LAUSR

OBJECTIVES The objectives of this article are to review the implications of N-nitrosodimethylamine (NDMA) contamination in medications and the risk of exposure, and summarize the key points for patient education. SUMMARY NDMA is a semivolatile organic chemical classified as a probable carcinogen by the International Agency for Research on Cancer. NDMA exposure to humans is potentially vast, with reports of it occurring in tobacco products, food, water, interior air of cars, toiletries, and a variety of other household goods. Public attention has recently focused on NDMA contamination because it has been implicated in the recall of several medications, including valsartan, losartan, irbesartan, and, most recently, the removal of ranitidine from the market. Its potential for elevated risk of cancer has sparked concern in the health care community. CONCLUSION Pharmacists are uniquely situated to process and use this complex information because of their extensive pharmacokinetic and pharmacodynamic knowledge of medications, direct and regular contact with patients, insights and familiarity with recalls, and ability to discuss alternative medications that may alleviate a patient's concerns. It is important to communicate the context and clinical relevance of NDMA contamination to both patients and fellow health care clinicians. Pharmacists can help balance the potential adverse effects of switching medication and the concern related to NDMA in making an informed health decision.