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The overall mean estimate for counterfeit anabolic steroids found on the black market was 36% (95% CI = 29, 43). An additional 37% (95% CI = 17, 63) were of substandard quality.

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These items are not included in this pill identifier. We recommend contacting your doctor, pharmacist, or another healthcare professional for assistance with identifying an unknown medication. Supraphysiologic doses of anabolic androgenic steroids (AAS) are widely used to improve body image and sport performance goals. These substances can easily be acquired over the internet, leading to a substantial black market. We reviewed literature that assessed the quality and quantity of AAS found on the black market. We also demonstrate that these drugs could contain no active ingredient, or in another amount than that labeled, a wrong active ingredient, as well as not all or more active ingredients than were labeled. High heterogeneity among all analyses and significant differences between geographical subgroups were found. With this systematic review and meta-analysis, we demonstrate that substantial mean proportions of black-market AAS are counterfeit and of substandard quality. These products pose a considerable individual and public health threat, and the very wide range in proportions of fake black-market AAS puts the user in a situation of unpredictable uncertainty. There is a great need for future prevention and harm-reduction programs to protect users from these substances. The online version contains supplementary material available at 10.1186/s12889-022-13734-4. Create an account to use our new Smart Search tool Images Images homepage Photos Vectors Illustrations 360° panoramic images Image categories Contributor spotlight Videos Videos homepage Video collections Creative Creative homepage Fresh picks Editorial Editorial homepage News Live News Sports Entertainment Archive Archive homepage Biographies Obituaries World events Discoveries & launches Blog Blog homepage News Features Spotlights Inspiration Education Galleries Enterprise Enterprise homepage Education Gaming Museums Trade books Travel TV & film Alamy API AI Training Book a demo About us Sell Make money with Alamy Contributor help page Sign up as a contributor Our Licenses Image licenses Video licenses Lightboxes Cart Sign in Hi there! Lightboxes Share Alamy images with your team and customers Create a lightbox › All images All images Photographs Vectors Illustrations 360° images Video Live news Search by image Search for images Search for stock images, vectors and videos Search by image Search with an image file or link to find similar images All images Creative images Editorial images Smartphone images Videos All images Ultimate Vital Uncut Foundation All images Archive (greater than 20 years old) Filters Relevant Relevant Most recently uploaded Newest date taken Oldest date taken Blue tablets Stock Photos and Images Filter by agency collections No agencies were found for this search Filter Cancel Search builder Build your search with words and phrases. Use any combination to refine your search. Exact phrase At least one of these words Without these words Refine Cancel Download Confirmation Download Cancel Password Confirmation Please enter your password * Forgotten your password? Methylene blue (ProvayBlue) is a medication doctors use to treat a rare blood condition called methemoglobinemia. But as a medical treatment, it’s dissolved in water to make a blue liquid solution you get as an injection. Methylene blue has been around since it was invented in the 19th century by a German chemist. The textile industry first used it for dyeing purposes. Later, bacteriology, microscopy, and chemistry labs used its color-changing properties in experiments and tests. About 125 years ago, a German physician began using methylene blue as a medical treatment for malaria.

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This refers to the letters and numbers you'll find on a pill, used to help identify it. The Food and Drug Administration (FDA) requires that most prescription and over-the-counter medications in pill form have an imprint code. If your pill has no imprint code, it may be a homeopathic drug, a dietary supplement, or a counterfeit or illegal drug. Pills made by a compounding pharmacy typically lack an imprint. Drugs produced in other countries or used in clinical trials may also lack an imprint. Currently, it’s FDA-approved only for treating methemoglobinemia, although doctors also use it off-label for other conditions. The FDA approved methylene blue as a treatment for methemoglobinemia in 2016. Methemoglobinemia is a blood disorder that keeps your red blood cells from delivering oxygen to your tissues. Sometimes methemoglobinemia is called “blue baby syndrome” because the lack of oxygen to the body’s tissues turns your lips, skin, tongue, and nail beds blue. Some people inherit this condition through genes they get from their parents, but many people get it when they take certain medications or recreational drugs or are exposed to certain chemicals. Methylene blue is a cure for the disorder.

