, N-demethylation, O-methylation, ring cleavage and oxydation.

Drug Contamination↗
PubMed1997

[A preliminary study on the identification of crude snake drugs by molecular genetic markers].

DNA was amplified from 11 samples of crude snake drugs by 2 random primers. "Wushaoshe" (Zaocys dhumnades) and its substitutes, Elaphe taeniurus, E. rufodorsata, E. carinata and Sinonatrix annularis, and "Jinqian Baihyashe" (Bungarus multicinctus) and its adulterants, Dinodon rufozonatum and Sinonatrix annularis, can be distinguished by electrophoresis pattern of the amplified products. The results showed that the molecular genetic marker technique can be used as a new method for the identification of crude snake drugs.

Animals↗
PubMed1997

Herbal products in Canada. How safe are they?

OBJECTIVE: To examine existing evidence and inform family physicians about issues concerning herbal product use in Canada. QUALITY OF EVIDENCE: The Canadian Food and Drug Act and findings of an Expert Advisory Committee on Herbs and Botanical Preparations were consulted to provide an overview of the issues regarding herbal product regulation in Canada. Case reports of herbal toxicity were identified to illustrate some of the hazards of herbal products, and references provided to guide health professional in searching the literature for clinical trials that evaluate these drugs' efficacy. MAIN FINDINGS: Herbal products not registered as drugs in Canada are sold as foods and are exempt from the drug review process that evaluates product efficacy and safety. This places the public at risk of unwanted effects from the use of herbal products that are adulterated with other substances and of forgoing effective conventional therapy. Moreover, consumers are exposed to a plethora of information portraying herbal products as harmless. Some progress has been made to address these concerns by facilitating the registration of herbal products as drugs. CONCLUSIONS: Most herbal products that were evaluated were unsafe or ineffective, or no information was available to evaluate their efficacy. Despite the perception that herbal products are innocuous, family physicians need to be aware that herbal therapy can be harmful in order to help their patients make informed choices.

Canada↗
PubMed1988

Specific effect of putative 5-HT1A agonists, 8-OH-DPAT and gepirone, to increase hypertonic saline consumption in the rat: evidence against a general hyperdipsic action.

Previous reports indicate that 5-HT1A agonists, in addition to benzodiazepines, increase the consumption of hypertonic saline in rehydrating rats. Experiment 1 investigated the effects of 8-OH-DPAT (10-100 micrograms/kg) and gepirone (0.1-3.0 mg/kg) on consumption of water and of saline over a range of concentrations (0.45%-2.8%) in a 30 min drinking test. The two 5-HT1A agonists dose-dependently increased ingestion of two hypertonic salt solutions, but produced little or no increase in the drinking of water, hypotonic or isotonic saline. Experiment 2 demonstrated that 8-OH-DPAT and gepirone did not enhance water consumption in animals given a water preload, or markedly increase drinking quinine-adulterated water. Taken together, the results indicate a selective dose-related effect of the two drugs to increase hypertonic saline drinking; they did not have a general hyperdipsic effect across all salt and water conditions, and they did not increase intake simply because of a low baseline level of consumption. Hence, 5-HT1A agonist act much more selectively than benzodiazepines in their effects on drinking responses.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed1998

Heroin associated nephropathy--a post-mortem study.

Renal specimens were obtained from 179 autopsies of persons autopsied in the Institute of Forensic Medicine, University of Bonn, from 1987 to 1997. All persons were known as intravenous drug addicts. All renal specimens were examined with hematoxylin-eosin, PAS, Siriusred and Gomori (methenamine silver trichrome stain) and investigated with primary antibody against LCA (leucocyte common antigen), CD 68, IgG and IgM. 105 specimens (61.7%) showed a mono-lymphocytic membranoproliferative glomerulonephritis (MPGN), 48 specimens (45.7%) deposits of IgM. No case with focal segmental glomerulosclerosis (FSGS) as reported in male African-American intravenous drug addicts was found. In 37 out of 54 cases, hepatitis antibodies were detected in serum and three out of these 54 cases were HIV-positive. Chronic hepatitis B and C are known to be associated with glomerulonephritis. We found some cases without detection of hepatitis antibodies but with severe glomerulonephritis. In contrast to African-American drug addicts, European drug addicts do not develop a FSGS but a MPGN, partly due to heroin or other adulterants and apparently independent from hepatitis infection.

