Severe hepatic injury and adulterated Chinese medicines

doi:10.1136/bmj.332.7536.304-b

BMJ 2006;332:304-305 (4 February), doi:10.1136/bmj.332.7536.304-b

Letter

Severe hepatic injury and adulterated Chinese medicines

The first 150 words of the full text of this article appear below.

EDITOR—The incidence of obesity in the United Kingdomis increasing in parallel with an increase in the use of slimmingaids, including traditional Chinese medicines. The safety andquality of herbal medicines have been weakly regulated becauseof an exemption in the Medicines Act 1968 that allowed themto be marketed without going through stringent criteria requiredfor licensing of normal medicine.¹

Between November 2003 and June 2004 we treated four patientswho developed severe acute liver injury within two months ofstarting to take such a slimming aid (Shubao), widely availablein the West Midlands. Three patients fully recovered on discontinuingthe agent; one patient progressed to fulminant hepatic failure,requiring liver transplantation. Samples of Shubao were forwardedto the Medicines and Healthcare products Regulatory Agency (MHRA),and laboratory analysis showed adulteration with N-nitrosofenfluramine,a recognised hepatotoxin. This derivative of fenfluramine isan appetite suppressant that was . . . [Full text of this article]