18 September 2018

Study finds supplements contain huge higenamine doses

Study published in Clinical Toxicology has found that 24 sports supplements that list higenamine on the label contain doses ranging from a trace amount to 62mg per serving. It found that when following recommended serving sizes on supplement labels, consumers could be exposed to 110mg of higenamine a day, which may present a health risk.

As of June 2018, the National Institute of Health’s Dietary Supplement Label Database lists over 30 brands of supplements labelled as containing higenamine. The Study (PDF below) found that although five of the 24 supplements attempted to list the concentration of higenamine in their product, none were accurately labelled. ‘The quantity in these supplements ranged from <0.01% to 200% of the quantity listed on the label’, it found.

The Study mentions that the US Food and Drug Administration (FDA), which has not approved higenamine as a drug, has received reports of adverse effects from higenamine-containing supplements since 2014. It states that a Chinese Study involving administering gradual 2.5mg or 5mg infusions of higenamine increased the heart rate of subjects. ‘Subjects who received higenamine in these trials reported dyspnea, palpitations, dizziness, headaches, chest tightness as well as other adverse effects’, it reads.

The Study also references a case report involving a 22 year old athlete who ingested a supplement containing higenamine and completed an intensive exercise regime, after which he developed rhabdomyolysis, a condition in which damaged skeletal muscle breaks down rapidly. However the Study doesn’t draw any conclusions from that, as the other ingredients in the supplement were not analysed and other factors could have led to the decision.

Higenamine is a stimulant and beta-2 agonist prohibited by the World Anti-Doping Agency (WADA). The Study mentions that it was added to the Prohibited List in 2017. That is correct, but it was prohibited before then due to the ‘catch-all’ statement under section S3 of previous versions of the List, which reads: ‘All beta-2 agonists, including all optical isomers, e.g. d- and l- where relevant, are prohibited’. 

It was specifically named on the 2017 List after UEFA was forced to drop all charges against Mamadou Sakho following a positive test for higenamine in 2016. Sakho was able to cast significant doubt on whether higenamine is a Beta-2 agonist at all, and therefore was not covered by the ‘catch-all’ statement referred to above.

‘Although the safety of oral doses of higenamine as high as 62mg remains unknown, higenamine-containing supplements can pose immediate risks to competitive athletes’ careers’, the Study concludes. The Study mentions that dietary supplements lead to an estimated 23,000 emergency department visits in the US alone, and recent studies have found that such supplements can contain experimental stimulants; pharmaceutical stimulants; anabolic steroids; and selective androgen receptor modulators (SARMS).

Although the Study only analyses supplements that list higenamine on their list of ingredients, a warning put out by UK Anti-Doping (UKAD) in August last year listed seven other names by which higenamine can be known. Higenamine was responsible for 55 adverse analytical findings in 2016, before it was specifically named on WADA’s Prohibited List. By 2017, this number had risen to 58. Analysis of The Sports Integrity Initiative’s archives reveals that it is an increasingly common substance involved in AAFs.

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