HSA Alert: Five Products Detected To Contain Potent Medicinal Ingredients Including Steroids; Two Consumers Experienced Serious Adverse Effects

The Health Sciences Authority (HSA) is alerting members of the public not to purchase or use five products, including a cream marketed for use in babies. HSA’s analysis of these products revealed that they contained potent medicinal ingredients, including steroids that led to serious adverse events in two consumers. The five products are:

2        ‘AlphaMiracHERBS’ and ‘Shu Jin’ capsules were obtained from Malaysia, while ‘Jolicare™’ creams were sold on local e-commerce platforms (company website, Carousell, Lazada and Shopee) and social media platforms (Facebook, Instagram and TikTok). HSA has worked with the platform administrators to remove the affected listings and investigations are ongoing. Please refer to Annex A for photos of the products and Annex B for more information on the medicinal ingredients found in them.

Two consumers developed serious steroid-induced adverse effects after taking ‘Shu Jin’ and ‘AlphaMiracHERBS’ capsules

3          A woman in her 60s who took ‘Shu Jin’ capsules regularly over 10 years for joint pain had to be hospitalised shortly after she stopped taking it. She experienced fever, giddiness, joint pain and loss of appetite. She was diagnosed with adrenal insufficiency^[1] (a serious steroid withdrawal condition, where the body does not produce adequate amounts of steroid hormones after stopping long-term steroid use) and osteoporosis. She told HSA that her relative had obtained the product from a clinic in Malaysia and recommended it to her.

4        A man in his 60s developed Cushing’s syndrome (a serious steroid-induced condition characterised by a round face or ‘moon face’ appearance) after taking ‘AlphaMiracHERBS’ capsules for three to four months for psoriasis (an inflammatory skin condition which causes rash with itchy, scaly patches). He gained about 10 kilograms and developed a round face. He had obtained the product from Malaysia through his friend.

5        These cases were reported to HSA by their treating physicians. ‘AlphaMiracHERBS’ was labelled as a “herbal supplement for inflammation” containing “100% vegetarian herbs”. However, contrary to its claims of being purely herbal, HSA tested it to contain dexamethasone (a steroid), chloramphenicol and tetracycline (antibiotics), chlorpheniramine (an antihistamine), ibuprofen (a non-steroidal anti-inflammatory drug) and lovastatin (a cholesterol-lowering medicine). ‘Shu Jin’ capsules were also tested by HSA to contain multiple potent ingredients including dexamethasone, chlorpheniramine and atorvastatin (another cholesterol-lowering medicine). Long-term unsupervised use of steroids such as dexamethasone can cause increased blood glucose levels which may lead to diabetes, Cushing’s syndrome, and other serious adverse effects.

“Natural, herbal” creams marketed for babies and pregnant women found to contain potent steroids

6        HSA was alerted to the online sale of ‘Jolicare™’ creams based on multiple feedback, including from a pharmacist who was suspicious of ‘Jolicare™’ cream when a three-year-old child’s chronic eczema unexpectedly improved after using it for only three days, and from a doctor who came across it on social media chatgroups among mothers. ‘Jolicare™’ products were falsely promoted as “natural, herbal” and “proven effective” for a variety of skin conditions, such as eczema, fungal infection and psoriasis. Their online sales postings carried a disclaimer that the products contained “a minimal amount of dexamethasone and clobetasol” and falsely claimed that “the dose is approved by skin specialists and is safe for all, including babies and pregnant mums”. Creams containing such potent steroids for treatment of skin conditions should be evaluated and approved by HSA, and they should only be prescribed by doctors for use under medical supervision. These products were not approved by HSA.

7        Apart from clobetasol propionate and dexamethasone, HSA detected chloramphenicol and ketoconazole (an antifungal) in all three ‘Jolicare™’ creams. These ingredients can pose serious health risks, especially in infants, children and pregnant women, if used without medical supervision.

Advisory to consumers

8        Consumers are advised on the following:

• See a doctor as soon as possible if you or other family members are using these products as they contain potent medicinal ingredients including steroids. Long-term steroid use can suppress the body’s production of steroids. Sudden stopping of these products without medical supervision may result in worsening of underlying medical conditions or other serious withdrawal conditions such as adrenal insufficiency.

• Exercise caution when buying products online or from well-meaning friends as you cannot be certain where and how these products were made and whether they have been adulterated with harmful ingredients. Only buy from reputable pharmacies or retailers’ websites or those with an established retail presence in Singapore. Adulterated products are often manufactured under poor conditions with no quality control, and different batches of the same product may contain variable amounts of ingredients and/or different types of adulterants.

• Exercise caution when purchasing products for use in babies and pregnant women, including those that are applied on the skin such as creams, as they are more vulnerable to suffering serious adverse effects. Potent ingredients added into the creams can be absorbed into the body and cause adverse effects. Consult a doctor if you are pregnant or have a child who requires prolonged use of products intended for treatment to ensure that these products are appropriate.

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

• Be wary of products that deliver unexpectedly quick effects such as fast relief of chronic medical conditions, or carry exaggerated claims, while claiming to be “herbal” or “natural". Contrary to the claims, they can contain potent ingredients that can seriously harm your health. Recommendations or testimonials found online can be falsified and are not easily verifiable.Read more about supposedly herbal or natural products that turned out to be harmful.

Advisory to sellers and suppliers

9        All sellers and suppliers must stop selling these products immediately. HSA will not hesitate to take stern enforcement actions against anyone who sells and/or supplies products found to be adulterated with potent medicinal ingredients. Sellers and suppliers who are selling such health products are liable to be prosecuted and if convicted, may be imprisoned for up to 3 years and/or fined up to $100,000.

10       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
14 NOVEMBER 2022

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^[1]Adrenal insufficiency can lead to fatigue, generalised weakness, muscle and joint pain, low blood pressure, fits or shock.