title: Study on health hazards through medicines purchased on the Internet: a cross-sectional investigation of the quality of anti-obesity medicines containing crude drugs as active ingredients.
abstract: BACKGROUND
  Weight-loss medicines, including crude drugs and herbal supplements disguised as diet-aid products, are readily obtainable and distributed widely, especially in Southeast Asia. Even if such products are unapproved or prescription-only medicines, consumers can purchase them through an agency or directly on the Internet. We evaluated the quality and safety of herbal products purchased on the Internet to reveal their influence on public health.
  
  
  METHODS
  Diet-aid products containing Bukuryo (Poria sclerotium), Bakumondo (Ophiopogonis tuber), or Daio (rhubarb rhizome) were purchased through websites that did not provide physical addresses or which advertised misleading medicines (e.g., unapproved Cialis 100 mg tablets, Viagra 100 mg tablets) on websites. We carefully noted details in the descriptions on package inserts or accompanying product characteristics and analyzed the ingredients using qualitative and quantitative methods, namely high-performance liquid chromatography equipped with a photodiode array detector. We requested the respective manufacturers to authenticate their products through a structured questionnaire.
  
  
  RESULTS
  We purchased 15 items from 15 Internet sites and imported all 15 items to Japan. One item stated to contain rhubarb rhizome was identified as a prescription medicine; the others were dietary supplements and not medicines. Even though we did not analyze the constituents of all crude drugs, we found some active ingredients in the items. Sibutramine was detected in items confirmed to be supplements, including those containing Poria sclerotium and Ophiopogonis tuber. Each capsule contained ≈ 12 mg of sibutramine, which is the daily dose for anti-obesity medicines. Sibutramine is not approved for use in Japan and its sale has been suspended in Europe and the USA owing to serious adverse effects on the circulatory system.
  
  
  CONCLUSIONS
  Our findings indicate that dietary supplements containing injurious ingredients are distributed to Japanese consumers and potentially to a broader international audience, and that purchasing them through unreliable websites bears potential health risks. To avoid potential adverse events, there should be adequate alerts about the risks of taking products without appropriate indications.
authors.affiliation: Drug Management and Policy, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan. naoko@p.kanazawa-u.ac.jp.
authors.forename: Naoko
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Faculty of Pharmaceutical Sciences, Doshisha Women's University, Kodo, Kyotanabe, Kyoto, 610-0395, Japan. yku095@dwc.doshisha.ac.jp.
authors.forename: Midori
authors.initials: M
authors.lastname: Numano
authors.affiliation: Faculty of Pharmaceutical Sciences, Doshisha Women's University, Kodo, Kyotanabe, Kyoto, 610-0395, Japan. yku078@dwc.doshisha.ac.jp.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Nagasaka
authors.affiliation: Drug Management and Policy, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan. mibiki15@stu.kanazawa-u.ac.jp.
authors.forename: Kaori
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Drug Management and Policy, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan. tsuboih@p.kanazawa-u.ac.jp.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Tsuboi
authors.affiliation: Faculty of Pharmaceutical Sciences, Doshisha Women's University, Kodo, Kyotanabe, Kyoto, 610-0395, Japan. ttanimot@dwc.doshisha.ac.jp.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tanimoto
authors.affiliation: Drug Management and Policy, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan. kimurak@p.kanazawa-u.ac.jp.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Kimura
mesh_terms: D019440:Anti-Obesity Agents / Q000032:analysis* / Q000592:standards*; D045424:Complex Mixtures / Q000737:chemistry / Q000592:standards; D003430:Cross-Sectional Studies; D003503:Cyclobutanes / Q000032:analysis*; D019587:Dietary Supplements / Q000032:analysis / Q000592:standards; D005060:Europe; D020407:Internet; D007564:Japan; D031441:Ophiopogon; D008517:Phytotherapy; D028321:Plant Preparations / Q000737:chemistry* / Q000592:standards*; D055441:Poria; D012250:Rheum
chemical_list: D019440:Anti-Obesity Agents; D045424:Complex Mixtures; D003503:Cyclobutanes; D028321:Plant Preparations; C058254:sibutramine