Adulteration of Proprietary Chinese Medicines and Health Products with Undeclared Drugs: Experience of a Tertiary Toxicology Laboratory in Hong Kong

Summary

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 aims to examine the problem of adulteration of pCMs and health products in Hong Kong.

Methods

This study was conducted in a tertiary referral clinical toxicology laboratory in Hong Kong. All cases involving use of pCMs or health products which were confirmed to contain undeclared adulterants from 2005 to 2015 were retrospectively reviewed.

Results

Four hundred and four 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 NSAIDs (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, Internet, Chinese medicine practitioners, etc. 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 to citizens. Public education and effective regulatory measures are essential to address the problem.

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