Multiple incidence of the prescription diuretic hydrochlorothiazide in compounded nutritional supplements. Issue 3 (18th October 2018)

• Record Type: Journal Article
• Authors: Favretto, Donata; Visentin, Sindi; Scrivano, Salvatore; Roselli, Emanuele; Mattiazzi, Fabio; Pertile, Roberto; Vogliardi, Susanna; Tucci, Marianna; Montisci, Massimo
• Is Part Of: Drug testing and analysis. Volume 11:Issue 3(2019)
• Page Start: 512
• Page End: 522
• Publication Date: 2018-10-18
• Subjects: adverse analytical finding -- contamination -- doping -- hydrochlorothiazide -- nutritional supplements; Drugs -- Analysis -- Periodicals; Drug testing -- Periodicals; Chemistry, Forensic -- Periodicals; 615.1901
• DOI: 10.1002/dta.2499
• Languages: English
• ISSNs: 1942-7603

Abstract

Abstract: Diuretic agents are prohibited in sports in‐ and out‐of‐competition according to the regulations of the World Anti‐Doping Agency (WADA) because of their possible masking effects on other doping agents in urine samples, and their ability to produce fast acute weight losses. Despite previous studies reported adverse analytical findings (AAFs) resulting from contaminations at ppm level (μg/g) of medicinal products, and recommended to introduce reporting limits for diuretics in doping controls, these are not adopted in analyses performed by WADA‐accredited laboratories. We report the case of an athlete with two AAFs for hydrochlorothiazide (HCTZ) at low urinary concentrations (<10 ng/mL), who declared the use of nutritional supplements prepared in a compounding pharmacy. His nutritional supplements were analyzed revealing HCTZ presence in different concentrations, at the ppm level (μg/g and ng/mL). With the aim of testing the plausibility of the observed urinary HCTZ concentrations with the nutritional supplement ingestion, a urinary excretion study with three healthy volunteers was performed. HCTZ‐contaminated powder (6.4 μg/g of HCTZ) was administered to each subject in different dosages, reproducing the possible ingestion pattern occurred. Urine specimens were collected before and after ingestion of the powder, up to 24 hours, and underwent liquid–liquid extraction and liquid chromatography–tandem mass spectrometry determination. Post‐administration specimens were found to contain HCTZ at concentrations of 5–230 ng/mL, which supported the accidental inadvertent intake of the prohibited substance by the athlete. This study makes the argument that the introduction of reporting limits for diuretics are warranted in doping control samples, in order to protect against inadvertent AAFs due to contaminated products. Abstract : The study confirms the necessity of introducing reporting limits for diuretics in doping controls, in order to avoid adverse analytical findings due to contaminated medicinal drugs or nutritional supplements. However, the actual minimum required performance limit (MRLP) for diuretics, proposed as the reporting limit to be introduced in all World Anti‐Doping Agency (WADA) accredited laboratories, may be exceeded by use of contaminated supplements at ppm levels.