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Adulterated Over The Counter Energy Supplements–A Case Report To Reiterate The Need For Regulation Of Herbal Supplements

Ritica Chaudhary, Akhila Aravind, Patrick B Kyle

Numerous herbal and dietary supplements available in the market are gaining popularity as they claim to be natural without synthetic analogs. These pills can be hazardous, as their clinical efficacy and safety have not been proven and they can interact with prescription medication, potentially causing life-threatening side effects in patients with preexisting heart conditions or at risk of stroke. We present the case of a 70-year-old male with a history of hypertension and diabetes who was brought to the emergency after a motor vehicle crash and had altered sensorium and severe bradycardia upon arrival which required external pacing. Paramedics recovered a large amount of over-the-counter “Rhino” pills from his car, which was sent for toxicology analysis. Each pill contained 709 mg of powder from which 100 mg was extracted with methanol and subjected to liquid chromatography-mass spectrometry (Thermo-scientific analyzer) which identified 149.5 mg of sildenafil citrate in the pill contents. The patient recovered well with external pacing and pressor therapy and was discharged after 8 days of hospitalization. Unregulated herbal supplements containing synthetic analogs can result in adverse health effects including emergency department visits and fatalities. The lack of regulation and standardization in the production and distribution of these supplements poses a great risk to consumers and healthcare professionals who may not be aware that their patients are taking such supplements. Reporting such incidents can create awareness and can lead to the strengthening of regulatory procedures.