Adolescent↗
PubMedDate not supplied

Liquid chromatographic monitoring of the depletion of carbadox and its metabolite desoxycarbadox in swine tissues.

A liquid chromatographic method was used to monitor a depletion study of carbadox (and its most important metabolite, desoxycarbadox) in young pigs fed carbadox-treated rations for 1 week. Carbadox was found in blood (20 ppb), blood serum (26 ppb), and muscle tissue 24 h after withdrawal from treated ration; residues were reduced to a trace (less than 2 ppb) in 48 h, and eliminated by 72 h. Desoxycarbadox, although not detected in blood, was found in muscle (17 ppb) 24 h after withdrawal; it was reduced to 9 ppb at 48 h and to a trace by 72 h. Although no carbadox was detected in liver 24 h after withdrawal, appreciable desoxycarbadox (125 ppb) was found in liver 24 h after withdrawal; it was reduced to 17 ppb at 48 h and to a trace by 72 h. Whereas only a trace of carbadox was found in kidney 24 h after withdrawal, 186 ppb desoxycarbadox was found in kidney at 24 h, 34 ppb at 48 h, and a trace at 72 h. No metabolite of carbadox other than desoxycarbadox was found in extracts of swine tissues during this medicated feed trial, and no metabolite was found in blood extracts by using the established methodology. The effect of tissue storage (aging) at -20 degrees C on levels of the drug and its metabolite was a modest alteration of residue levels. The inadvertent use of feed adulterated with furazolidone and initially medicated with chlortetracycline, sulfamethazine, and penicillin G, did not affect the uptake of carbadox in this depletion study or interfere with the analytical methodology.

Animal Feed↗
PubMed1989

An evaluation of the results of a drug sample analysis.

An analysis of drug samples received by the National Toxicology Institute at Madrid during the period from September 1985 to May 1987 was undertaken with a view to carrying out an epidemiological assessment of drug abuse. Of 414 street drug samples, 63.5 per cent contained heroin, 12.5 per cent cocaine, 8.5 per cent amphetamine and 15.4 per cent other substances. The concentration of heroin ranged from 21 to 60 per cent in most of the samples (91.8 per cent) that contained it. Similar concentrations of cocaine were found in the samples containing that substance. Adulterants were detected in 78.8 per cent of the samples containing heroin, 59.6 per cent of the samples containing cocaine and 56 per cent of the samples containing amphetamine. The most common adulterants in the samples containing heroin were caffeine (68.4 per cent), phenobarbital (19.7 per cent), methaqualone (13.4 per cent) and procaine (13.4 per cent), while lidocaine was the most common adulterant (52 per cent) in the samples containing cocaine.

Amphetamines↗
PubMed2002

Skin eruption following the use of two Chinese herbal preparations: a case report.

OBJECTIVE: To describe a patient who developed a widespread skin eruption following the use of two Chinese herbal medications, Fang Feng Tong Sheng Wan and Bi Yan Pian. CASE SUMMARY: A 34-year-old man developed widespread erythematous papules that coalesced into plaques after five days of therapy with two Chinese herbal preparations. There was no lymphadenopathy or hepatosplenomegaly, and the patient denied any fever, chills or malaise. The skin biopsy was compatible with a drug eruption. When the patient's oral medications, including the herbal medications, were discontinued, the skin eruption resolved over the next few weeks. All of the regular long term medications were restarted without any sequalae. DISCUSSION: This case, once again, emphasizes that, although herbal medications are marketed as natural products, these products can be associated with adverse drug effects. Other adverse effects that have been implicated with the use of Chinese herbal medications include interstitial fibrosis, renal failure, liver toxicity and severe dermatitis. In addition, there are several cases of adulteration of Chinese herbal products with synthetic medications. CONCLUSION: Although rare, Chinese herbal medications can be associated with serious adverse effects. Clinicians should question patients about the use of herbal products whenever an adverse drug effect is suspected.

Adult↗