Illicit distribution of various illicit or counterfeit drugs containing sildenafil and tadalafil has increased and caused noticeable problems in Korea. This study has been performed to determine the content range of sildenafil and tadalafil in various fake drugs. Among the illicit or counterfeit drugs seized by Korean authorities, 105 exhibits were used for the quantification. HPLC-UV analysis of methanol extractions was used for separation and quantitation of the two target compounds. The most abundant type of fake drug was counterfeit Viagra(®) tablets. Sildenafil was found in 73 exhibits, and tadalafil was found in seven exhibits. Twenty-five exhibits out of the 105 contained both sildenafil and tadalafil. The contents of sildenafil ranged from 4.3 to 453.2 mg; for tadalafil, the range was 2.2-40.4 mg. The proportion of cases of having more than 100 mg of sildenafil was 50% and 78% had more than 20 mg of tadalafil.

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BACKGROUND AND OBJECTIVEIntoxications related to ”mad honey” are frequently encountered in the Black Sea region of Turkey. Intoxication is established on the basis of whether honey was consumed when history was taken at presentation. The search for a simple and reliable method for showing the grayanotoxins (GTXs) in mad honey in body fluids and in honey consumed by patients is still at the research stage. The purpose of this preliminary study was to investigate GTX levels in blood, urine, and honey consumed by patients with mad honey intoxication and to determine whether there is an association with clinical status.DESIGN AND SETTINGSThis descrptive study was conducted at the department of Emergency Medicine of Karadeniz Technical University Medical Faculty in Turkey. Mad honey, blood, and urine samples were obtained from patients between September 2013 and October 2014.METHODSFour cases presenting the Department of Emergency Medicine and diagnosed with mad honey intoxication were included in the study. GTX levels in blood, urine, and honey consumed by patients were determined using liquid chromatography–tandem mass spectrometry.RESULTSPatients’ mean blood GTX I level was 30.62 ng/mL, GTX III level 4.917 ng/mL, urine GTX I level 0.447 mg/mL, and GTX III level 1.998 mg/mL. The mean GTX I level in the honey samples consumed was 4.683 mg/g and GTX III level 8.423 mg/g.CONCLUSIONThe present study is unique in representing the first time that GTXs have been determined in human body fluids. There is now an urgent need for a large series of studies to provide statistical evidence whether there is a relationship between levels of toxins in human body fluids and clinical picture.

ObjectivesThe purpose of this study was to investigate whether there is an association between grayanotoxin levels in urine and blood of patients with mad honey intoxication and in the honey consumed, and the resulting clinical picture. The pilot data acquired from this study was analysed in National Forensic Service, Daejeon Institute, South Korea and first results were published as a preliminary study.Patients and methodsThis descriptive study was conducted at a university hospital emergency department in Turkey. 25 cases diagnosed with mad honey intoxication were obtained the study. Samples of mad honey consumed by patients were obtained. Blood and urine specimens were collected at presentation to the emergency department. GTX 1 and GTX 3 levels from patients' blood, urine and honey consumed were investigated simultaneously using the LC-MS/MS system.ResultsMean GTX 1 concentration in blood was 4.82 ng/mL and mean GTX 3 level 6.56 ng/mL. Mean GTX concentration in urine was 0.036 μg/mL and mean GTX 3 level 0.391 μg/mL. Mean GTX I concentration in honeys consumed was 8.73 μg/gr and mean GTX 3 level 27.60 μg/gr.ConclusionThis descriptive study is show grayanotoxin levels in body fluids of patients with mad honey intoxication. No association was determined between grayanotoxin levels in blood and clinical data.