Cholestatic Jaundice With the Use of Methylstenbolone and Dymethazine, Designer Steroids Found in Super DMZ Rx 2.0 “Nutritional Supplement”

Agbenyefia, Priscilla; Arnold, Christina A.; Kirkpatrick, Robert M.

doi:10.1177/2324709614532800

Cited by 7 publications

(8 citation statements)

References 6 publications

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“…Due to the lack of clinical studies, little is known about the pharmacological effects of these designer steroids. Use of other banned anabolic‐androgenic steroids are known to cause long‐term health effects . Regulatory agencies are increasingly tasked with detecting and identifying these designer steroids in products.…”

Section: Introductionmentioning

confidence: 99%

Identification of the designer steroid Androsta‐3,5‐diene‐7,17‐dione in a dietary supplement

Lorenz

Toomey

Lanzarotta

et al. 2019

Drug Testing and Analysis

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A liquid chromatography‐mass spectrometry (LC–MS) screen for known anabolic‐androgenic steroids in a dietary supplement product marketed for “performance enhancement” detected an unknown compound having steroid‐like spectral characteristics. The compound was isolated using high performance liquid chromatography with ultraviolet detection (HPLC–UV) coupled with an analytical scale fraction collector. After the compound was isolated, it was then characterized using gas chromatography with simultaneous Fourier Transform infrared detection and mass spectrometry (GC–FT–IR–MS), liquid chromatography–high resolution accurate mass–mass spectrometry (LC–HRAM–MS) and nuclear magnetic resonance (NMR). The steroid had an accurate mass of m/z 285.1847 (error−0.57 ppm) for the protonated species [M + H]+, corresponding to a molecular formula of C19H24O2. Based on the GC–FT–IR–MS data, NMR data, and accurate mass, the compound was identified as androsta‐3,5‐diene‐7,17‐dione. Although this is not the first reported identification of this designer steroid in a dietary supplement, the data provided adds information for identification of this compound not previously reported. This compound was subsequently detected in another dietary supplement product, which contained three additional active ingredients.

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Section: Introductionmentioning

confidence: 99%

Identification of the designer steroid Androsta‐3,5‐diene‐7,17‐dione in a dietary supplement

Lorenz

Toomey

Lanzarotta

et al. 2019

Drug Testing and Analysis

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“…Owing to the structural relationship between DMZ and methasterone and the reported toxic effects on liver and kidney after administration of methasterone (Jasiurkowski et al , ; Nasr and Ahmad, ; Singh et al , ), the use of human excretion studies is ethically limited. Moreover, a case of liver injury was linked to combined administration of DMZ and methylstenbolone (Agbenyefia et al , ). Therefore, the aim of this study was to elucidate the metabolism of DMZ with human liver microsomes (HLM) and a uPA +/+ ‐SCID chimeric mouse model to target the best DMZ metabolites for doping control purposes.…”

Section: Introductionmentioning

confidence: 99%

In vitro and in vivo metabolism studies of dimethazine

Geldof

Tudela

Lootens

et al. 2016

Biomedical Chromatography

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The use of anabolic steroids is prohibited in sports. Effective control is done by monitoring their metabolites in urine samples collected from athletes. Ethical objections however restrict the use of designer steroids in human administration studies. To overcome these problems alternative in vitro and in vivo models were developed to identify metabolites and to assure a fast response by anti-doping laboratories to evolutions on the steroid market. In this study human liver microsomes and an uPA(+/+) -SCID chimeric mouse model were used to elucidate the metabolism of a steroid product called 'Xtreme DMZ'. This product contains the designer steroid dimethazine (DMZ), which consists of two methasterone molecules linked by an azine group. In the performed stability study, degradation from dimethazine to methasterone was observed. By a combination of LC-High Resolution Mass Spectrometry (HRMS) and GC-MS(/MS) analysis methasterone and six other dimethazine metabolites (M1-M6), which are all methasterone metabolites, could be detected besides the parent compound in both models. The phase II metabolism of dimethazine was also investigated in the mouse urine samples. Only metabolites M1 and M2 were exclusively detected in the glucuro-conjugated fraction; all other compounds were also found in the free fraction. For effective control of DMZ misuse in doping control samples, screening for methasterone and methasterone metabolites should be sufficient. Copyright © 2016 John Wiley& Sons, Ltd.

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“…Cholestatic jaundice has been commonly reported with anabolic steroids with bilirubin levels around 50 mg/dl in some cases . Anabolic steroid‐related hyperbilirubinemia can be prolonged, and may take weeks to months to resolve (up to 4 months has been reported) after discontinuation . Acute hepatitis has also been reported in one series of 20 bodybuilders taking various dietary supplements, with an ALT/ALP ratio suggesting hepatocellular injury.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of N‐Acetylcysteine to Treat Severe Hepatic Injury Caused by a Dietary Fitness Supplement

et al. 2015

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In the absence of adequate premarketing efficacy and safety evaluations, adverse events from over-the-counter supplements are emerging as a public health concern. Specifically, bodybuilding products are being identified as a frequent cause of drug-induced liver injury. We present a case of a 20-year-old Hispanic male who presented with acute nausea and vomiting accompanied by severe right upper quadrant abdominal pain, shivering, and shortness of breath. Laboratory data pointed to mixed cholestatic and hepatocellular damage, and after exclusion of known alternate etiologies, the patient was diagnosed with acute drug-induced liver injury secondary to the use of "Friction," a bodybuilding supplement. Treatment with N-acetylcysteine (NAC) 20% oral solution was initiated empirically at a dose of 4000 mg [DOSAGE ERROR CORRECTED] (70 mg/kg) every 4 hours and was continued once the diagnosis was made. Within 48 hours of admission to our hospital, the patient began to show clinical resolution of right abdominal pain and tolerance to oral diet associated with a significant decline toward normal in his liver function tests and coagulopathy. The WHO-UMC causality assessment system suggested a "certain causality" between exposure to the supplement and the acute liver injury. In the event of suspected drug-induced liver injury, treatment with NAC should be considered given its favorable risk-benefit profile.

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Cholestatic Jaundice With the Use of Methylstenbolone and Dymethazine, Designer Steroids Found in Super DMZ Rx 2.0 “Nutritional Supplement”

Cited by 7 publications

References 6 publications

Identification of the designer steroid Androsta‐3,5‐diene‐7,17‐dione in a dietary supplement

Identification of the designer steroid Androsta‐3,5‐diene‐7,17‐dione in a dietary supplement

In vitro and in vivo metabolism studies of dimethazine

Successful Use of N‐Acetylcysteine to Treat Severe Hepatic Injury Caused by a Dietary Fitness Supplement

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