Review Article Volume 13 Issue 12 - 2025

Impact of the Nitrosamine Triangle in the Pharmaceutical Ingredients. A Review

Juan Carlos Ortiz Lara*

Sintenovo S.A de C.V., México

*Corresponding Author: Juan Carlos Ortiz Lara, Sintenovo S.A. de C.V., Plant Director, Jiutepec, Morelos, Mexico.
Received: October 23, 2025; Published: December 30, 2025



Recently, several pharmaceutical ingredients have been found to contain nitrosamines as impurities, either in the final product or in the active pharmaceutical ingredient (API) itself. Nitrosamines are highly toxic compounds and can produce cancer, as a result, the contaminated active substances were recalled. This situation poses a significant problem, primarily for patients, as it disrupts the supply chain.

A secondary issue is the need to manufacture more nitrosamine-free pharmaceutical ingredients. In this context, it is essential to understand the factors that can lead to the formation of nitrosamines through amine oxidation. These factors include pH, the presence of amines, and nitrosating agents collectively referred to as the "nitrosating triangle". To prevent nitrosamine formation, at least one of these variables must be eliminated during the manufacturing process.

This document presents a perspective on nitrosamine formation in sartans, the degradation of amines, fundamental aspects of analytical development, and general measures to prevent nitrosamine formation in APIs.

 Keywords: Pharmaceutical Ingredient; Impurities; Nitrosamines; Nitrosamine Triangle; Analysis; Control

