Amphetamine lacing of an Internet-marketed neutraceutical

Common risks of adulterated and mislabeled herbal preparations

Due to the growing trend of returning to nature and the fear of adverse reactions from conventional medicines, people are increasingly resorting to the use of herbal preparations. Because of long-term use and natural origin these preparations give a sense of security. But herbal formulations also possess undesirable effects and, among other dangers, present a risk connected with deliberate addition of synthetic compounds, deliberate or unintentional replacement of the plant species or simply a risk of mislabeling. While the replacement of the plant species occurs in a very different groups of herbal products, reports of added illicit synthetic substances often include groups of herbal weight-loss preparations, sexual enhancers, preparations for treatment of rheumatic and inflammatory diseases, antidiabetic and blood pressure lowering preparations. In the world of Internet ordering, these are the dangers that everyone should be aware of. In this article, we reviewed the safety issues related to adulterated or mislabeled herbal products.

Identifying Complementary and Alternative Medicine Usage Information from Internet Resources. A Systematic Review

OBJECTIVES

Identify and highlight research issues and methods used in studying Complementary and Alternative Medicine (CAM) information needs, access, and exchange over the Internet.

METHODS

A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines from PubMed to identify articles that have studied Internet use in the CAM context. Additional searches were conducted at Nature.com and Google Scholar.

RESULTS

The Internet provides a major medium for attaining CAM information and can also serve as an avenue for conducting CAM related surveys. Based on the literature analyzed in this review, there seems to be significant interest in developing methodologies for identifying CAM treatments, including the analysis of search query data and social media platform discussions. Several studies have also underscored the challenges in developing approaches for identifying the reliability of CAM-related information on the Internet, which may not be supported with reliable sources. The overall findings of this review suggest that there are opportunities for developing approaches for making available accurate information and developing ways to restrict the spread and sale of potentially harmful CAM products and information.

CONCLUSIONS

Advances in Internet research are yet to be used in context of understanding CAM prevalence and perspectives. Such approaches may provide valuable insights into the current trends and needs in context of CAM use and spread.

Thyrotoxic hypokalemic periodic paralysis due to dietary weight-loss supplement

Herbal and dietary supplements for weight loss and in treatment of obesity are growing in popularity and acceptance in the United States. Most of these supplements can be obtained over the counter and can have serious adverse effects associated with their consumption. We describe 2 patients who developed thyrotoxic hypokalemic periodic paralysis 2-3 weeks after consuming thyroxine-containing weight-loss supplements. This is the first known case of thyrotoxic hypokalemic periodic paralysis secondary to dietary supplements. It is important that patients and physicians are aware of the severe adverse reactions associated with dietary supplements. Physicians should as a routine inquire about herbal and dietary supplement consumption during all patient encounters.

Use of a pharmaceutically adulterated dietary supplement, Pai You Guo, among Brazilian-born women in the United States

BACKGROUND

Pai You Guo is a weight loss supplement manufactured in China and adulterated with the banned pharmaceutical products sibutramine and phenolphthalein. The US Food and Drug Administration (FDA) announced a voluntary recall of Pai You Guo in 2009, yet clinicians have noted its continued use among Brazilian-born women in Massachusetts.

OBJECTIVE

To assess prevalence of Pai You Guo use, associated side effects, modes of acquisition, and impact of FDA regulatory action on these outcomes.

DESIGN

Cross-sectional study using an anonymous questionnaire.

PARTICIPANTS

Women ≤60 years of age, born in Brazil who attended one primary care clinic or one of six churches in Massachusetts.

MAIN MEASURES

Prevalence of use, how users first heard about the product, location of purchase, associated side effects, patterns of use before and after the FDA recall.

KEY RESULTS

Twenty-three percent (130/565) of respondents reported using Pai You Guo. In multivariate analysis, obesity (adj OR 3.7, p-value <0.001) and lack of insurance (adj OR 2.6, p-value 0.005) were associated with use. The majority of users (85%) reported at least one side effect. Dry mouth (59%), anxiety (29%), and insomnia (26%) were most commonly reported adverse effects. Nearly thirty-percent of users (38/130) purchased Pai You Guo from local stores and 9% (11/130) purchased it over the Internet. The majority of respondents (79/130; 61%) purchased Pai You Guo after the FDA recall. No respondent was aware of the FDA recall.

CONCLUSIONS

Use of this pharmaceutically adulterated supplement is common among Brazilian-born women in Massachusetts. The FDA alerts and recall did not appear to decrease its use.

Quality of online pharmacies and websites selling prescription drugs: a systematic review

BACKGROUND

Online pharmacies are companies that sell pharmaceutical preparations, including prescription-only drugs, on the Internet. Very little is known about this phenomenon because many online pharmacies operate from remote countries, where legal bases and business practices are largely inaccessible to international research.

