среда, 6 января 2016 г.

UNREGULATED : The hidden drugs in your favorite supplements

http://www.vox.com/a/supplements



By  and  on January 6, 2016
When you take a prescription drug in the United States, you can be reasonably sure of what's in it. The Food and Drug Administration (FDA) requires that all pharmaceuticals be thoroughly tested in humans, that they contain whatever ingredients are listed on the label, and that they have evidence to back their marketing claims.
Unfortunately, the same isn't true for dietary supplements.
Americans spend more than $30 billion on supplements each year. Supplements are now the most common form of alternative medicine, and many of these pills promise to do incredible things, from boosting memory and building muscles to burning fat fast.
There's just one problem: These pills are barely regulated. Supplement makers don't need to prove their products are safe or even effective before putting them on store shelves. And while supplements are supposed to be accurately labeled, a Vox review of government databases, court documents, and scientific studies uncovered more than 850 products that illegally contain hidden ingredients — including banned drugs, pharmaceuticals like antidepressants, and other synthetic chemicals that have never been tested on humans.
We found examples of weight loss supplements spiked with cancer-causing drugs that had been pulled from the US market, and brain enhancers laced with chemicals that have never been approved for sale in the US. More than 100 products contained DMAA, a drug that's been banned in the US, UK, and several other countries because it is linked to strokes, heart failure, and sudden death. 
In the absence of more stringent regulation, state attorneys general and federal prosecutors have been going after supplement makers and retailers that sell bogus products. Last year, federal researchers released the first estimate on how much damage supplements can do, finding that these pills and potions cause 23,000 emergency department visits nationwide every year, and more than 2,000 hospitalizations.
Were you or someone you know harmed by a dietary supplement? Tell us your story.
Now you can see if your favorite supplement has been flagged by health authorities. We used data from the FDA and the Department of Defense, as well as published studies from scientific journals and court documents, to create a searchable database of dangerous supplements. All of the products listed below have been found to contain hidden drugs.
This database is by no means exhaustive; it only includes products that have been studied or were the subject of safety complaints. Some products in the database may have also been reformulated since they were flagged, and others that are dangerous may never have been tested. Still, it's the most comprehensive look so far at what may lurk in your supplement bottle. As Pieter Cohen, an expert on the supplement industry, warned: "Supplements spiked with dangerous drugs are found in hundreds of stores across America, even in the largest supplement retail chains. Until the law is reformed, tens of thousands of Americans will continue to be harmed by supplements every year."
Below the database, you'll find descriptions of the classes of pharmaceuticals and illegal drugs that have been found in supplements. Many of these ingredients are sold as prescription drugs, which means that patients, at least in theory, have been screened by doctors and are aware of the drugs' potential side effects. When these drugs are illegally added to supplements, consumers don't know they're there and aren't aware of the potential side effects or, importantly, any dangerous interactions with other medicines.
Does this mean your vitamin C is unsafe or that vitamin D doesn't contain what it says on the label? Not necessarily. Representatives from the supplement industry argue it's usually the supplement products that carry big health claims — promising more muscle or faster weight loss — that are the problem. In our database, weight loss products seemed to contain hidden drugs most frequently, followed by sexual enhancement supplements and muscle builders. (This squares with the findings in previous research on supplement safety.)
But the truth is right now you have no way of knowing for sure what's in your supplement bottle.

Does your favorite supplement contain an illegal drug? Search our database to find out.

Appetite suppressants 

Appetite suppressants iconHidden drugs found in supplements in our database: sibutramine and its analogs (deisobutyl-benzylsibutramine, desmethyl sibutramine, didesmthyl sibutramine, n-desmthylsibutramine, n-di-desmethylsibutramine), cetilistat, fenfluramine, lorcaserin, rimonabant
The government removed sibutramine from the market in 2010 for safety reasons: It can increase blood pressure and pulse rate, causing coronary artery disease, heart failure, arrhythmias, stroke, and even death. But that doesn't mean it's also been removed from supplements. Sibutramine was the most popular drug on our database: 240 products, mostly for weight loss, contained this drug or one of its derivatives.

Laxatives

Laxatives iconHidden drugs found in supplements in our database: phenolphthalein
Phenolphthalein is a laxative no longer approved for sale in the US. According to the FDA, its health risks include irregular heartbeat, and cancer with long-term use. Sixty-six supplements in our database contained phenolphthalein, most of them marketed for weight loss. Some companies — such as Pure Edge Nutrition, MyNicKnaxs, and New Life Nutritional Center — included the drug in several of their formulations. For example, the FDA has warned consumers about Slim Xtreme supplements. Marketed as "100% natural," they have been found to contain phenolphthalein as well as sibutramine (the withdrawn pharmaceutical that causes heart problems).

Muscle relaxants

Muscle relaxants iconHidden drugs found in supplements in our database: chlorzoxazone, methocarbamol
A number of supplements marketed as arthritis and joint pain relievers have been pulled from the market for containing illegal drugs. In 2014, the supplement maker Nano Well-being Health Inc. recalled its Super Arthgold after an FDA laboratory analysis found the product contained chlorzoxazone, diclofenac, and indomethacin, "making it an unapproved new drug." The FDA warned that Super Arthgold could be deadly for some people with underlying illnesses as well as people who had recently undergone cardiac bypass graft surgery. There's also another problem with some of these muscle relaxants: They can put people at risk of feeling tired and falling asleep while driving.

