In the words of The Weeknd, here we go…again. There is yet another recall of blood pressure medications due to unacceptable levels of a substance that may cause cancer. This time it’s Pfizer that’s doing the voluntary recalling. This recall includes six lots of Accuretic tablets, which Pfizer directly distributes. It also includes medications distributed by Greenstone: four lots of tablets combining quinapril hydrochloride (HCl) with hydrochlorothiazide and one lot of tablets combining quinapril with hydrochlorothiazide. And this time the carcinogenic culprit of concern is a nitrosamine impurity called N-nitroso-quinapril.
As I wrote before for Forbes in October 2021, in recent years, “blood-pressure-medication-recalls-for-possible-cancer-causing-impurity” announcements have become seemingly more common than sequels of the Halloween movie franchise. And like the Halloween sequels the storylines for each recall have all been quite similar and not good. After all, when you order some blood pressure medications, you probably don’t say, “hey could you sprinkle some more of that potentially cancer-causing stuff on those tablets?” The specific impurities and the specific manufacturers may have differed from recall to recall. But in each case such impurities have been present in quantities that may be exceeding Acceptable Daily Intake (ADI) levels.
Of course, taking one tablet with a little too much N-nitroso-quinapril won’t change your life forever like taking the blue pill in The Matrix movie. If you’ve been trying to go completely nitrosamine-free, you’ve probably already failed, assuming that you aren’t a cinder block and do in fact regularly drink water and eat food. Nitrosamines are typically found in many things that you may regularly put into your mouth such as cured and grilled meats, dairy products, and vegetables. So nitrosamine impurities are more like reality TV shows such as “Married at First Sight.” While some limited exposure to such things may be OK, be careful about too much accumulated exposure over time. Cancer concerns may eventually arise if over a long period of time you regularly consume nitrosamine in quantities that exceed the ADI levels.
The U.S. Food and Drug Administration (FDA) also posted a copy of the Pfizer recall announcement. They also tweeted the following:
Distribution of all of these lots occurred from November 2019 through March 2022. So if you’ve purchased some blood pressure medications over the past few years, you’ve got lots to check. These recalled lots encompass the following products:
- Accuretic tablets that combine 10 mg of quinapril HCl with 12.5 mg of hydrochlorothiazide,
- Accuretic tablets that combine 20 mg of quinapril HCl with 12.5 mg of hydrochlorothiazide,
- Accuretic tablets that combine 20 mg of quinapril HCl with 25 mg of hydrochlorothiazide.
- Tablets that combine 20 mg of quinapril with 25 mg of hydrochlorothiazide tablets, distributed by Greenstone
- Tablets that combine 20 mg of quinapril HCl with 12.5 mg of hydrochlorothiazide, distributed by Greenstone
- Tablets that combine 20 mg of quinapril HCl with 25 mg of hydrochlorothiazide, distributed by Greenstone
Again, the recall involves only specific lots of these blood pressure medications that have been distributed by Pfizer or Greenstone in the U.S. and Puerto Rico. So just because you are taking medications that include quinapril, quinapril hydrochloride, or hydrochlorothiazide, doesn’t mean that you are affected.
Quinapril hydrochloride is essentially quinapril but just a little salty, so to speak. It’s the hydrochloride salt form of quinapril. Both are ACE inhibitors. In this case, ACE is not the place with the helpful hardware but stands for angiotensin-converting enzyme. This enzyme is normally present in the walls of your blood vessels and helps produce a substance called angiotensin II. This substance makes your blood vessel walls tighten like a pair of Spanx so that your blood vessels get more narrow. This in turn can raise your blood pressure. Thus, inhibiting ACE, as quinapril can do, will reduce the amount of angiotensin II, allowing your blood vessels to relax more.
Here’s a video with very soothing piano music in the background from the British Heart Foundation describing how ACE inhibitors work:
Hydrochlorothiazide is another common blood pressure medication. It is a diuretic, which is medical-speak for something that makes you pee more. Of course, you probably don’t usually say, “my day would be so much better if I could just pee more.” Peeing more can have a medical purpose, helping reduce the amount of fluid in your blood vessels, which, as a result, can lower your blood pressure.
If you do find that you are taking blood pressure medications affected by this recall, don’t just stop taking your medications cold turkey. Blood pressure medications aren’t like underwear. You should just choose to not use them one day. Instead, talk to your doctor first to discuss possible alternatives to your current medications.
With all of these blood pressure medication recalls in recent years, you’ve gotta wonder whether enough safety monitoring and quality control measures and regulatory oversight are in place for pharmaceutical manufacturers. Over the past several decades, many pharmaceutical companies have expanded their supply chains globally, trying to find lower cost ways of manufacturing medications. Manufacturing medications, though, is not the same as making other products such as underwear. You can often readily tell when a pair of underwear has a defect, such as three leg holes instead of two. Plus, such underwear defects probably won’t have significant health consequences, unless someone knees you in the groin when they see your underwear has an extra hole. By contrast, you are probably relying on pharmaceutical companies and regulators to ensure that medications are indeed safe to take. After all, in the words of The Weeknd, “in your eyes” the medications may still appear to be OK even when they have unacceptable levels of impurities.