The Pharmacovigilance Unit recently received an ADR report of Cushing's syndrome suspected to be associated with Pil Ajiab®, a traditional medicine which is labelled to contain herbs and spices. The patient has been taking this product which was purchased from outside of Singapore for her joint pain for two years. The purported indications of the product include relief of various pain and numbness.
On admission to the hospital for other medical conditions, the attending doctor noted that the patient was clinically cushingnoid. The patient who was not on any other medications also complained of weight gain, multiple joint pains and lethargy. Further tests conducted suggested that the Cushing's syndrome may be precipitated by consumption of exogenous steroids.
HSA investigations
The analysis of the samples of Pil Ajaib® revealed that it was adulterated with indomethacin 15.42 mg/capsule and dexamethasone 0.22 mg/capsule. Based on the manufacturer's recommended dose of 4 capsules per day, the total intake of indomethacin and dexamethasone per day are about 60 mg and 0.88 mg respectively. These are therapeutic doses of the two drugs. The presentation of Cushing's syndrome in this patient is consistent with the effects of prolonged consumption of dexamethasone.
Conclusion
Herbal medicinal products are generally perceived by the public to be safer than conventional western medicines. However the safety of some unlicensed herbal products may be compromised by lack of suitable quality control and inadequate labelling. The purchase of these products from unreliable sources could pose additional safety problems if they are adulterated with western medicines. As part of medical history taking, healthcare professionals are encouraged to ask if their patients are also taking complementary medicine.
Healthcare professionals are encouraged to report any suspected ADRs arising from consumption of complementary medicines to the Pharmacovigilance Unit at HSA. If adulterations with western drugs are suspected, samples may be forwarded together with the report for further investigations.
