Since 2018, N-nitrosamine impurities have become a widespread
concern
in the global regulatory landscape of pharmaceutical products. This
concern arises due to their potential for contamination, toxicity,
carcinogenicity, and mutagenicity and their presence in many active
pharmaceutical ingredients, drug products, and other matrices. N-Nitrosamine
impurities in humans can lead to severe chemical toxicity effects.
These include carcinogenic effects, metabolic disruptions, reproductive
harm, liver diseases, obesity, DNA damage, cell death, chromosomal
alterations, birth defects, and pregnancy loss. They are particularly
known to cause cancer (tumors) in various organs and tissues such
as the liver, lungs, nasal cavity, esophagus, pancreas, stomach, urinary
bladder, colon, kidneys, and central nervous system. Additionally,
N-nitrosamine impurities may contribute to the development of Alzheimer’s
and Parkinson’s diseases and type-2 diabetes. Therefore, it
is very important to control or avoid them by enhancing effective
analytical methodologies using cutting-edge analytical techniques
such as LC-MS, GC-MS, CE-MS, SFC, etc. Moreover, these analytical
methods need to be sensitive and selective with suitable precision
and accuracy, so that the actual amounts of N-nitrosamine impurities
can be detected and quantified appropriately in drugs. Regulatory
agencies such as the US FDA, EMA, ICH, WHO, etc. need to focus more
on the hazards of N-nitrosamine impurities by providing guidance and
regular updates to drug manufacturers and applicants. Similarly, drug
manufacturers should be more vigilant to avoid nitrosating agents
and secondary amines during the manufacturing processes. Numerous
review articles have been published recently by various researchers,
focusing on N-nitrosamine impurities found in previously notified
products, including sartans, metformin, and ranitidine. These impurities
have also been detected in a wide range of other products. Consequently,
this review aims to concentrate on products recently reported to contain
N-nitrosamine impurities. These products include rifampicin, champix,
famotidine, nizatidine, atorvastatin, bumetanide, itraconazole, diovan,
enalapril, propranolol, lisinopril, duloxetine, rivaroxaban, pioglitazones,
glifizones, cilostazol, and sunitinib.