Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong Special Administrative Region, China.
Clin Toxicol (Phila). 2010 Oct;48(8):832-8. doi: 10.3109/15563650.2010.517208.
Sibutramine, or its structurally related analogs, is often found as an adulterant in proprietary herbal slimming products in Hong Kong. A few solitary case reports of sibutramine-associated psychosis have been published since 2000. As the only tertiary referral center for clinical toxicology analysis in Hong Kong, we noticed that psychosis was an unusually common feature in patients taking "herbal slimming products" adulterated with sibutramine or its structurally related analogs over the past 5 years.
To examine the association between psychosis and the use of sibutramine-adulterated herbal products, in an attempt to elucidate this possible adverse drug reaction.
This retrospective study reviewed all cases hospitalized with psychotic symptoms confirmed to have used herbal slimming products adulterated with sibutramine, or its analogs, between January 2004 and October 2009. The cases' clinical features, outcome, drug history, and analytical findings of the offending slimming products were studied. Results. Among the 16 confirmed cases, 15 (94%) were female; the median age was 19 years (range: 15-47). Auditory hallucination was documented in 10 (63%), visual hallucination in 6 (38%), persecutory ideas in 6 (38%), delusions in 4 (25%), and suicidal ideation in 2 (13%). For 20 "herbal" slimming products analyzed, 16 were found to have been adulterated with sibutramine, 2 with N-desmethyl-sibutramine, and 1 with N-bisdesmethyl-sibutramine. Other concomitant adulterants were also found and included phenolphthalein in 9, fenfluramine, mazindol, animal thyroid tissue in 2, hydrochlorothiazide and spironolactone in 1. Eight patients disclosed the source of the products: four through the Internet, one obtained over-the-counter locally, with three acquired outside Hong Kong.
Slimming products claimed "herbal" in origin could often be adulterated with sibutramine and other Western medications. We observed an association between the use of these products and psychotic features. Further studies are warranted to study whether these adverse events are an uncommon adverse drug reaction of sibutramine.
西布曲明或其结构类似物常被发现作为香港专利草本减肥药中的掺杂物。自 2000 年以来，已经有少数关于西布曲明相关精神病的个案报道。作为香港唯一的临床毒理学分析三级转诊中心，我们注意到，在过去 5 年中，因服用掺有西布曲明或其结构类似物的“草本减肥药”而出现精神病的患者非常常见。
探讨精神病与使用掺有西布曲明的草本产品之间的关系，试图阐明这种可能的药物不良反应。
本回顾性研究对 2004 年 1 月至 2009 年 10 月期间因使用掺有西布曲明或其类似物的草本减肥产品而住院并确诊为精神病的所有病例进行了研究。研究了病例的临床特征、结局、药物史以及掺假减肥产品的分析结果。结果：在 16 例确诊病例中，15 例（94%）为女性；中位年龄为 19 岁（范围：15-47 岁）。记录到 10 例（63%）有听觉幻觉，6 例（38%）有视觉幻觉，6 例（38%）有迫害观念，4 例（25%）有妄想，2 例（13%）有自杀意念。对 20 种“草本”减肥产品进行分析，发现 16 种含有西布曲明，2 种含有 N-去甲基西布曲明，1 种含有 N-双去甲基西布曲明。还发现了其他伴随的掺杂物，包括 9 种酚酞、2 种芬氟拉明、马吲哚、2 种动物甲状腺组织、1 种氢氯噻嗪和螺内酯。8 名患者披露了产品来源：4 名通过互联网，1 名在当地非处方获得，3 名在香港以外获得。
声称“草本”起源的减肥产品往往可能掺有西布曲明和其他西药。我们观察到使用这些产品与精神病特征之间存在关联。需要进一步的研究来研究这些不良事件是否是西布曲明的一种罕见药物不良反应。
