HSA updates on products found overseas that contain potent ingredients (October 2022)

The Health Sciences Authority (HSA) would like to update the public on products that have been found and reported by overseas regulators in October 2022 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

Name of product	Potent ingredient(s)	Source (Regulatory Agency)
Africa Black Ant	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Asam Urat	Paracetamol	Indonesian Food and Drug Authority
Beruang Putih	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Bintang Dua Mustika Dewa	Piroxicam (NSAID)	Indonesian Food and Drug Authority
Black Panther Power Gummy	Sildenafil and Tadalafil (PDE-5 inhibitors)	Health Canada
Del Cing Fung San Powder	Ephedrine and Pseudoephedrine	Indonesian Food and Drug Authority
Delias (Ke Cie Siao Chuan Yen)	Ephedrine and Pseudoephedrine	Indonesian Food and Drug Authority
Gaining Weight Capsule	Cyproheptadine and Dexamethasone (Corticosteroid)	Indonesian Food and Drug Authority
Gan Mao Tong Kaplet	Ephedrine and Pseudoephedrine	Indonesian Food and Drug Authority
Gold Rhino Super Long Lasting Extreme 285k	Tadalafil (PDE-5 inhibitor)	Health Canada
Greeng Jos Kopi BAPAK	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
GS Serbuk Guna Sehat	Cyproheptadine	Indonesian Food and Drug Authority
Guci Emas	Paracetamol	Indonesian Food and Drug Authority
Haemun Cream	Miconazole	Malaysia Ministry of Health
Hammer of Thor	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Herb Viagra	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Jamu “Duan Dewa”: Pegel Linu	Mefenamic acid (NSAID)	Indonesian Food and Drug Authority
Jamu “Duan Dewa”: Asam Urat	Mefenamic acid and Piroxicam (NSAIDs)	Indonesian Food and Drug Authority
JIU JENG PUSHEN JIAO NANG	Tadalafil (PDE-5 inhibitor)	Thailand Food and Drug Administration
Kaplet C-100	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Karisma Birds Nest Gel	Hydroquinone and Tretinoin	Malaysia Ministry of Health
Kopi Cethot	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Kopi Rempah Grenk	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Kuat Lelaki Suromadu 100ml	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
LAB LUMINUS ANTI-SENSITIVE SERUM	Betamethasone (Corticosteroid)	Hong Kong Department of Health
Lalake	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Libigrow Platinum 10,000	Prasterone	Health Canada
New Cobra Mas	Paracetamol	Indonesian Food and Drug Authority
Ninaskincare Skin Puteh Moisturizer	Mercury	Malaysia Ministry of Health
Obat Gatal-Gatal Cap Cobra	Chlorpheniramine	Indonesian Food and Drug Authority
Obat Kuat dan Tahan Lama Urat Jantan	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Obat Sakit Gigi Kombinastan	Chlorpheniramine, Dexamethasone (Corticosteroid), Indomethacin (Antalgin) (NSAID) and Paracetamol	Indonesian Food and Drug Authority
Pegal Linu Raja Madu Klanceng Plus	Dexamethasone (Corticosteroid) and Phenylbutazone (NSAID)	Indonesian Food and Drug Authority
Pemikat	Paracetamol	Indonesian Food and Drug Authority
Pi Yen Pian	Ephedrine and Pseudoephedrine	Indonesian Food and Drug Authority
Pinky	Sibutramine and Theophylline	Indonesian Food and Drug Authority
Plus Power Love 20,000	Sildenafil (PDE-5 inhibitor)	Health Canada
Ramping Herbal Alami RHA	Sibutramine	Indonesian Food and Drug Authority
Ramuan Pak Kumis 120ml	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Rhino Super Long Lasting Premium 500k	Sildenafil (PDE-5 inhibitor)	Health Canada
Rhino Super Long Lasting 750k	Sildenafil and Tadalafil (PDE-5 inhibitors)	Health Canada
Samuraten	Dexamethasone (Corticosteroid) and Paracetamol	Indonesian Food and Drug Authority
Skin Dessert Cream	Mercury	Malaysia Ministry of Health
Slim by Mimo	Sibutramine and N-desmethyl Sibutramine	Indonesian Food and Drug Authority
Super Kecetit Asam Urat	Paracetamol	Indonesian Food and Drug Authority
Sweet 13 Skincare Treatment Cream	Mercury	Malaysia Ministry of Health
Tang Bing Yao	Metformin	Indonesian Food and Drug Authority
Tangkur Ganas	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Tou Gubao	Phenylbutazone (NSAID)	Indonesian Food and Drug Authority
Urat Madu Black	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Viagra Gold	Sildenafil (PDE-5 inhibitor)	Indonesian Food and Drug Authority
Wantong Pegel Linu	Dexamethasone (Corticosteroid)	Indonesian Food and Drug Authority
Xian Ling	Paracetamol	Indonesian Food and Drug Authority

 

Annex B

The possible side effects of the potent ingredients

Chlorpheniramine

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

 

Corticosteroids

Betamethasone and dexamethasone are potent steroids that are usually prescribed for inflammatory conditions and should only be used under strict medical supervision. Long-term unsupervised use of steroids (including topical use where the steroid can be absorbed into the body) can cause increased blood glucose levels (which may lead to diabetes), high blood pressure, cataracts, muscular and bone disorders, an increased risk of infections and Cushing’s syndrome (a round face or ‘moon face’ appearance and upper body obesity with thin limbs). Discontinuation of steroids without proper medical supervision can cause serious withdrawal symptoms such as fatigue, confusion and low blood pressure, especially when the product has been taken for more than a few weeks.

 

Cyproheptadine

Cyproheptadine is an antihistamine used to relieve allergy symptoms. Side effects associated with its use include weight gain, diarrhoea, nausea, and vomiting.

 

Ephedrine and Pseudoephedrine

Ephedrine and pseudoephedrine are medicines used in the treatment of low blood pressure. The inappropriate use of ephedrine or pseudoephedrine may lead to side effects such as nausea, high blood pressure, irregular heart rate, vomiting and dizziness.

  

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.

 

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 diarrhoea, nausea and abdominal pain. An overdose can cause severe hypoglycemia or lactic acidosis, which can be fatal.

 

Miconazole

Miconazole is a medicine used to treat fungal infections. Side effects from inappropriate use of creams containing miconazole include burning, stinging, swelling, irritation, redness and flaking of the skin.

 

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs are anti-inflammatory medications used to relieve pain and reduce inflammation.  Their prolonged use may potentially cause serious gastric bleeding, nausea, high blood pressure and cardiovascular events such as heart attacks and strokes. They should be used under close medical supervision, especially in patients with underlying heart conditions, stomach bleeding and ulceration. Examples include aspirin, diclofenac, ibuprofen, indomethacin, mefenamic acid, meloxicam, phenylbutazone and piroxicam

 

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.

 

Phosphodiesterase Type 5 (PDE-5) inhibitors

This class of medicine includes sildenafil and tadalafil. 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 while on nitrates have been reported overseas.

 

Prasterone

Prasterone, also known as 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.

 

Sibutramine and N-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. N-desmethyl sibutramine is similar to sibutramine and may have similar side effects.

 

Theophylline

Theophylline is a prescription medicine used in the treatment of asthma and should be used under medical supervision. The use of theophylline has been associated with side effects including seizures, irritability, headaches, nausea and vomiting.

 

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.

 

Download PDF: HSA Foreign Alert_2022_Oct1148 KB

Published: 7 Nov 2022

Safety Alerts