The use of slimming products of plant origin, is now a practice particularly widespread and rapid increase in the control weight, since two thirds of the world's adult population was overweight. Consumers have direct access to these products, increasingly shun the advice of your doctor or pharmacist and also relies on product purchases on Web sites, which are supporting its effectiveness. Often the labels on the packages do not contain the information necessary for the safety of the product. In addition, consumers make use of dietary supplements along with conventional drugs, unaware of the potential risks of drug interactions that may suffer. Medicinal plants are commonly used Amorphophallus konjac, chitosan, Cyamoppsis tetragonolobus, conjugated linoleic acid, Ephedra, Garcinia cambogia e Plantago ovata. Un recente studio ha analizzato una serie di sospette reazioni avverse provocate da formulazioni dimagranti di origine vegetale, allo scopo di sensibilizzare un utilizzo responsabile di tali prodotti (1) . Le reazioni sono state a carico del sistema cardiovascolare, pelle, apparato digerente, sistema nervoso centrale, fegato e altri organi come reni tiroide e pancreas. La maggior parte dei prodotti conteneva un elevato numero di componenti. Reazioni cardiovascolari come ipertensione, tachicardia, fibrillazione ventricolare sono state associate a prodotti contenenti Citrus aurantium, guarana, o ma huang, poiché tali sostanze contengono diversi alcaloidi (come sinefrina, caffeina and ephedrine) that stimulate the sympathetic nervous system and increase the risk of arrhythmias, stroke and myocardial infarction. These cardiovascular responses are sufficient to highlight the need for careful consideration when using the medicinal plants that contain cardiac, especially in those subjects with cardiovascular risk factors and / or suffer from hypertension. As regards, however, drugs with anticoagulant activity and / or antiplatelet, these are often implicated in drug-herb interactions, and some medicinal plants contained in the suspect products (for example, dandelion, nettle, papaya) are known to induce isoforms of CYPs enzymes. Therefore, in order to avoid dangerous interactions, older patients with chronic diseases, which are usually treated in polytherapy medication, avoid taking natural remedies. Dietary supplements containing Coleus Forskohlii, were held responsible for any adverse effects to the central nervous system. The root of this plant contain fact, forskolin, which, by activating adenylyl cyclase, increases levels of cyclic adenosine monophosphate (cAMP) stimulates lipolysis in fat cells, and promotes the secretion of thyroid hormone, contributing to the control of weight. In some subjects, the intake of this substance has caused an anticholinergic syndrome. Gastrointestinal disorders in patients treated con preparazioni a base di fibre solubili sono ben noti, tuttavia, un caso ha richiesto ulteriore attenzione. Una giovane donna di 22 anni è stata sottoposta ad un intervento chirurgico a causa di una lesione esofagea dopo una grave ostruzione dovuta all'ingestione di una compressa contenente chitosano, inulina, e altri ingredienti. Per quanto riguarda le reazioni avverse epatiche, sono stati segnalati sei casi di epatite. Due di questi erano legati a prodotti contenenti Garcinia Cambogia. In un caso l'uso di Garcinia Cambogia è stato associato con tè verde e acido linoleico. Un altro caso riguarda una donna di 45 anni di età, asmatica, che è stata ricoverata in ospedale, una settimana dopo l'assunzione per 7 giorni di due weight loss dietary supplements that contain, among other ingredients, Garcinia Cambogia and Citrus aurantium. The patient was on chronic treatment with montelukast, a leukotriene receptor antagonist, from 5 years before the onset of fatal liver failure. Significantly, the citroflavonoids contained in Citrus aurantium may have inhibited the CYP3A4 isoform with a consequent increase in plasma concentration and the relative toxicity of the drug metabolized by the same system. Other adverse reactions have been attributed to dermatological formulations containing Ginkgo biloba. Many products used for weight control contain substances of plant origin with characteristics Drug makers are also well known that side effects are predictable and therefore preventable. For these reasons, some food supplements should be used under strict medical supervision, and not as self-medication. Another recent survey (2) , conducted in Brazil has been using highly sophisticated analytical methods (including electrophoretic and chromatographic techniques, spectroscopic and electrochemical) in order to selectively identify all the components of some formulations slimming herbal medicine, which had provoked reported adverse consumer (headache, insomnia, nausea, chest pain, palpitations and fatigue). The analysis of the products have revealed the presence of active ingredients of synthetic origin added as adulterants in order to make more effective the product at the expense of consumer health. Such sophistication regarding the addition of pharmaceutical agents anorectics, antidepressants and anxiolytics as well as laxatives and diuretics. Have been identified fenproporex, chlordiazepoxide, fluoxetine, and sibutramine. In another study published in Brazil, 50% of samples analyzed were adulterated formulations of benzodiazepines but also from phenolphthalein, spironolactone, furosemide, hydrochlorothiazide and other stimulating agents such as fenfluramine and phenylpropanolamine. In light of the above, in order to improve the quality and safety of supplementi dietetici, risulta importante lo sviluppo di tecniche innovative nel campo della chimica analitica per la caratterizzazione di componenti bioattivi e l'individuazione di adulteranti pericolosi e contaminanti. Allo stesso tempo sarebbe necessario migliorare la qualità dell'informazione nei mezzi di comunicazione di massa con un chiaro ed esplicito profilo del rapporto rischio/beneficio. - Vitalone A, Menniti-Ippolito F, Moro PA, Firenzuoli F, Raschetti R, Mazzanti G. Suspected adverse reactions associated with herbal products used for weight loss: a case series reported to the Italian National Institute of Health. Eur J Clin Pharmacol. 2011 Jan 18.
- de Carvalho LM, Martini M, Moreira AP, de Lima AP, Correia D, Falcão T, Garcia SC, de Bairros AV, do Nascimento PC, Bohrer D. Presence of synthetic pharmaceuticals as adulterants in slimming phytotherapeutic formulations and their analytical determination. Forensic Sci Int. 2011 Jan 30;204(1-3):6-12.
Loreta Longo ed Eugenia Gallo
Istituto di Farmacologia preclinica e clinica
Università degli Studi di Firenze |
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