HSA updates on products found overseas that contain potent ingredients (April 2024)

The Health Sciences Authority (HSA) would like to update the public on products that have been found and reported by overseas regulators in April 2024 to contain potent ingredients which are not allowed in these products and may cause side effects. This information is provided to increase awareness on safety issues of such products found overseas, which may impact the local population. Please refer to Annex A and Annex B for the list of products and the possible side effects of the potent ingredients. Please refer to the pdf document for images of the products.

HSA’s Advisory

2          Members of the public are advised to:

• Consult a doctor if you have consumed any of the products and are feeling unwell.
• Avoid buying any of the products when abroad.
• Exercise caution when purchasing health products online or from sources (either local or overseas) which you may not be familiar with, even if well-meaning friends or relatives have recommended them. You cannot be certain where and how these products were made. They may be illegal, counterfeit or substandard, and may contain potent ingredients which can harm your health. If buying health products online, we encourage you to buy them from websites with an established retail presence in Singapore.
• Be wary of products that promise quick and miraculous results or carry exaggerated claims like “100% safe”, “no side effects” or “scientifically proven”. Consumers should also be cautious of products that produce unexpected quick recovery of medical conditions.
• Consult your doctor or pharmacist if you need help for the management of your acute and chronic medical symptoms and conditions (e.g. diabetes, hypertension, eczema).
  

3          Additionally, members of the public are encouraged to visit https://www.hsa.gov.sg/consumer-safety/ to learn more about the dangers of buying health products from dubious sources.

4          Members of the public who come across the sale and supply of these products in Singapore may contact HSA's Enforcement Branch at Tel: 6866 3485 during office hours (Monday to Friday) or email: hsa_is@hsa.gov.sg.

Annex A

List of Products

Note: There may be different versions or variants of the products listed below. You are advised to consult your doctor or pharmacist if you are unsure of any health product you intend to use, or if you need help for your acute and chronic medical symptoms and conditions

Name of product	Potent ingredient(s)	Source (Regulatory Agency)
Candace Night Cream	Mercury and Betamethasone	Thailand Food and Drug Administration
ForeverMen Supplements Natural Energy Boost	Sildenafil and Tadalafil (PDE-5 Inhibitors)	United Stated Food and Drug Administration
GREENLAB WHITE COCKTAIL OVERNIGHT	Mercury	Thailand Food and Drug Administration
Ginseng Red 2000	Sildenafil (PDE-5 Inhibitor)	Health Canada
Honey Q Level Up	Sibutramine, benzyl sibutramine and fluoxetine	Hong Kong Department of Health
Ossos-Sans	Diclofenac and methocarbamol	United States Food and Drug Administration
Rhino 7 Platinum 5000	Sildenafil (PDE-5 inhibitor) and Yohimbe	Health Canada
Rhino 7 Platinum 10,000	Sildenafil (PDE-5 inhibitor) and Yohimbe	Health Canada
Rhino 7 Platinum 15000	Sildenafil (PDE-5 inhibitor)	Health Canada
Rhino 25 Platinum 25,000	Sildenafil (PDE-5 inhibitor)	Health Canada
Rhino 69 23000K	Sildenafil (PDE-5 inhibitor)	Health Canada
Rush Hour 72	Sildenafil and Tadalafil (PDE-5 inhibitors)	Health Canada
Magnum Gold 24K	Sildenafil (PDE-5 Inhibitor)	Health Canada
Schwinnng Capsules	Nortadalafil (PDE-5 Inhibitor)	United States Food and Drug Administration
Spanish Fly 22,000	Tadalafil (PDE-5 Inhibitor)	Health Canada
Spanish Fly 99,000	Levodopa, Prasterone	Health Canada

 

Annex B

The possible side effects of the potent ingredients

Betamethasone (see also Corticosteroids and Dexamethasone)

Betamethasone is a potent steroid. Long term use of an oral steroid without medical supervision can cause high blood pressure, cataracts, an increased risk of infections, and Cushing’s syndrome (characterised by the appearance of round face or ‘moon face’ and upper body obesity with thin limbs).

 

Dehydroepiandrosterone (DHEA) – also known as Prasterone

Dehydroepiandrosterone (DHEA) is a hormone that could increase the risk of prostate, breast, ovarian and other hormone-sensitive cancers. Side effects may include serious cardiovascular disease, changes in fertility and sperm production, hair loss, voice deepening, insulin resistance, changes in menstrual pattern, liver dysfunction, abdominal pain, and high blood pressure.

 

Diclofenac

Diclofenac is a potent painkiller and may potentially cause cardiovascular events such as heart attacks and strokes, as well as serious gastric bleeding, when used for a prolonged period. It should be used under close medical supervision, especially in patients with underlying heart conditions, stomach bleeding and ulceration.

 

Fluoxetine

Fluoxetine is a prescription medicine used to treat conditions including depression and eating disorders, and it should be used under medical supervision. The use of fluoxetine has been associated with side effects including headaches, insomnia, palpitations and dizziness.

 

Levodopa

Levodopa is a prescription medicine used in the treatment of Parkinson’s Disease and should be used under medical supervision. Levodopa may potentially interact with medicines used to treat high blood pressure. Side effects of levodopa may include low blood pressure, irregular heart rate and breathing abnormalities.

 

Mercury

Mercury is a toxic substance and is prohibited for use as an ingredient in cosmetic products. Regular application of creams containing mercury could lead to rash, skin discolouration and blotching. Chronic exposure to very high levels of mercury in cosmetic products may also cause toxic effects to the kidneys, digestive and nervous system, as it can be absorbed through the skin. This could lead to organ damage.

 

Methocarbamol

Methocarbamol is a medicine used to treat acute, painful musculoskeletal spasms. Common side effects include headaches, sleepiness and dizziness. Serious side effects may include anaphylaxis, liver problems, confusion and seizures.

 

Phosphodiesterase Type 5 (PDE-5) inhibitors

This class of medicine includes carbodenafil, sildenafil, tadalafil, vardenafil and their derivatives. These medicines can cause serious side effects such as strokes, heart attacks, decreased or loss of vision and hearing and priapism (painful and exceedingly long erections). If priapism is not treated immediately, it may lead to permanent impotence. PDE-5 inhibitors are also not suitable for patients with medical conditions such as certain heart-related problems or who are on heart medications such as nitrates. Deaths of patients found to be using sildenafil while on nitrates have been reported overseas.

 

Sibutramine /Benzyl sibutramine

Sibutramine, previously a prescription weight loss medicine used in the treatment of obesity, has been disallowed for sale in Singapore since 2010 due to increased risk of heart attacks and strokes. The use of sibutramine has been associated with serious side effects, including high blood pressure, irregular heartbeats, hallucinations and mood swings.  Benzyl sibutramine is an analogue (chemically related compound) of sibutramine and may have similar side effects.

 

Yohimbe/Yohimbine

Yohimbine is a potent medicinal ingredient derived from yohimbe, a bark extract. Side effects associated with yohimbe or yohimbine include insomnia, anxiety, palpitations (sensation of heart pounding, racing or skipped beats), sweating and blurred vision. Overdosage can cause low blood pressure, rapid heartbeats, seizures, paralysis and coma. Deaths from overdose have also been reported.

Download PDF:  HSA Foreign Alert_2024_April Published: 10 May 2024

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