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We searched PubMed/Medline, Embase and Google Scholar for articles published before March 2022. Additional hand searches were conducted to obtain studies not found in the primary literature search. Studies were included if they report on qualitative and/or quantitative analytical findings of AAS from the black market. Primary outcomes were proportions of counterfeit or substandard AAS. Eligible articles were extracted; quality appraisal was done using the ToxRTool for in-vitro studies. It works by causing a chemical reaction in your blood. Methylene blue donates electrons to (reduces) methemoglobin molecules and converts them to hemoglobin. This increases the amount of oxygen they can deliver to your tissues. A doctor or nurse will give you this medication in a clinic as an IV infusion into a vein. The infusion takes about 5 to 30 minutes. Usually it takes only one dose to work as a treatment for methemoglobinemia, but if you’re still having symptoms an hour after your first dose, your doctor may give you a second one.

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We used random-effects models to calculate the overall mean estimates for outcomes. The review protocol has been published and registered in INPLASY. Overall, 19 studies, which in total comprised 5,413 anabolic samples, met the inclusion criteria, and passed the quality appraisal from two WHO world regions that reported findings, the Americas and Europe. Most studies were nonclinical laboratory studies (95%) and provided samples seized by authorities (74%). In 18 articles, proportions of counterfeit substances and in eight articles, proportions of substandard substances were presented. Before your health care team gives you methylene blue, they’ll review your medical history to see if you have any conditions that could affect how the medication works in your body. The main contraindication (a specific situation in which you shouldn’t use it because it may be harmful) for methylene blue is having a glucose-6-phosphate dehydrogenase (G6PD) deficiency.

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Start by entering details like pill imprint code, color, and shape. This tool is for informational purposes only. Consult a healthcare professional before making health decisions. Enter all letters or numbers from both sides of your pill. In this example you’d enter 21 58 on one line, then 9 3 on the other. “We worry about the drug causing hemolysis [the breakdown of red blood cells] in people who have congenital deficiency of G6PD,” says Charles Abrams, MD, director of the Penn-CHOP Blood Center in Philadelphia. This is a genetic disorder you’re born with that also affects red blood cells. Using methylene blue can make this worse. Your doctor will also ask if you: Could have cyanide poisoning, which you can get from too much of certain foods, medications, or chemicals Have a genetic disorder called glucose-6-phosphate dehydrogenase (G6PD) deficiency Are allergic to methylene blue, phenothiazines, thiazide diuretics, other medicines, foods, dyes, or preservatives Are pregnant, trying to get pregnant, or breastfeeding. Taking methylene blue can cause some side effects, including: These side effects aren’t serious and should go away without medical care. You could have more serious side effects, such as: Tell your doctor right away if you have these side effects. Some medications don’t work well with methylene blue, either because they affect how methylene blue works or methylene blue affects how they work. Some medicines that should not be taken with methylene blue include: Certain medicines for depression or anxiety, including bupropion (Aplenzin, Forfivo, Wellbutrin), clomipramine (Anafranil), citalopram (Celexa), doxepin (Silenor), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), trazodone, and venlafaxine (Effexor) Monoamine oxidase inhibitors (MAOIs) for depression, such as isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate) Rasagiline (Azilect) and selegiline (Eldepryl, Emsam, Zelapar), Parkinson’s disease treatments Antidepressant medications are a concern because of a complication called serotonin syndrome. Serotonin syndrome is a drug reaction that happens when medication combinations create high levels of serotonin in your body. You can have mild symptoms like shivering and diarrhea or severe symptoms like muscle rigidity, fever, and seizures. It can even cause death if you don't treat it. Be sure your doctor knows all the medications you take so they can discuss how methylene blue may interact with them.

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A pill identifier is a tool that helps identify pills by their imprint, color, and shape. It lets you find the name and details of a medication based on its appearance. Start by entering the imprint code found on the pill into the pill identifier. It may appear on only one side or both sides of the pill. Next, if needed, select the pill's color and shape from the drop-down menus to refine your search.