title: A Rare Case of Psychomotor Disturbances Linked to the Use of an Adulterated Dietary Supplement Containing Sibutramine.
abstract: BACKGROUND
  Sibutramine, an oral anorexiant, is often found as an adulterant in various counterfeit herbal slimming products and dietary supplements. The use of sibutramine has been associated with various cardiovascular and psychiatric symptoms. Here, we report a rare case of psychomotor disturbances, in a patient with no previously diagnosed movement disorders.
  
  
  METHODS
  A 26-year-old woman developed abnormal behavior, visual hallucinations, hyperkinesia, facial flushing, and dizziness after taking a counterfeit dietary supplement which contained undeclared sibutramine and phenolphtalein. Laboratory work-up revealed microcytic anemia; leucopenia; and elevated erythrocyte sedimentation rate, C-reactive protein levels, and antistreptolysin O titer, but rheumatic fever was ruled out. After a neurologic examination, involuntary movements were classified as chorea. The psychiatric examination result was unremarkable. The patient responded well to haloperidol therapy. Body temperature, erythrocyte sedimentation rate, and C-reactive protein levels eventually normalized. The patient was discharged.
  
  
  CONCLUSIONS
  This is the first report we are aware of about a transient, chorea-like psychomotor movement disorder associated with sibutramine. Although the causal relationship between sibutramine and the patient's symptoms cannot be proven definitely, the temporal dimension does suggest sibutramine initiation and termination led to onset and resolution of symptoms, respectively. Furthermore, because of the widespread availability of adulterated food supplements containing sibutramine, physicians should be more aware of their implications for patients.
authors.affiliation: *Division of Enforcement and Inspection, Israeli Health Ministry, Jerusalem; †Clinical Pharmacology Unit; and ‡Neurology Clinic, Haemek Medical Center, Afula, Israel.
authors.forename: Barak
authors.initials: B
authors.lastname: Shapira
authors.forename: Lee
authors.initials: L
authors.lastname: Goldstein
authors.forename: Amikam
authors.initials: A
authors.lastname: Reshef
authors.forename: Alina
authors.initials: A
authors.lastname: Poperno
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D003503:Cyclobutanes / Q000009:adverse effects*; D003863:Depression / Q000188:drug therapy; D005260:Female; D006801:Humans; D011596:Psychomotor Disorders / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000928:Antidepressive Agents; D003503:Cyclobutanes; C058254:sibutramine