A counterfeit multivitamin product inducing severe bleeding disorders in humans.

Context: During a period of 6 months, 36 people reported to health authorities in the Department of Antioquia, Colombia, presenting episodes of bleeding in varying magnitude and locations in the body and alterations in coagulation tests, after having taken a falsified dietary supplement. The identification of the first four cases were to the cell-phone line at the Drug and Poison Research Information Center (CIEMTO). The successive presentation of cases with similar manifestations, taking the same product, served to suspect a possible common link.Case details: All of the patients needed hospitalization, the administration of blood products and / or vitamin K to reverse the clinical manifestations, and to stop the oral consumption of the falsified supplement. For each patient there was a full recovery of coagulation and improvement of haemorrhagic manifestations after the first week of management. The Food and Drug administration of Colombia (INVIMA), withdrew the product from the market, alerted the medical community and the general public and conducted an investigation that finally showed warfarin as a the main contaminant in the dietary supplement.Conclusion: This cases series emphasize the importance of the Poison Control Center to detect promptly potential new exposure of hazards to hundreds of products to the population, some of them fraudulent.

Bioequivalencia de dos formulaciones de Metformina, tabletas de 850 mg, en voluntarios sanos colombianos / Bioequivalence of two metformin formulations: 850 mg tablets in healthy colombian volunteers

Introducción: la metformina es un antihiperglicemiante útil en el manejo de la diabetes mellitus tipo II, del que se encuentran en el mercado colombiano tanto el producto innovador como diferentes formulaciones genéricas. Para garantizar la seguridad y eficacia de estas últimas, es necesario demostrar su bioequivalencia con respecto al producto innovador.Objetivo: determinar si el producto Dimefor®/Metformina MK es bioequivalente con el producto Glucophage? (referencia) cuando se administran en dosis iguales a un grupo de voluntarios sanos.Método: el estudio se realizó sobre veinticuatro voluntarios que cumplieron con los requisitos de inclusión y decidieron participar espontáneamente después de ser informados sobre su función en el estudio. Se utilizó un diseño aleatorio cruzado, en dos períodos, dos secuencias y doble ciego. Se administró una dosis única de 850 mg de cada producto y se tomaron muestras de sangre por un período de 24 horas. La cuantificación de la metformina se realizó por HPLC (High Performance Liquid Chromatography). Para la determinación estadística de bioequivalencia se utilizó la prueba de Schuirmann.Resultados: los dos productos fueron bioequivalentes con intervalos de confianza contenidos entre 80.0 por ciento y 125.0 por ciento para ln ABC0-8 (84.6 por ciento-100.0 por ciento), ln Cmax (89.1 por ciento-109.0 por ciento) e ln ABC0-Tmax (83.4 por ciento-101.4 por ciento) y entre 80.0 por ciento y 120.0 por ciento para Tmax (85.1 por ciento y 109.8 por ciento).

INTRODUCTION: Metformin is an orally active antidiabetic agent used to treat type II diabetes; it is found in the Colombian market in both the innovator brand and the generic formulations. The latter have to prove some biopharmaceutical quality outcomes to guarantee interchangeable proprieties. OBJECTIVE: To determine whether the drug Dimefor®/Metformina MK is bioequivalent to the reference product Glucophage®, when the products are administrated, at the same dose, to a group of healthy volunteers. METHOD: The study was made with 24 healthy volunteers who met the inclusion criteria and spontaneously decided to participate after being thoroughly informed. We used a two-sequence threeperiod randomized, crossed and double-blind study. The volunteers took an 850 mg dose of each medicine; then, blood samples were taken throughout 24 hours and the metformin quantification in plasma was determined by High Performance Liquid Chromatography with UV detection (HPLC/UV). For statistical analysis, Schuirmann's test was used. RESULTS: The study showed that both preparations are bioequivalent; confidence intervals for ln AUC0-∞, ln Cmax, ln AUC0-Tmax and Tmax were [84.6-100.0%], [89.1-109.0%], [83.4­01.4%] and [85.1-109.8% ], respectively.