HSA Alert: “骨節靈 (Gu Jie Ling)” Found to Contain Potent Medicinal Ingredients; One Consumer Experienced Serious Adverse Effects

The Health Sciences Authority (HSA) is alerting members of the public not to purchase or consume “骨節靈 (Gu Jie Ling)”. HSA’s analysis of the product found that it contained a potent steroid, dexamethasone, which led to a consumer developing Cushing’s syndrome (a serious steroid-induced condition characterised by a ‘moon face’ appearance and several other medical complications). The product was also tested to contain cetirizine, an antihistamine. Please refer to Annex A of the pdf version for photos of the product analysed by HSA.

2        A woman in her 60s was found with Cushingoid symptoms (round and puffy face) and low blood pressure after being admitted to hospital for other medical conditions. Further investigations revealed that her blood cortisol levels were low^[1] and that she had gained weight one month prior to hospitalisation. She was diagnosed with Cushing’s syndrome. She informed her doctor that she had been taking “骨節靈 (Gu Jie Ling)” for several months to relieve her foot pain. The product was recommended by her husband’s friend who had purchased it from a “traditional medicine shop” in Johor Bahru, Malaysia.

3            “骨節靈(Gu Jie Ling)” was labelled as a “traditional medicine” containing various herbal ingredients. It claimed to be “made entirely from traditional Chinese medicines”, had “no side effects” and can be “safely used” for symptomatic relief of backache, joint and muscular pain. Contrary to these claims, HSA’s analysis detected potent medicinal ingredients, dexamethasone (steroid) and cetirizine (antihistamine), in the product. The product was also labelled with a Malaysian product registration number which gave the impression that the product was registered by the Malaysian health authority. However, the registration number stated was not valid based on HSA’s checks on the Malaysian health authority’s website, suggesting that it may be an illegal product. HSA has alerted its Malaysian counterpart to this product.

Possible harmful effects of the potent medicinal ingredients

4        Dexamethasone is a potent steroid that is usually prescribed for inflammatory conditions and should only be used under strict medical supervision. Long-term unsupervised use of steroids can cause increased blood sugar levels (which may lead to diabetes), high blood pressure, cataracts, muscular and bone disorders, an increased risk of infections and Cushing’s syndrome. Sudden discontinuation of steroids without proper medical supervision can cause serious withdrawal symptoms such as fatigue, confusion and low blood pressure. Cetirizine is an antihistamine used to relieve allergic reactions and should be used under medical supervision. Adverse effects from the use of cetirizine include drowsiness, fatigue, headache and dry mouth.

Advisory to consumers

5        Consumers are advised to:

• See a doctor as soon as possible if you are taking “骨節靈 (Gu Jie Ling)” as it contains a potent steroid. Do not stop taking the product on your own as sudden stopping of the product without medical supervision may result in the worsening of underlying medical conditions or other serious withdrawal conditions.

• Be wary of products carrying exaggerated claims such as “no side effects” as they can contain potent ingredients that can seriously harm your health.

• Do not buy products from unknown or unverifiable sources, and exercise caution when buying from overseas, or even from well-meaning friends or relatives, as you cannot be certain where and how these products were made and whether they have been adulterated with harmful ingredients. Adulterated products are often manufactured under poor conditions with no quality control. They may also falsely claim to be registered in a particular country. Hence you should only buy products from reputable pharmacies or retailers’ websites or those with an established retail presence in Singapore.

• Always consult your doctor or pharmacist if you need help to manage your chronic medical conditions (such as joint pain).

Advisory to sellers and suppliers

6        All sellers and suppliers must stop selling this product immediately. HSA will not hesitate to take stern enforcement actions against anyone who sells and supplies products found to be adulterated with potent medicinal ingredients. Sellers and suppliers are liable to prosecution and if convicted, may be imprisoned for up to 2 years and/or fined up to $10,000.

7        Members of the public who have any information on the sale and supply of these illegal products may contact HSA’s Enforcement Branch at Tel: 6866-3485 during office hours (Monday to Friday) or email: hsa_is@hsa.gov.sg.

HEALTH SCIENCES AUTHORITY
SINGAPORE
1 FEBRUARY 2024

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[1] Potent steroids may suppress the normal production of cortisol, a natural steroid hormone produced by the body. This can lead to adrenal insufficiency. Adrenal insufficiency can in turn, lead to fatigue, generalised weakness, muscle and joint pain, low blood pressure, fits or shock.