{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T06:15:46Z","timestamp":1783664146236,"version":"3.55.0"},"reference-count":83,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The use of complementary health products (CHPs), including Chinese Proprietary Medicines (CPMs), health supplements, traditional medicines and homeopathic medicines, has become increasingly prevalent in Singapore's multicultural society. While these products are widely used for maintaining health and treating minor ailments and are generally safe, potential adverse effects have been reported. This study analyzes adverse event reports related to CHPs submitted to Singapore Health Sciences Authority (HSA) from 2017 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AE reports involving CHPs assessed by the Vigilance and Compliance Branch (VCB) of HSA from 2017 to 2023 were collated and analyzed. The analysis included patient demographics, AE details, suspected product information, medical history, laboratory results, concomitant therapies, and reporter's profession.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 182,131 AE reports associated with pharmaceutical products and CHPs, 727 reports (0.4%) were associated with CHPs. Health supplements accounted for the highest number of reports (68% of total). \u201cSkin and appendages disorders\u201d were the most commonly reported system organ class, with glucosamine-containing products accounting for the highest number of adverse events. Patients primarily used CHPs for pain relief (33.1%), general health and wellbeing (20.6%), and weight management (8.8%). Products found to contain undeclared illegal substances were most frequently indicated for pain relief. The three most common adulterants were dexamethasone, chlorpheniramine, and prednisolone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>While CHPs are generally safe, adulterated products, especially those from dubious sources, pose real health risks. Healthcare professionals and consumers should remain vigilant about potential adulteration and report suspected CHPs related AEs. Even when causality remains unclear, reporting supports timely regulatory actions when concerning patterns emerge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study examined 727 adverse event reports associated with CHPs between 2017 and 2023, accounting for 0.4% of all reported adverse events. Health supplements were the most frequently reported category, with glucosamine-containing products accounting for the highest number of adverse events, predominantly affecting the skin. Products found to contain undeclared illegal substances were most frequently indicated for pain relief, with dexamethasone, chlorpheniramine, and prednisolone being the most common adulterants found. These findings highlight the need for continued vigilance in the monitoring of CHPs to safeguard public health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1872698","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:38:16Z","timestamp":1783661896000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of adverse event reports associated with complementary health products in Singapore from 2017 to 2023"],"prefix":"10.3389","volume":"13","author":[{"given":"Yi-Ling","family":"Quek","sequence":"first","affiliation":[{"name":"Pharmaceutical Division, Applied Sciences Group, Health Sciences Authority","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Zeng","sequence":"additional","affiliation":[{"name":"Pharmaceutical Division, Applied Sciences Group, Health Sciences Authority","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowei","family":"Ge","sequence":"additional","affiliation":[{"name":"Pharmaceutical Division, Applied Sciences Group, Health Sciences Authority","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Yong","family":"Low","sequence":"additional","affiliation":[{"name":"Pharmaceutical Division, Applied Sciences Group, Health Sciences Authority","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suet-Leng P.","family":"Ng","sequence":"additional","affiliation":[{"name":"Vigilance and Compliance Branch, Health Products Regulation Group, Health Sciences Authority","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mun-Yee","family":"Tham","sequence":"additional","affiliation":[{"name":"Vigilance and Compliance Branch, Health Products Regulation Group, Health Sciences Authority","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Soh","sequence":"additional","affiliation":[{"name":"Vigilance and Compliance Branch, Health Products Regulation Group, Health Sciences Authority","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.ctim.2004.11.002","article-title":"Complementary and alternative medicine use in multiracial Singapore","volume":"13","author":"Lim","year":"2005","journal-title":"Complement Ther Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"749","DOI":"10.47102\/annals-acadmedsg.V35N11p749","article-title":"Complementary and alternative medicine, and traditional Chinese medicine: time for critical engagement","volume":"35","author":"Lee","year":"2006","journal-title":"Ann Acad Med Singap."},{"key":"B3","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1093\/fampra\/cmh613","article-title":"Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs","volume":"21","author":"Lee","year":"2004","journal-title":"Fam Pract."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.1093\/ndt\/gfm167","article-title":"For patients taking herbal therapy\u2014lessons from aristolochic acid nephropathy","volume":"22","author":"Nortier","year":"2007","journal-title":"Nephrol Dial Transplant."