OBJECTIVE

The aim of the study was to perform an up-to-date and comprehensive review of the scientific literature focusing on the broader picture of online pharmacies by scanning several scientific and institutional databases, with no publication time limits.

METHODS

We searched 4 electronic databases up to January 2011 and the gray literature on the Internet using the Google search engine and its tool Google Scholar. We also investigated the official websites of institutional agencies (World Health Organization, and US and European centers for disease control and drug regulation authorities). We focused specifically on online pharmacies offering prescription-only drugs. We decided to analyze and report only articles with original data, in order to review all the available data regarding online pharmacies and their usage.

RESULTS

We selected 193 relevant articles: 76 articles with original data, and 117 articles without original data (editorials, regulation articles, or the like) including 5 reviews. The articles with original data cover samples of online pharmacies in 47 cases, online drug purchases in 13, consumer characteristics in 15, and case reports on adverse effects of online drugs in 12. The studies show that random samples with no specific limits to prescription requirements found that at least some websites sold drugs without a prescription and that an online questionnaire was a frequent tool to replace prescription. Data about geographical characteristics show that this information can be concealed in many websites. The analysis of drug offer showed that online a consumer can get virtually everything. Regarding quality of drugs, researchers very often found inappropriate packaging and labeling, whereas the chemical composition usually was not as expected in a minority of the studies' samples. Regarding consumers, the majority of studies found that not more than 6% of the samples had bought drugs online.

CONCLUSIONS

Online pharmacies are an important phenomenon that is continuing to spread, despite partial regulation, due to intrinsic difficulties linked to the impalpable and evanescent nature of the Web and its global dimension. To enhance the benefits and minimize the risks of online pharmacies, a 2-level approach could be adopted. The first level should focus on policy, with laws regulating the phenomenon at an international level. The second level needs to focus on the individual. This approach should aim to increase health literacy, required for making appropriate health choices, recognizing risks and making the most of the multitude of opportunities offered by the world of medicine 2.0.

Adverse Consequences of Internet Purchase of Pharmacologic Agents or Dietary Supplements

Background:

The Internet is commonly used to advertise and sell medications and dietary supplements directly to consumers. Prescriptions are often not needed, and consumers may engage in unmonitored and risky health practices. No systematic attempt has been made to evaluate reported cases of adverse events following such purchases.

Objective:

To systematically identify and examine reported cases of adverse events associated with the purchase of medications and dietary supplements from the Internet.

Methods:

MEDLINE (1990-June 2009), EMBASE (1990-June 2009), IBIDS (to June 2009), TOXNET (to June 2009), bibliographies of identified articles, and Web sites of relevant health ministries and professional associations in the US and Canada were reviewed to identify eligible articles that describe adverse events associated with the purchase of medications or dietary supplements from the Internet.

Results:

Thirty-two reports of 41 cases of adverse consequences of pharmaceutical products (n = 31) or dietary supplements (n = 10) were identified. Purchases were made by people in the 30- to 50-year-old age group in 36% of cases. Prescription medications were implicated in 27% of cases and narcotic and controlled drugs were implicated in 49% of cases. Drug abuse was responsible for harm in 73% of cases, whereas adverse drug reactions occurred in 27% of cases. Nine (22%) patients died as a result of adverse consequences following such purchases. The remaining patients suffered serious adverse events such as seizures, liver damage, and hallucinations.

Conclusions:

An unexpectedly large number of case reports were identified from the literature; however, these reports do not fully illustrate the magnitude of the problem. Life-endangering adverse consequences signify a need for increased regulation and control of Internet Web sites and a need for healthcare provider involvement. Pharmacists should know where their patients obtain medications, how to verify the validity of the sources of prescriptions, and how to report adverse consequences.

Imported fenproporex-based diet pills from Brazil: a report of two cases

Banned amphetamine-based anorectics are illicitly imported into the United States (US), but little is known regarding the harm these diet pills pose to US residents. A 26-year-old woman using imported diet pills presented with a two-year history of intermittent chest pains, palpitations, headaches and insomnia. Urine toxicology screen detected amphetamines and benzodiazepines. Fenproporex and chlordiazepoxide were detected in her pills. Her symptoms resolved after she stopped using diet pills. A 38-year-old man using imported diet pills presented after his occupational urine screen was significantly positive for amphetamine. Fenproporex and fluoxetine were detected in his pills. These cases illustrate the potential harm from imported prescription diet pills that combine fenproporex with benzodiazepines, antidepressants, diuretics, laxatives and other substances. Increasing physicians' awareness of imported diet pill use may improve care of patients suffering from the pills' many adverse effects.