  1. The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use. ICH Harmonised Tripartite Guideline Good manufacturing practice guide for active pharmaceutical ingredients Q7 [Internet]. Switzerland: The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use (2006).
  2. NOM 164. Cofepris. Official Mexican Standard NOM-164-SSA1-2015, Good Drug Manufacturing Practices [Internet]. Mexico: Cofepris (2016).
  3. The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use. ICH Harmonised Tripartite Guideline. Impurities in new Drug products Q3B(R2) [Internet]. Switzerland: The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use (2006).
  4. NOM 59. Cofepris. Official Mexican Standard NOM-059-SSA1-2015, Good Manufacturing Practices for Medicines [Internet]. Mexico: Cofepris (2016).
  5. The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use. ICH Harmonised Tripartite Guideline. Impurities in new drug substances Q3A(R2). [Internet]. Switzerland: The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use (2006).
  6. The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use. ICH Harmonised Guideline. Impurities: Guideline for residual solvents Q3C(R8). [Internet]. Switzerland: The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use (2016).
  7. The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use. ICH Harmonised Guideline. Impurities: Guideline for elemental impurities Q3D(R1). [Internet]. Switzerland: The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use (2019).
  8. The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use. ICH Harmonised Guideline. Assessment and control of DNA reactive (mutagenic) Impurities in pharmaceuticals to limit the potential carcinogenic risk. M7(R2) (2023).
  9. Muller L., et al. “A rational for determining, testing, and controlling specific impurities in pharmaceuticals that possess potential genotoxicity”. Regulatory Toxicology and Pharmacology 3 (2006): 198-211.
  10. National Toxicology Program. 14th report on carcinogens (RoC). 14th Edition (2015).
  11. Nitrosoamines información.
  12. Food Drug Administration. FDA announces voluntary recall of several medicines containing valsartan following detection of an impurity (2018).
  13. Tatarkiewicz J and Bujalska-Zadrozny M. “The antihypertensive drugs and contamination with carcinogenic nitrosamines”. Folia Cardiologica 6 (2019): 564-571.
  14. Baumann M., et al. “An overview of the key routes to the bestselling 5-membered ring heterocyclic pharmaceuticals”. Beilstein Journal of Organic Chemistry 7 (2011): 442-495.
  15. Vangala VB., et al. “A review on synthesis of antihypertensive Sartan drugs”. International Journal of Physiology, Pathophysiology and Pharmacology 11 (2014): 46-56.
  16. Scherf-Clavel O., et al. “The contamination of valsartan and other sartans. Part 2: Untargeted screening reveals contamination with amides additionally to known nitrosamines impurities”. Journal of Pharmaceutical and Biomedical Analysis 172 (2019): 278-284.
  17. Taniguchi J., et al. “Nitrosoamines in pharmaceuticals: toxicity, risk, analysis, chemistry and test methods”. American Pharmaceutical Review (2020).
  18. Food Drug Administration. Statement from Janet Woodcock, M. D., Director of FDA´s center for drug evaluation and research, on impurities found in diabetes drugs outside the U.S. [Internet].
  19. Food Drug Administration. Statement from Janet Woodcock, M.D., director of FDA’s Center for Drug Evaluation and Research, on impurities found in diabetes drugs outside the U.S.
  20. Food Drug Administration. Zantac (ranitidine); safety information -NDMA found in samples of some ranitidine medicines.
  21. Food Drug Administration. FDA request removal of all ranitine products (Zantac) from the market.
  22. Food Drug Administration. FDA Updates and Press Announcements on NDMA in Zantac (ranitidine).
  23. Food Drug Administration. Laboratory test ranitidine.
  24. Zeng T and Mitch WA. “Oral intake of ranitidine increases urinary excretion of N-nitrosodimethilamine”. Carcinogenesis 6 (2016): 625-634.
  25. Taylor G. “Pharmacy Learning network. Duloxetine capsules recalled over nitrosamine impurity”.
  26. Holzgrabe U. “Nitrosated active pharmaceutical ingredients-lessons learned?” Journal of Pharmaceutical Sciences 5 (2023): 1210-1215.
  27. Olender D., et al. “Multidirectional efficacy of biologically active nitro compounds included in medicines”. Pharmaceuticals2 (2018): 54.
  28. Schmiddtsdorff S., et al. “Risk assessment for nitrosated pharmaceuticals: A future perspective in drug development”. Archiv der Pharmazie 4 (2022): e2100435.
  29. Schlingemann J., et al. “The landscape of potential small drug substance related nitrosamine pharmaceuticals”. Journal of Pharmaceutical Sciences 5 (2023): 1287-1304.
  30. European Medicines Agency. Lesson learnt from presence of N-nitrosamine impurities in sartan medicines.
  31. Usman R., et al. “Hyphenated techniques of drug analysis”. Scholars Academic Journal of Pharmacy 6 (2017): 263-272.
  32. Sorgel F., et al. “The contamination of Valsartan and other Sartans, Part 1: New findings”. Journal of Pharmaceutical and Biomedical Analysis 172 (2019): 395-405.
  33. Lim HH., et al. “Determination of Nitrosodimethylamine and N-notrosomethylamine in drug substances and products of sartans, metformine and ranitidine by precipitation and solid phase extraction and gas chromatography-tandem mass spectrometry”. Journal of Pharmaceutical and Biomedical Analysis 189 (2020): 113460.
  34. Parr MK and Joseph JF. “NDMA impurity in Valsartan and other pharmaceutical products: analytical methods for the determination of Nitrosamines”. Journal of Pharmaceutical and Biomedical Analysis 164 (2019): 536-549.
  35. Vikram HPR., et al. “Nitrosamine crisis in pharmaceuticals-Insights on toxicological implication, root causes and risk assessment: A systematic review”. Journal of Pharmaceutical Analysis 5 (2024): 100919.
  36. Food Drug Administration. Control off nitrosamine impurities in human drugs. Guidance for the industry (2024).
  37. Shakleya D., et al. “Bumetanide as a model NDSRI Substrate: -N-Nitrosobumetanide impurity formation and its inhibition in bumetanide tablets”. Journal of Pharmaceutical Sciences 12 (2023): 3075-3087.
  38. Crossed reference. Shakleya, D.
  39. Ortiz Lara JC. “Pharmaceutical Salts as a purification tool in pharmaceutical ingredients”. Revista Colombiana de Ciencias Químico - Farmacéuticas 1 (2024): 184-218.
  40. Beard JC and Swager TM. “An organic chemist´s guide to N-nitrosamines: their structure, reactivity, and role as contaminants”. Journal of Organic Chemistry 3 (2021): 2037-2057.
  41. Bayne AC., et al. “N-nitrosamine mitigation with nitrite scavengers in oral pharmaceutical drug products”. Journal of Pharmaceutical Sciences7 (2023): 1794-1800.
  42. The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use. ICH Harmonised Guideline. Quality risk management Q9. The international Council for Harmonisation of Technical requirements for Pharmaceutical for Human use (2016).
  43. Rother M and Shook J. “Learning to see. Value stream mapping to create value and eliminate muda”. Lean Enterprise institute Inc. United States (2009).
  44. Shigeo S. “Zero quality control: source inspection and the pokayoke system”. Productivity press (1986).

Juan Carlos Ortiz Lara. “Impact of the Nitrosamine Triangle in the Pharmaceutical Ingredients. A Review”. EC Pharmacology and Toxicology  13.12 (2025): 01-18.