title: 'You've got m@il: fluoxetine coming soon!': accessibility and quality of a prescription drug sold on the web.
abstract: BACKGROUND
  The increasing phenomenon of online pharmacies has potential for serious public health problems. This study aimed to evaluate the possibility of accessing a prescription drug in the absence of a prescription for an Italian purchaser.
  
  
  METHODS
  Fluoxetine pills were ordered from several online pharmacies. The study included website analysis, and the quality of the received product including packaging, chemical and microbiological analyses.
  
  
  RESULTS
  Orders could be placed correctly on 61 of the 98 selected websites, and a sales transaction was concluded successfully on 17 websites. Thirteen drug samples were eventually received. In one case it was necessary to fill in a questionnaire before ordering the drugs. All websites displayed aggressive marketing strategies. There was wide variation in terms of domain registration, company base (when declared) and manufacturer's location (mostly India). All pills were delivered in sealed blister packs showing the lot number and manufacturer's details. A leaflet was enclosed in one case only. In three cases we received more pills than ordered, and in one case Viagra pills as a free gift. Pharmacopoeia microbiological requirements were satisfied. Chemical analysis revealed that the active principle was always present, although many samples did not meet the Pharmacopoeia "other impurities" or "total impurities" criteria. Heavy metals and solvents regulated by the Pharmacopoeia did not exceed the set limits; some of the non-regulated ones were also assessed, in some cases with a positive result (e.g. styrene).
  
  
  CONCLUSIONS
  About 20% of purchase attempts resulted in delivery of the drugs, even in the absence of a medical prescription. Traceability was poor and drug quality was generally worse compared to conventional pharmacy-purchased products. Based on all these broad-spectrum results, user safety appears not to be globally guaranteed.
authors: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - University of Brescia, Viale Europa 11, 25123 Brescia, Italy. Electronic address: gelatti@med.unibs.it.
authors: U
authors: U
authors: Gelatti
authors: R
authors: R
authors: Pedrazzani
authors: C
authors: C
authors: Marcantoni
authors: S
authors: S
authors: Mascaretti
authors: C
authors: C
authors: Repice
authors: L
authors: L
authors: Filippucci
authors: I
authors: I
authors: Zerbini
authors: M
authors: M
authors: Dal Grande
authors: G
authors: G
authors: Orizio
authors: D
authors: D
authors: Feretti
mesh_terms: D003132:Commerce / Q000379:methods*; D004340:Drug Contamination; D004349:Drug Packaging; D005473:Fluoxetine / Q000032:analysis / Q000191:economics*; D006801:Humans; D020407:Internet / Q000191:economics*; D055553:Prescription Drugs / Q000032:analysis / Q000191:economics*
chemical_list: D055553:Prescription Drugs; D005473:Fluoxetine
keywords: Consumer safety; E-commerce; Internet; Online pharmacies; Prescription drugs; Public health