Chinese Proprietary Medicine in Singapore

Abstract

Traditional Chinese medicine (TCM) is gaining popularity as a form of complementary and alternative medicine. Reports of efficacy of TCM are increasing in numbers. TCM includes both crude Chinese medicinal materials (plants, animal parts and minerals) and Chinese proprietary medicine (CPM) [final dosage forms]. Despite the belief that CPM and herbal remedies are of natural origin, unlike Western medicine, and are hence safe and without many adverse effects, there have been numerous reports of adverse effects associated with herbal remedies. Factors affecting the safety of herbal medicines include intrinsic toxicity, adulteration, substitution, contamination, misidentification, lack of standardisation, incorrect preparation and/or dosage and inappropriate labelling and/or advertising. Hence, new regulations on the control of CPM were enforced in Singapore with effect from 1 September 1999. These include licensing and labelling requirements, as well as control of microbial contamination. This article also reviews reports of excessive toxic heavy metals and undeclared drugs in CPM in Singapore between 1990 and 1997. The names, uses, toxic heavy metal or drug detected and the year of detection are tabulated. Information on the brand or manufacturer's name are provided whenever available. The public and healthcare professionals should be better informed of the basic concept of TCM and its usefulness, as well as the potential adverse effects associated with its use. Greater control over the safety and quality of CPM could be achieved through good manufacturing practice, regulatory control, research, education, reporting usage of Chinese medicine (as in drug history) as well as reporting of adverse events.

Levels of Arsenic, Cadmium, Lead, Manganese and Zinc in Biological Samples of Paralysed Steel Mill Workers with Related to Controls

“…Signs of lead toxicity include central nervous system (CNS) effects, peripheral neuropathy, haematological abnormalities, nephropathy and infertility. Effects on the CNS seem to occur at blood lead levels >30 μg/dL [64]. The values of Pb in all three biological samples of steel mill paralysis workers are higher compared to the results obtained by other workers in the same field [65].…”

Raw materials: the importance of quality and safety. A review.

“…[84] Adulterants present in several Chinese preparations included berberine, chlorphenamine, acetaminophen, theophylline, caff eine, ephedrine, dipyrone and fl uocinonide. [85] Another main problem related to botanical products is their possible contamination with toxic substances (heavy metals, pesticides, herbicides) or microorganisms and mycotoxins.…”

Protocols on safety, efficacy, standardization, and documentation of herbal medicine (IUPAC Technical Report)

“…This happened because of a manufacturing error when one of the medicinal plants in the pills was replaced with Aristolochia fangchi, which contains aristolochic acids as its main components [57]. The presence of undeclared drugs, such as chlorphenamine, paracetamol, and others, can be found in health supplements and herbal preparations, as has been reported in some countries [58].…”