},{"key":"B5","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1016\/j.jep.2012.01.051","article-title":"Pharmacovigilance of herbal medicine","volume":"140","author":"Shaw","year":"2012","journal-title":"J Ethnopharmacol."},{"key":"B6","unstructured":"WHO Guidelines on Safety Monitoring of Herbal Medicines in Pharmacovigilance Systems\n          \n          2004"},{"key":"B7","unstructured":"Health Supplements Guidelines\n          \n          2024"},{"key":"B8","unstructured":"Guidelines on Chinese Proprietary Medicines Product Listing\n          \n          2025"},{"key":"B9","unstructured":"Traditional Medicines Guidelines\n          \n          2024"},{"key":"B10","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.healthpol.2003.09.013","article-title":"Regulatory control of Chinese Proprietary Medicines in Singapore","volume":"71","author":"Yee","year":"2005","journal-title":"Health Policy."},{"key":"B11","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1080\/15563650600795578","article-title":"Safety evaluation and adverse events monitoring by poison control centers: a framework for herbs and dietary supplements","volume":"44","author":"Woolf","year":"2006","journal-title":"Clin Toxicol."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/87.2.509S","article-title":"Ensuring the safety of botanical dietary supplements","author":"van Breemen","year":"2008","journal-title":"Am J Clin Nutr."},{"key":"B13","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/j.taap.2009.12.005","article-title":"Assessment of herbal medicinal products: challenges, and opportunities to increase the knowledge base for safety assessment","volume":"243","author":"Jordan","year":"2010","journal-title":"Toxicol Appl Pharmacol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"438139","DOI":"10.1155\/2013\/438139","article-title":"Herbal medicines: Malaysian women's knowledge and practice","volume":"2013","author":"Sooi","year":"2013","journal-title":"Evid Based Complement Alternat Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"481","DOI":"10.3109\/15563650.2012.700402","article-title":"Adverse events associated with the use of complementary medicine and health supplements: an analysis of reports in the Singapore Pharmacovigilance database from 1998 to 2009","volume":"50","author":"Patel","year":"2012","journal-title":"Clin Toxicol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"167","DOI":"10.3389\/fmed.2018.00167","article-title":"Retrospective study of reported adverse events due to complementary health products in Singapore from 2010 to 2016","volume":"5","author":"Xu","year":"2018","journal-title":"Front Med."},{"key":"B17","unstructured":"Adverse Event Reporting Form\n          \n          2022"},{"key":"B18","unstructured":"The Use of the WHO-UMC System for Standardised Case Causality Assessment\n          \n          2013"},{"key":"B19","unstructured":"Uppsala Monitoring Centre\u2014Accessing Global Data with VigiBase Analysis and Search Services\n          \n          2024"},{"key":"B20","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1007\/978-3-211-89836-9_1467","author":"WHO-Adverse","year":"2009","journal-title":"Dictionary of Pharmaceutical Medicine"},{"key":"B21","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1016\/S0731-7085(00)00571-9","article-title":"HPLC and GC-MS screening of Chinese proprietary medicine for undeclared therapeutic substances","volume":"24","author":"Liu","year":"2001","journal-title":"J Pharm Biomed Anal."},{"key":"B22","unstructured":"HSA Alert: Four Products Found to Contain Potent Medicinal Ingredients Including Steroids and Banned Substance; Four Consumers Had Adverse Effects After Consuming Three of the Products\n          \n          2023"},{"key":"B23","doi-asserted-by":"publisher","first-page":"7597596","DOI":"10.1155\/2017\/7597596","article-title":"Radix bupleuri: a review of traditional uses, botany, phytochemistry, pharmacology, and toxicology","volume":"2017","author":"Yang","year":"2017","journal-title":"Biomed Res Int."},{"key":"B24","unstructured":"HSA Alert: Two Consumers Experienced Adverse Effects After Taking Products with Potent Undeclared Ingredients\n          \n          2022"},{"key":"B25","unstructured":"HSA Alert: Consumer Developed Diabetes & Other Adverse Reactions After Taking \u2018PHQ 1001 Khasiat Penawar Herba Qaseh Serata Herb' Which Contains Undeclared Potent Western Medicines\n          \n          2017"},{"key":"B26","unstructured":"HSA Alert: \u2018Lung Tan Tsao' and \u2018Candy B\n          \n          2020"},{"key":"B27","unstructured":"HSA Alert: \u2018D'sihat Herba Gout & Sendi' & \u2018Yanwo Chongcao Yanyin Qinfei Huatan Dan' Found to Contain Potent Medicinal Ingredients; One Consumer Hospitalised, Another Had Serious Adverse Effects\n          \n          2023"},{"key":"B28","unstructured":"HSA Alert: A Consumer Was Hospitalised in ICU and Another Developed Serious Adverse Reactions After Taking Health Products Bought Overseas\n          \n          2017"},{"key":"B29","unstructured":"HSA Alert: Five Products Detected to Contain Potent Medicinal Ingredients Including Steroids; Two Consumers Experienced Serious Adverse Effects\n          \n          2022"},{"key":"B30","unstructured":"HSA Alert: Three Products Found with Undeclared Potent Medicinal Ingredients; One Led to Serious Adverse Reaction in Consumer\n          \n          2019"},{"key":"B31","unstructured":"HSA Alert: Three Products Found to Contain Potent Medicinal Ingredients, Including Steroids and High Levels of Banned Substance Sibutramine; Two Consumers Developed Adverse Effects\n          \n          2023"},{"key":"B32","unstructured":"HSA Alert: \u2018Clinic K' and \u2018RO Slim