Sexual enhancers

Sexual enhancers iconHidden drugs found in supplements in our database: sildenafil, tadalafil, vardenafil, and their analogs (acetildenafil, aidenafil, aminotadalafil, benzamidenafil, dapoxetine, desmethyl carbondenafil, dimethyl sildenafil, dimethylacetildenafil, dimethylsildenafilthione, hydroxyhomosildenafil, hydroxylthiohomosildenafil , hydroxythiohomosildenafil, noracetildenafil, piperadino vardenafil, propoxyphenyl sildenafil, sulfoaildenafil/thioaildenafil, sulfoaildenafil methanesulfonate, sulfohomosildenafil, sulfohydroxyhomosildenafil, sulfosildenafil, thiomethisosildenafil); dapoxetine
Sildenafil is the active ingredient in the prescription drug Viagra. It's been found in hundreds of supplements (including 159 on our database). Consider the supplement Reload. According to the FDA, "This undeclared ingredient may interact with nitrates found in some prescription drugs such as nitroglycerin and may lower blood pressure to dangerous levels. Men with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates." This means people are taking prescription drugs when they think they're taking a botanical sexual enhancer. What's more, many of these analogs of sildenafil have not been tested in humans, so they might have the same side effects as Viagra — or might have entirely new ones.
We also found dapoxetine in eight supplements in our database. Chemically, it's an antidepressant, but it has never been approved by the FDA — though it's been used in other countries to treat premature ejaculation. Supplement makers have laced their products — including several formulations of the popular Rhino sexual enhancer — with this drug.

Anti-anxiety drugs

Anti-anxiety drugs iconHidden drugs found in supplements in our database: picamilon
The FDA recently sent warning letters to companies that put picamilon in their products illegally — prompted by Sen. Claire McCaskill, who accused the agency of inaction. Used in Russia to treat various neurological conditions, the synthetic drug has never been approved for sale in the US but has been found in many brain-enhancing supplements here unbeknownst to consumers.

Antidepressants

Antidepressants iconHidden drugs found in supplements in our database: fluoxetine, doxepin
Seven of the weight loss supplements in our database contained fluoxetine, which is the active drug in the prescription antidepressant Prozac. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), a type of drug used to treat depression, obsessive-compulsive disorder, and panic disorder. You'd have no idea you were taking an SSRI in your weight loss supplement. "SSRIs have been associated with serious side effects including suicidal thinking, abnormal bleeding, and seizures," an FDA warning letter reads. "In patients on other medications for common conditions (aspirin, ibuprofen, or other drugs for depression, anxiety, bipolar illness, blood clots, chemotherapy, heart conditions, and psychosis), ventricular arrhythmia or sudden death can occur."

Diuretics

Diuretics iconHidden drugs found in supplements in our database: bumetanide, furosemide
Some weight loss supplements contain prescription-strength diuretics. In 2013, for example, the FDA warned about a supplement called Hydravax. Though it wasn't listed on the bottle, Hydravax contained a diuretic. Diuretics can cause electrolyte imbalance from losing too much fluid. With large doses, people can also experience dehydration, nausea, vomiting, and weakness and low-blood pressure.

Stimulants

Stimulants iconHidden drugs found in supplements in our database: BMPEA, DMAA, DMBA, ephedrine, ephedrine alkaloids, fenproporex
BMPEA, DMAA, and DMBA were hidden ingredients in many popular muscle-building and fat-burning supplements. But they're all extremely dubious. DMAA was banned in the US, UK, and several other countries because it has been linked to strokes, heart failure, and sudden death. Yet it was the second most popular drug on our database, appearing in 110 products on our database. DMBA is a synthetic version of DMAA. The health effects of DMBA are unknown because the drug has only ever been studied in a small number of cats and dogs, never humans. Similarly, BMPEAwas never approved as a pharmaceutical, so it has never been studied in humans — and, again, it's another common supplement ingredient. 

Anabolic steroids

Anabolic steroids icon
Anabolic steroids lurked in 81 products on our database. Most of them were marketed to men, promising to help build muscle fast. These drugs can lead to liver injury, increase the risk of heart attack and stroke, and cause the testicles to shrink, as well as cause infertility in males, among other side effects.

Anti-inflammatory drugs

Anti-inflammatory drugs iconHidden drugs found in supplements in our database: diclofenac, ibuprofen, indomethacin, naproxen, phenylbutazone 
Though many people use anti-inflammatories like ibuprofen for a headache, they don't come without side effects, and some people aren't supposed to take these drugs. Ibuprofen puts people at risk of bleeds in the gastrointestinal tract and kidney damage. Using the drug in high doses also seems to raise blood pressure and increase the risk of heart attack and stroke — one reason the FDA recently warned that people should only use ibuprofen (and other "nonsteroidal anti-inflammatory drugs," NSAIDS, like naproxen) for short periods of time and in small amounts. Yet ibuprofen (as well as naproxen) has been found in a number of supplements.

Other

Other iconHidden drugs found in supplements in our database: anthistamines (chlorpheniramine, cyproheptadine), phenytoin (anticonvulsant), chlorpromazine (antipsychotic), aromatase inhibitor, propranolol (beta blocker), nefopam (non-opioid pain relief)

 

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