Case series on a diversity of illicit weight‐reducing agents: from the well known to the unexpected

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Adulteration of over‐the‐counter proprietary medications has been reported previously. However, to date a detailed study specifically on illicit slimming products has been lacking. WHAT THIS STUDY ADDS This study showed the presence of a wide variety of illicit weight‐reducing agents in over‐the‐counter slimming products, including registered or banned drugs and pharmaceutical analogues. These products may result in significant toxicities and even mortality. AIMS To provide an overview of illicit weight‐reducing agents found in over‐the‐counter slimming products ingested by poisoned patients. METHODS The clinical details and analytical findings of slimming products involved in poisoning cases between 2004 and 2009 were reviewed. RESULTS Sixty‐six (including one fatal) poisoning cases were encountered. Eighty‐one products were analysed and found to contain undeclared prescription weight‐loss drugs, drug analogues, banned drugs, drugs used for an inappropriate indication or animal thyroid tissue, with up to six illicit agents within the same product. Many products were readily available from shops or the Internet. CONCLUSIONS A rich diversity of illicit, potentially harmful weight‐reducing agents was found in over‐the‐counter slimming products.

Detection of Illicit Substances in Slimming Products Available in UAE

“…In the present study, 60% slimming products were found to contain with sibutramine and/or phenolphthalein although they have been banned by the Food and Drug Administration (FDA). A study conducted in Hong Kong reported that the presence of these illicit chemicals resulted in high mortality and morbidity [4]. Another study on the slimming products also showed the presence of sibutramine in high concentrations (2400 µg/g) comparable to our study where the highest concentration of sibutramine was also estimated to be 2846 µg/g.…”

“…These products are often advertised to contain purely natural ingredients, hence assumed to be harmless. However, many such products have been reported to contain various illicit agents, including sibutramine, diethylpropion, phenolphthalein, fenfluramine, N-nitroso-fenfluramine, phentermine phenytoin, and even animal thyroid tissue posing a health risk on prolonged usage [1][2][3][4][5][6]. One study reported that the presence sibutramine and phenolphthalein resulted in high mortality and morbidity in Hong Kong population [4].…”

Use of a Pharmaceutically Adulterated Dietary Supplement, Pai You Guo, Among Brazilian-Born Women in the United States

“…2,3 However, many weight loss supplements have been found to contain a variety of banned pharmaceutical ingredients, some of which have led to life-threatening adverse reactions and deaths. [4][5][6] Since 2005, the US Food and Drug Administration (FDA), as well as European regulatory agencies, have identified over 300 such pharmaceutically adulterated weight loss supplements. 7,8 A wide variety of banned compounds have been identified including sibutramine, cetilistat, rimonabant, fenproporex, phenolphthalein, and many others.…”

Corticosteroid adulteration in proprietary Chinese medicines: a recurring problem

“…For the general public, a simple rule can be taught: if it sounds too good to be true, it probably is; and this is especially so for pCMs that claim to treat certain conditions in which western-drug adulteration is common, for example, weight reduction and diabetes, as previously reported by our unit, 10,11 and pain, respiratory conditions, and skin problems, as reported in the present study. It is prudent to consider brands and retailers that are trustworthy and, in case of doubt, patients should seek opinion from their primary care doctors.…”