Cardiac arrest caused by sibutramine obtained over the Internet: a case of a young woman without pre‐existing cardiovascular disease successfully resuscitated using extracorporeal membrane oxygenation

Bunya, Naofumi; Sawamoto, Keigo; Uemura, Shuji; Kyan, Ryoko; Inoue, Hiroyuki; Nishida, Jun‐ichi; Kouzu, Hidemichi; Kokubu, Nobuaki; Miura, Tetsuji; Narimatsu, Eichi

doi:10.1002/ams2.275

Cited by 11 publications

(6 citation statements)

References 13 publications

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“…Use of monoamine oxidase inhibitors (MAOIs) and sibutramine can lead to increase of blood pressure [122,123]. The unintentional intake of compound like sibutramine because of contaminated DS could affect overall health, the intake of medicines which are used for management of serious diseases, and a professional sport career [124][125][126].…”

Section: Stanozololmentioning

confidence: 99%

Dietary Supplements as Source of Unintentional Doping

Kozhuharov

Ivanov

Ivanova

2022

BioMed Research International

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Background. The substances used in sport could be divided into two major groups: those banned by the World Anti-Doping Agency and those which are not. The prohibited list is extremely detailed and includes a wide variety of both medicinal and nonmedicinal substances. Professional athletes are exposed to intense physical overload every day. They follow a relevant food regime and take specific dietary supplements, which is essential for the better recovery between trainings and competitions. However, the use of “nonprohibited” dietary supplements (DS) is not always completely safe. One of the risks associated with the use of dietary supplements is the risk of unintended doping—originating from contaminated products. The presence of undeclared compounds in the composition of DS is a serious concern. The aim of this study is to evaluate the risk of unintentional doping. Materials and Methods. Literature search was done through PubMed, Science Direct, Google Scholar, and Web of Science. Studies investigating the presence of undeclared compounds, in dietary supplements, banned by WADA met the inclusion criteria. The last search was conducted in June 2021. The present review is based on a total of 50 studies, which investigated the presence of undeclared compounds in DS. Results. The total number of analyzed DS is 3132, 875 of which were found to contain undeclared substances. Most frequently found undeclared substances are sibutramine and anabolic-androgenic steroids. Conclusion. More than 28% of the analyzed dietary supplements pose a potential risk of unintentional doping. Athletes and their teams need to be aware of the issues associated with the use of DS. They should take great care before inclusion of DS in the supplementation regime.

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Section: Stanozololmentioning

confidence: 99%

Dietary Supplements as Source of Unintentional Doping

Kozhuharov

Ivanov

Ivanova

2022

BioMed Research International

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“…With this respect, other studies reported the presence of sibutramine, synephrine, oxilofrine, 1,4‐dimethylamylamine, deterenol, among others 10,22,24,58,59 . Most of these substances are prohibited in many countries and may cause severe side effects, like tremors, concentration deficiency, anxiety, high blood pressure, hyperthermia, heart failure, and stroke 60,61 . In addition, although we tried to replicate the PWS consumers' purchasing habits, a limited amount of samples was collected from different sources; thus, this may not be generalizable to all PWS present in Brazil.…”

Section: Resultsmentioning

confidence: 99%

“…10,22,24,58,59 Most of these substances are prohibited in many countries and may cause severe side effects, like tremors, concentration deficiency, anxiety, high blood pressure, hyperthermia, heart failure, and stroke. 60,61 we suggest that future studies analyze the caffeine concentration of different lots over a period of time to assess inter-lot variation.…”

Section: Caffeine Daily Intake Assessmentmentioning

confidence: 99%

Pre‐workout supplements marketed in Brazil: Caffeine quantification and caffeine daily intake assessment

Costa

Haddad

Freitas

et al. 2021

Drug Testing and Analysis

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The stimulating and performance-enhancing properties of caffeine are often explored in one the most consumed types of supplements: the pre-workout supplements (PWS). However, despite the popularity of PWS, previous studies have reported incompatibilities between what is described in their labels and their actual caffeine content. This study aimed to develop, to optimize, and to validate a gaschromatography coupled to nitrogen-phosphorus detector (GC-NPD) method to quantify caffeine in PWS and to analyze commercial PWS marketed in Brazil to estimate the caffeine daily intake. For this purpose, three different extraction procedures were evaluated: agitation in vortex, shaker, and sonication. Sonication yielded the best extraction results. Next, the parameters' temperature and time were optimized by using central composite rotatable design (CCRD) and response surface methodology, which revealed the optimal values of 70 C and 10 min. The method was validated and applied to quantify caffeine in 52 PWS. From the 36 PWS labels that specified the caffeine amount, seven (19%) presented more than 120% of the declared quantity, whereas 15 (42%) contained less than 80% of the labeled caffeine.Additionally, six products presented undeclared caffeine. Considering the label stated doses, five supplements exceeded the safe caffeine daily intake (400 mg). On the basis of these findings, supplement quality control remains an issue that deserves more attention from consumers, manufacturers, and regulatory agencies. Finally, we suggest that PWS consumers be careful of the habit of ingesting caffeine through other sources and avoid ingesting two or more different PWS products in the same day.

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“…However, the continued presence of sibutramine in some over-the-counter weight loss formulations is a very concerning public health issue. The FDA has now implemented stricter guidelines for the control of dietary supplements, which is a welcome step to ensure public safety [ 10 ]. Aggressive internet-based marketing plays a vital role in capturing customers for over-the-counter supplements; unfortunately, despite its withdrawal from the market since 2010, sibutramine continues to be present in many antiobesity food supplements sold on the Internet [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Sibutramine as a Cause of Sudden Cardiac Death

Rodríguez-Guerra¹,

Yadav

Bhandari³

et al. 2021

Case Reports in Cardiology

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Importance. Sibutramine was withdrawn from the US market due to association with adverse cardiovascular outcomes especially with patients having preexisting cardiac disease. However, continued presence of sibutramine in herbal medications is a concern to public safety. Results. We report a case of a patient with no evidence of previous coronary heart disease, who presented with non-ST elevation acute coronary syndrome (NSTE-ACS). Urgent coronary catheterization showed nonobstructive coronaries. However, patient died unexpectedly within 24 hours of admission. The patient denied toxic habits but was taking over-the-counter weight loss herbal supplements. Complete autopsy was performed which showed sibutramine in the toxicology. Patient died due to complications of acute inadvertent intoxication of sibutramine. Conclusion and Relevance. This is the first case report in literature showing association of sibutramine to sudden cardiac death in patients with no prior cardiac history. The continued presence of sibutramine in some over-the-counter weight loss formulations is a very concerning public health issue.

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Cardiac arrest caused by sibutramine obtained over the Internet: a case of a young woman without pre‐existing cardiovascular disease successfully resuscitated using extracorporeal membrane oxygenation

Cited by 11 publications

References 13 publications

Dietary Supplements as Source of Unintentional Doping

Dietary Supplements as Source of Unintentional Doping

Pre‐workout supplements marketed in Brazil: Caffeine quantification and caffeine daily intake assessment

Sibutramine as a Cause of Sudden Cardiac Death

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