These findings were based on 727 CHP-related adverse event reports submitted to the Singapore Health Sciences Authority (HSA) between 2017 and 2023. <\/p>\n
CHPs include Chinese Proprietary Medicines, health supplements, and traditional medicines such as Malay traditional medicine, Jamu, and Ayurvedic medicine. <\/p>\n
The most common reasons for using CHPs were pain relief (33%), followed by general health and wellbeing (21%) and weight management (9%). <\/p>\n
The analysis, published in Frontiers in Medicine, also revealed that pain relief products were most frequently adulterated with pharmaceutical ingredients, highlighting an ongoing safety concern despite CHPs\u2019 generally safe profile. <\/p>\n
Skin reactions most commonly driven by glucosamine products <\/p>\n
Skin reactions were the most frequently reported adverse events associated with CHP use, accounting for nearly 60% of cases. Symptoms ranged from rash and itching to swelling around the eyes and face. <\/p>\n
In particular, glucosamine-containing products accounted for approximately 65% of these skin-related reports, followed by melatonin-containing supplements and products containing dried ivy leaf extract. <\/p>\n
\u201cGlucosamine supplements, widely available in Singapore\u2019s hospitals, clinics, retail pharmacies, and online platforms, have gained popularity as a potential treatment for joint pain and arthritis, being generally considered safe. This accessibility may lead to increased usage without adequate consideration of potential risks,\u201d researchers wrote. <\/p>\n
Glucosamine is typically derived from shellfish, hence may trigger allergic reactions in sensitive individuals. <\/p>\n
\u201cThis manufacturing origin creates an inherent allergenic potential that may not be immediately apparent to consumers or adequately communicated through product labelling,\u201d the researchers added. <\/p>\n
General disorders such as pain, fever and swelling were the second most commonly reported adverse events associated with CHP use, followed by liver disorders, such as liver injury, hepatitis, abnormal liver function and jaundice. Endocrine disorders ranked fourth, primarily due to Cushing\u2019s syndrome linked to products adulterated with corticosteroids. <\/p>\n
HSA flags adulterated pain relief products <\/p>\n
Almost seven in 10 (68.1%) CHP-related adverse events were due to health supplements use. <\/p>\n
Chinese Proprietary Medicines were the second largest contributor to CHP-related adverse events, with one in 10 cases (10.7%) linked to its use. The remaining 22.8% of cases were linked to the use of other traditional medicines.<\/p>\n
According to the researchers, the easy accessibility of these products in pharmacies, health stores and online marketplaces, coupled with their \u201cnatural\u201d marketing stance, may lead consumers to perceive them as safe and use them for prolonged periods without medical guidance. <\/p>\n
Adulteration test<\/p>\n
While the analysis suggests that CHPs are generally safe, some reported symptoms were detrimental to health, which prompted researchers to test these products for adulteration. <\/p>\n
Of the 727 CHPs, only 10% of products were tested. The remaining 90% were not tested due to product unavailability, insufficient evidence linking adverse events to the products, and products that are already known to contain adulterants based on publicly available information. <\/p>\n
Among the tested products, 77% of products were found to contain undeclared drugs, with some containing as many as six adulterants. <\/p>\n
The majority (60%) of adulterated products were marketed for treating rheumatic joint pain, knee pain, back pain, gout pain, and inflammation. <\/p>\n
These products typically contain non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, as well as oral steroids including dexamethasone and prednisolone. Researchers flagged this as a significant concern \u201cas prolonged usage of NSAIDs may lead to cardiovascular complications, including myocardial infarction and stroke.\u201d <\/p>\n
An example of a product containing six adulterants is \u201cTraditional Herbs Preparation XPE\u201d marketed for joint pain. The product contains a steroid, an antihistamine, ibuprofen, a cholesterol-lowering medicine, and two antibiotics. A patient who consumed it for over nine months reported worsening joint pain when attempting to reduce or cease usage. <\/p>\n
Another example is a muscle pain relief product called \u201cCHONG CAO DAN\u201d, which was found to be adulterated with chlorpheniramine, dexamethasone, and furosemide. A patient developed Cushing\u2019s syndrome after consuming the product for two to three years. <\/p>\n
The researchers warned that prolonged exposure to these undeclared drugs in CHPs may lead to increased risk of cardiovascular events, diabetes, hypertension, increased susceptibility to infection and steroid-induced Cushing\u2019s syndrome. <\/p>\n
Regulatory implications <\/p>\n
While CHPs are generally considered safe, the findings show that they can still cause adverse events ranging from mild skin reactions to severe medical complications, particularly when products are adulterated with undeclared pharmaceutical ingredients. <\/p>\n
With CHPs now becoming increasingly popular for maintaining health and treating minor ailments, researchers at HSA emphasised the need for continued post-market surveillance through targeted laboratory testing, as well as consumer vigilance to safeguard public health. <\/p>\n
The widespread availability of health supplements at pharmacies, health stores, and online platforms leads to higher consumption rates and consequently higher reporting rates of adverse events. Getty Images <\/p>\n