Your sister takes something from the supplement aisle for weight and tells you it works. Two bottles of your own are sitting in the cupboard from last year, and since you bought them you have started a prescription. What you want to know is whether taking any of it alongside what you are on now is a problem.
Two questions get you most of the way, and neither is about whether the pills do anything: what gets checked before a bottle reaches a shelf, and what has been found inside bottles once somebody tested them. Run both against the exact product in your hand, and you will know what to tell your prescriber before you take another one.
Supplements are not approved before they go on sale, and prescription drug ingredients have repeatedly been found hidden inside weight-loss ones. One of those hidden ingredients was withdrawn from the United States market in December 2010 after data showed it raised the risk of heart attack and stroke. That is why what can sit alongside your prescription is a question for the person who writes it, and why looking the exact product up first makes that conversation a short one.
What gets checked before a supplement reaches the shelf
Before a supplement reaches the shelf, nobody federal checks the product itself: FDA does not approve dietary supplements, vitamins or other non-drug products before they are sold. Generally, manufacturers do not need to register their products or get approval before producing or selling them, and supplements do not have to go through the testing that drugs do.
Where you buy one is not a screen either. Products contaminated with hidden ingredients have been found in social media advertisements, in pharmacies, gas stations, convenience stores and supplement stores, and in salons and spas. A pharmacy carrying a bottle has stocked it, not vetted it.
A prescription label works the other way round, and the directions on one are written for situations a supplement bottle never mentions. Stopping when a pregnancy is recognized, stopping a set stretch of time before trying for one, and weighing breastfeeding against why the medicine was prescribed are all on the semaglutide label — three directions that depend on somebody knowing you are pregnant, might be, or are feeding an infant. Nothing on a fat-burner label carries a direction of that kind, and nobody at the register is going to ask you the question that would prompt it.
The prescription drugs hidden in weight-loss supplements
The prescription drugs hidden in weight-loss supplements are ingredients the label does not list at all. Active prescription drug ingredients not listed on the product label have turned up in products sold as all-natural weight loss supplements, and the one named in that example is sibutramine.
Sibutramine is a controlled substance and was the active ingredient in Meridia, a prescription obesity drug approved in 1997 and withdrawn from the US market in December 2010 after data indicated it raised the risk of heart attack and stroke. In someone with no history of health problems at all, a product carrying enough of it can cause increased blood pressure, tachycardia, palpitations and seizure. The risk is larger again for anyone with a history of coronary artery disease, congestive heart failure, arrhythmias or stroke.
This is the part that reaches you if you already take something. Sibutramine may interact, in life-threatening ways, with other medications a person is taking, and a hidden ingredient is by definition absent from the list you would hand a pharmacist to check. It was one of nine drugs FDA laboratory tests found in over-the-counter weight-loss products; the others include fluoxetine, furosemide, a second prescription diuretic, a seizure medicine, a laxative, and three weight drugs never approved for sale in the United States.
Chest pain or tightness, fainting, palpitations, shortness of breath or heavy sweating after taking one of these is a 911 call right away rather than a next-morning one. Anything milder that started when you started the bottle is worth telling your prescriber about the same day, with the bottle in your hand.
How to look up a bottle before you buy it
Look a bottle up by name in FDA's health fraud product database, which lists unapproved products that have been subject to health-fraud violations, including undeclared ingredients. Search the brand and the product name exactly as they are printed on the front, including any words you would skip over.
A hit means that product has been caught. An empty search is not a clearance: the list covers only a small fraction of the potentially hazardous products marketed to consumers online and in retail stores. Treat it as the start of the conversation with your prescriber rather than the end of it.
The wording on the package is worth reading as a warning rather than a pitch. Claims that seem too good to be true, rave reviews touting the effectiveness, and the words herbal or all natural are what consumers are told to read as warning signs. Talk to a health care professional before buying or trying a new product for your health, and tell your health care provider about any dietary supplements you use — which includes the two bottles from last year.
The two bottles in your cupboard
- Write down the brand and product name from each label, exactly as printed.
- Search both in FDA's health fraud product database before you take either.
- Add both to the medication list you give your prescriber and your pharmacist, under those same names.
- Ask your prescriber the direct question: does either of these belong alongside what I am taking now.
- Ask your sister for the name of hers and run it the same way, whatever you decide about your own.
Nobody analyzed the bottle in your cupboard, so what you can get instead is the record of what the product on its label has been caught carrying — and the name of it written down in front of the person who prescribes for you. That is a smaller answer than the one you wanted, and it is the one that reaches the appointment.
