Safety precautions to consider when buying Chinese medicinal pills and capsules

Chinese Proprietary Medicines (CPM) are medicinal products, used according to the traditional Chinese medicine (TCM) system of treatment, that have been manufactured into finished dosage forms such as tablets, capsules and pills. The finished products contain Chinese herbs, animal parts and/or minerals as active ingredients. 

How are CPM regulated in Singapore?

There are regulations in place to ensure the safety and quality of CPM in Singapore:

• CPM Dealer's Licence - All local dealers (i.e. importers, manufacturers, wholesalers and re-packers) must be licensed by HSA.

• CPM Product Listing - Dealers must also apply for product listing approval for each CPM before they can import, manufacture and/or sell the products in Singapore. To get listed, the CPM must meet the safety and quality requirements specified by HSA. For example, the products must not contain any potent/toxic substances controlled under the Poisons Act, synthetic chemical compounds found in western medicines, toxic heavy metals and microbial contents exceeding the permissible limits.

• Product Labels - All CPM must have English labels which include important information such as product name, batch number, expiry date, active ingredients, and dosage.

• Prohibited Claims - Labels for CPM are not allowed to make claims for treating a specified list of serious medical conditions, including cancer and diabetes.

There is a post-market surveillance programme to monitor the safety of CPM. It has two components:

• Risk-based surveillance - Sampling and testing of products found in the market  

• Adverse reaction monitoring - Draws on HSA’s network of local healthcare professionals and international regulatory partners to pick up signals of any health products that may be causing adverse reactions.

This system of checks and controls has enabled HSA to initiate timely recalls of harmful and inferior quality products.

Safety precautions to keep in mind when you are buying CPM

• Be aware of possible interactions with western medicines. Taking CPM and other health products concurrently without medical supervision may be dangerous. An example is the interaction between CPM and western medicines which can result in unwanted effects, such as reducing the body’s absorption of either one of the medicines. Do talk to your doctor or physician if you are already taking western medicines and plan to take CPM as well.

• Do not buy a CPM if it has not been listed with HSA. To check if the CPM is listed, ask the product supplier, or do a search on HSA's website. Avoid putting yourself at risk by purchasing products from the Internet, mail orders, street peddlers, or even well-meaning friends or relatives.

• Exercise caution when buying CPM from overseas or unknown sources. Please refer to this article for more advice.

• Expectant and breastfeeding mothers, infants, children, the elderly, and individuals with chronic illnesses or going for surgery should exercise more caution. When in doubt, talk to a medical professional. In general, CPM should not be administered to infants less than 12 months of age, unless advised by TCM practitioners. If you are scheduled for a surgical operation, do inform your doctor about any CPM you are taking.

Woman suffered serious conditions after taking overseas CPM product

A woman in her 60s had taken ‘CHONG CAO DAN’ weekly for 2 to 3 years in a bid to improve blood circulation and relieve muscle aches. The pain returned if she did not take the product. At the time that HSA was alerted to the case, she had experienced two episodes of fainting and developed Cushing’s syndrome, with symptoms such as round or ‘moon’ face and thinning of the skin. Her high blood pressure also worsened due to long-term steroid consumption. She was placed under outpatient care for the management of these conditions.

The product, which she had purchased overseas, carried claims that it contained herbal ingredients to help with conditions such as pain and blood circulation. However, HSA tested the product and found that it contained a potent steroid, dexamethasone, as well as anti-allergy medicine and a diuretic to remove excess fluid from the body.

If you suspect that the product you are taking is making you unwell or causing side effects, consult a medical professional and bring along your product.