HSA updates on products found overseas that contain potent ingredients (July to August 2019)

The Health Sciences Authority (HSA) would like to update the public on products that have been found and reported by overseas regulators between July and August 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 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 undeclared potent ingredients

Acetaminophen / Paracetamol

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

Alkyl nitrites

"Poppers" is a slang term for products that contain alkyl nitrites. Despite being labelled for various uses such as leather cleaners, room odourizers or liquid incense, these products are inhaled or ingested by consumers for recreational purposes. Alkyl nitrites, such as amyl nitrite, butyl nitrite and isobutyl nitrite, are prescription medicines and should be used only under medical supervision. Products containing alkyl nitrites may pose serious risks, including death, depending on the amount used, how frequently they are used and how long they are used for, as well as the person's health and the other medications they may be taking. Since it is difficult to control how much is inhaled, people can accidentally overdose. Swallowing these products can lead to serious medical complications and may be fatal.

Caffeine

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

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.

Fenofibrate

Fenofibrate is a prescription medicine used to treat abnormal blood lipid levels and should be used under medical supervision. Common side effects include liver problems, shortness of breath, muscle pain or weakness, abdominal pain and nausea. Serious side effects may include gallstones, blood clots and pancreatitis.

Flibanserin

Flibanserin was originally developed as an antidepressant. Side effects include dizziness, nausea, sense of tiredness, sleepiness and difficulty in falling asleep.

Lidocaine

Lidocaine is a medicine used to decrease or eliminate the feeling of pain. The inappropriate use of products with high concentrations of lidocaine can cause low blood pressure and dizziness.

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.

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.

Metformin

Metformin is a prescription medicine for the treatment of diabetes and should be used under medical supervision. Common side effects include diarrhea, nausea and abdominal pain. An overdose can cause severe hypoglycemia or lactic acidosis, which can be fatal.

Orlistat

Orlistat is a medicine used in the management of obesity. This medicine should be used under the supervision of a healthcare professional. The inappropriate use of orlistat can cause headaches, abdominal pain, oily discharge from rectum, liquid stools, flatulence and fatigue.

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 and 5-dimethylpiperazinyl dithio-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.

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.

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 July_Aug [PDF, 1.1 MB]