Adulteration of proprietary Chinese medicines and health products with undeclared drugs: experience of a tertiary toxicology laboratory in Hong Kong

Abstract

Aims Proprietary Chinese medicines (pCMs) and health products, generally believed to be natural and safe, are gaining popularity worldwide. However, the safety of pCMs and health products has been severely compromised by the practice of adulteration. The current study aimed to examine the problem of adulteration of pCMs and health products in Hong Kong. Methods The present study was conducted in a tertiary referral clinical toxicology laboratory in Hong Kong. All cases involving the use of pCMs or health products, which were subsequently confirmed to contain undeclared adulterants, from 2005 to 2015 were reviewed retrospectively. Results A total of 404 cases involving the use of 487 adulterated pCMs or health products with a total of 1234 adulterants were identified. The adulterants consisted of approved drugs, banned drugs, drug analogues and animal thyroid tissue. The six most common categories of adulterants detected were nonsteroidal anti‐inflammatory drugs (17.7%), anorectics (15.3%), corticosteroids (13.8%), diuretics and laxatives (11.4%), oral antidiabetic agents (10.0%) and erectile dysfunction drugs (6.0%). Sibutramine was the most common adulterant (n = 155). The reported sources of these illicit products included over‐the‐counter drug stores, the internet and Chinese medicine practitioners. A significant proportion of patients (65.1%) had adverse effects attributable to these illicit products, including 14 severe and two fatal cases. Psychosis, iatrogenic Cushing syndrome and hypoglycaemia were the three most frequently encountered adverse effects. Conclusions Adulteration of pCMs and health products with undeclared drugs poses severe health hazards. Public education and effective regulatory measures are essential to address the problem.

Subacute and subchronic oral toxicity assessments of Acridocarpus smeathmannii (DC.) Guill. & Perr. root in Wistar rats

“…Toxicity testing can be used to obtain information on the biologic activity of a chemical substance and gain insight into its mechanisms of action [30,32,31]. More so, toxicological evaluation studies are important aspects of drug development and for the extension of their therapeutic potentials [[8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31]]. Thus, it helps pinpoint information on the adverse reactions which are potentially relevant to the substance being evaluated [33].…”

“…One of the most difficult adverse events recently documented stem from intoxications associated with the use of herbal medicines and this has elicited concerns [10,5,11]. On the other hand, an assessment using appropriate tools for ascertaining herbal toxicity in a number of cases has failed to show any causal effects or has indicated only weak causal relationship [12,13].…”

“…On the other hand, an assessment using appropriate tools for ascertaining herbal toxicity in a number of cases has failed to show any causal effects or has indicated only weak causal relationship [12,13]. More so, misuse of herbal concoctions, herb-drug interactions and poor pharmacovigilance surveys for medicinal products continues to be a challenge despite the availability of causality assessment tests already recruited to most developing countries [11,12]. It has also been reported that adverse herb reactions often overlap due to inherent toxic effects of herbal medicine and toxicities induced by handlings or during preparations [9,12].…”

Characteristics and Factors Associated with Adverse Cutaneous Drug Reactions Caused by Traditional, Complementary and Conventional Medicine in Malaysia

“…There are several ways that TCM products may cause adverse reactions. It may be due to its inherent toxic content, unintentional or intentional substitution, adulteration with prescription drugs or due to environmental contamination (Ching et al 2018).…”

Mania Induced by Steroid-Adulterated Herbal Medicine: A Case Report

“…Mental disorders can occur in up to 60% of patients who take corticosteroids regularly [1]. On the other hand, conventional herbal medicines are believed by many to be natural and void of side effects [2]. The consumption of traditional Chinese's medicine as a form of complementary medicine is, especially, prevalent in Chinese and other East Asian societies [3].…”