HSA updates on products found overseas that contain potent ingredients (September to October 2019)

The Health Sciences Authority (HSA) would like to update the public on products that have been found and reported by overseas regulators between September and October 2019 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.

 

Annex B

The possible side effects of the potent ingredients

Androsta-3,5-diene-7,17-dione

Androsta-3,5-diene-7,17-dione is a compound of the aromatase inhibitor class that claims to improve muscle mass and strength. Little is known about its effects as there are no studies in patients, but other similar banned anabolic androgenic steroids cause long‐term health effects. Side effects associated with the use of similar drugs include decreased bone growth, decreased sperm production, infertility, aggressive behaviour, adrenal insufficiency, kidney failure, and liver dysfunction.

 

Betamethasone and Dexamethasone

Betamethasone and dexamethasone are potent steroids. 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).

 

Caffeine

The inappropriate use of caffeine may lead to insomnia, agitation, restlessness, palpitations and increased heart rate.

 

Chlorpheniramine

Chlorpheniramine is an antihistamine used to relieve allergic reactions such as rhinitis, and should be used under medical supervision by a pharmacist or doctor. Side effects from the use of chlorpheniramine include drowsiness, blurred vision, vomiting, constipation and poor coordination.

 

Dehydroepiandrosterone (DHEA)

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.

 

Dimethylamylamine (DMAA)

DMAA is a stimulant. The use of DMAA can lead to high blood pressure, shortness of breath, irregular heart rate, tightening in the chest, and heart attacks, as well as seizures.

 

Glibenclamide

Glibenclamide is a prescription medicine used to treat diabetes mellitus and should be used under medical supervision. Inappropriate use of glibenclamide without medical supervision may cause severe low blood glucose which can cause seizures or coma. Other side effects may include nausea, vomiting, diarrhea and cholestatic jaundice.

 

Hydroquinone

Hydroquinone is a potent ingredient used in prescription medicines for the treatment of skin conditions. The ingredient is prohibited in skincare cosmetic products and should only be used under medical supervision, as hydroquinone may cause harmful effects if not used properly. The inappropriate use of hydroquinone could result in changes in skin colour and hypersensitivity reactions such as rashes, redness, tingling and burning of skin.

 

Levodopa (L-Dopa)

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.

 

Lovastatin

Lovastatin is a prescription medicine used to treat high cholesterol and should be used under medical supervision. The side effects associated with lovastatin use include constipation, joint pain and stomach pain.

 

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.

 

Oxandrolone

 Oxandrolone is an anabolic steroid. Anabolic steroids are not approved for use to increase muscle mass or boost athletic performance. Taking such medication without medical supervision can be dangerous as they can cause serious side effects such as insomnia, irritability, aggressive behaviour, hypertension, liver cancer, development or prominent breasts in men and impotence. In women, they can cause male characteristics such as an increase in facial hair growth, male pattern baldness, deepening of the voice and menstrual irregularities.

 

Paracetamol

Paracetamol is used for relieving pain, headache and fever. Products which contain paracetamol but do not have this declared on the label pose a danger to consumers as accidental overdose can result in liver damage.

 

Phenolphthalein

Phenolphthalein may cause kidney disorders and has been found in animal studies to be associated with cancer. It may also cause breathing difficulties, rashes and abdominal cramps.

 

Phosphodiesterase Type 5 (PDE-5) inhibitors

This class of medicine includes sildenafil, tadalafil, homosildenafil and 5-desmethylcarbodenafil. 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 (PDE-5 inhibitor) while on nitrates have been reported overseas.

 

Rauwolfia / Rauwolscine

The use of rauwolfia has been associated with dizziness, drowsiness, impotence and anxiety.

 

Selective Androgen Receptor Modulators (SARMs)

Selective Androgen Receptor Modulators (SARMs) are chemicals that mimic the effects of the male hormone, testosterone. Some of these chemicals are still undergoing research and no SARMs have been approved for clinical use in humans. Using such chemicals can be dangerous as not all their side effects are known. The possible side effects may be similar to testosterone, such as insomnia, irritability, aggressive behaviour, hypertension, and impotence. Examples include andarine, cardarine, ligandrol (LDG-4033), myostine (YK-11), ostarine (MK 2866), testolone, MK 677 and RAD-140.

 

Sennosides

Sennosides are laxatives which can cause diarrhea, stomach discomfort and abdominal cramps. Long-term consumption may be unsafe and cause serious side effects like electrolyte imbalance from decreased potassium levels in the body.

 

Sibutramine /Desmethyl 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. Desmethyl sibutramine is a substance similar to sibutramine which may have similar side effects.

 

Synephrine

Synephrine, when taken in combination with caffeine, can cause side effects ranging from dizziness, tremors, headaches and irregularities in heart rate to seizures, psychosis, heart attacks and strokes.

 

Tamoxifen

Tamoxifen is a prescription medicine used to treat breast cancer and should be used  under medical supervision. Side effects associated with tamoxifen use may include uterine cancers, stroke, blood clots, cataracts or damage to the retina of the eye, muscle pain, bone pain, increased blood calcium, and severe skin rashes or allergic reactions.

 

Tretinoin

Tretinoin is a potent ingredient used in prescription medicines for the treatment of skin conditions and should be used under medical supervision. The ingredient is prohibited in skincare cosmetic products. Inappropriate use of tretinoin could lead to side effects such as redness and peeling of skin.

 

Yohimbe/Yohimbine

Yohimbine is a potent medicinal ingredient. Side effects associated with 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 document: Foreign Alert_2019_Sep_Oct985 KB

Published: 1 Sep 2019

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