Herbal Weight Loss Pill Overdose: Sibutramine Hidden in Pepper Pill

Abstract

Supposedly herbal weight loss pills are sold online and are widely used in the world. Some of these products are found to contain sibutramine by FDA and their sale is prohibited. We report a case of a female patient who presented to the emergency department after taking slimming pills. 17-year-old female patient presented to the emergency room with palpitations, dizziness, anxiety, and insomnia. She stated that she had taken 3 pills named La Jiao Shou Shen for slimming purposes during the day. Her vital signs revealed tachycardia. On her physical examination, she was restless, her oropharynx was dry, her pupils were mydriatic, and no other pathological findings were found. Sibutramine intoxication was suspected. She was given 5 mg IV diazepam for restlessness. After supportive therapy and observation in emergency department for 12 hours there were no complications and the patient was discharged home. Some herbal pills that are sold online for weight loss have sibutramine hidden as an active ingredient, and their sale is prohibited for this reason. For people who use herbal weight loss drugs, sibutramine excessive intake should be kept in mind at all times.

Determining Undeclared Synthetic Pharmaceuticals as Adulterants in Weight Loss Herbal Medicines

“…However, the adulteration of herbal medicines products, like slimming formulations, is a common global concern; pharmaceutical adulterants are frequently found in herbal weight loss products [12][13][14][15][16][17][18][19]. The World Health Organization (WHO) has definitions for substandard, spurious, falsely labeled, falsified, and counterfeit medicinal products.…”

“…Previous studies in many countries, including Iran, have identified the most common undeclared active pharmaceutical ingredients as adulterants in weight loss herbal supplements from many pharmacological categories. These classes include amphetamine analogs, as anorexic agents (sibutramine, desmethyl sibutramine, amfepramone, fenproporex, fenfluramine, ephedrine, norephedrine, phendimetrazine), methylxanthines (caffeine), thyroid hormones, rimonabant, laxatives (phenolphthalein, docusate sodium), diuretics (furosemide, bumetanide, spironolactone, and hydrochlorothiazide), antidepressants (fluoxetine, paroxetine, sertraline, protriptyline, and bupropion), synthetic Phosphodiesterase type-5 (PDE5)-inhibitory drugs (sildenafil, vardenafil, and tadalafil), and opioids (methadone, tramadol) [1,[12][13][14][15][16][17][18][19].…”

“…However, a long consumption of adulterated weight loss herbal products may cause severe adverse effects and toxicity to patients and could be considered as a cause of morbidity and mortality [12,[14][15][16][17][18]. Therefore, the chemical analysis of adulterated herbal products is an essential issue in clinical and forensic medicine and toxicology [19].…”

Post-marketing withdrawal of anti-obesity medicinal products because of adverse drug reactions: a systematic review

“…Indeed, there have been many reports of suspected adverse reactions attributed to such products [7, 50, 51]. There should be tougher legislative action against the promoting and marketing of such products.…”

Misuse of sibutramine and bulimia nervosa: a dangerous combination

“…Although sibutramine was withdrawn from the U.S. and European markets,1 it is still widely prescribed in many countries, such as Brazil, and is available worldwide as an over-the-counter drug 2,3. There are many descriptions of the psychiatric side effects of sibutramine2-4; however, there is scant information about sibutramine misuse as a compensatory behavior in bulimia nervosa (BN) and its potential consequences.…”