Booster' Found to Contain Banned Substance, \u2018Rozell Detox' Detected with Potent Laxative\n          \n          2020"},{"key":"B33","unstructured":"HSA Alert: Four Products Detected with Potent Undeclared Ingredients; One Consumer Had a Life-Threatening Event and Severe Heart Failure\n          \n          2019"},{"key":"B34","unstructured":"HSA Alert: Four Products Sold Online Found to Contain Potent or Banned Ingredients Including High Levels of Arsenic and Sibutramine; Two Consumers Suffered Adverse Effects\n          \n          2023"},{"key":"B35","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s40545-023-00645-x","article-title":"Abd","volume":"16","author":"Ang","year":"2023","journal-title":"J of Pharm Policy and Pract"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e26893","DOI":"10.7759\/cureus.26893","article-title":"Clinical implications of herbal supplements in conventional medical practice: a US perspective","volume":"14","author":"Hassen","year":"2022","journal-title":"Cureus."},{"key":"B37","doi-asserted-by":"publisher","first-page":"S12","DOI":"10.1016\/j.semarthrit.2015.11.011","article-title":"Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: evidence from real-life setting trials and surveys","volume":"45","author":"Bruy\u00e8re","year":"2016","journal-title":"Semin Arthritis Rheum."},{"key":"B38","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.fct.2004.11.006","article-title":"Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy","volume":"43","author":"Anderson","year":"2005","journal-title":"Food Chem Toxicol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/2045-7022-1-3","article-title":"Bahna SL","volume":"1","author":"Woo","year":"2011"},{"key":"B40","unstructured":"Population Trends\n          \n          2023"},{"key":"B41","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s41999-021-00481-9","article-title":"Adverse drug reactions in older adults: a narrative review of the literature","volume":"12","author":"Zazzara","year":"2021","journal-title":"Eur Geriatr Med."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1432","DOI":"10.1111\/bcp.13590","article-title":"The relationship between frailty and polypharmacy in older people: a systematic review","volume":"84","author":"Gutierrez-Valencia","year":"2018","journal-title":"Br J Clin Pharmacol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"67","DOI":"10.4103\/jehp.jehp_630_22","article-title":"Prevalence of self-medication among the elderly: a systematic review and meta-analysis","volume":"12","author":"Rafati","year":"2023","journal-title":"J Edu Health Promot."},{"key":"B44","doi-asserted-by":"publisher","first-page":"640","DOI":"10.2174\/1389200211209050640","article-title":"Herb-drug interactions and mechanistic and clinical considerations","volume":"13","author":"Chen","year":"2012","journal-title":"Curr Drug Metab."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1378208","DOI":"10.3389\/fphar.2024.1378208","article-title":"Adverse events associated with herbal medicine products reported in the Korea adverse event reporting system from 2012 to 2021","volume":"15","year":"2024","journal-title":"Front Pharmacol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"21476","DOI":"10.1038\/s41598-021-00704-w","article-title":"A system for reporting and evaluating adverse drug reactions of herbal medicine in Taiwan from 1998 to 2016","volume":"11","author":"Chang","year":"2021","journal-title":"Sci Rep."},{"key":"B47","doi-asserted-by":"publisher","first-page":"100188","DOI":"10.1016\/j.eclinm.2019.10.001","article-title":"Reported adverse drug reactions in women and men: aggregated evidence from globally collected individual case reports during half a century","volume":"17","author":"Watson","year":"2019","journal-title":"eClinicalMedicine."},{"key":"B48","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s00228-008-0494-6","article-title":"Women encounter ADRs more often than do men","volume":"64","author":"Zopf","year":"2008","journal-title":"Eur J Clin Pharmacol."},{"key":"B49","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1186\/1472-6882-14-463","article-title":"Gender differences in prevalence and associations for use of CAM in a large population study","volume":"14","author":"Kristoffersen","year":"2014","journal-title":"BMC Complement Altern Med."},{"key":"B50","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.jsps.2013.02.003","article-title":"Factors affecting the development of adverse drug reactions","volume":"22","author":"Alomar","year":"2014","journal-title":"Saudi Pharm J."},{"key":"B51","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1093\/ecam\/nen023","article-title":"Who uses CAM? A narrative review of demographic characteristics and health factors associated with CAM use","volume":"7","author":"Bishop","year":"2010","journal-title":"Evid Based Complement Alternat Med"},{"key":"B52","doi-asserted-by":"publisher","first-page":"1088841","DOI":"10.3389\/fphar.2023.1088841","article-title":"Suspected cutaneous adverse drug reactions reported with traditional medicines: analysis of data for United Nations Asia region from WHO VigiBase","volume":"14","author":"Barvaliya","year":"2023","journal-title":"Front Pharmacol."},{"key":"B53","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1046\/j.1365-2133.2000.03822.x","article-title":"Adverse effects of herbal drugs in dermatology","volume":"143","author":"Ernst","year":"2000","journal-title":"Br J Dermatol."},{"key":"B54","doi-asserted-by":"publisher","first-page":"7","DOI":"10.7861\/clinmedicine.13-1-7","article-title":"Adverse effects of herbal medicines: an overview of systematic reviews","volume":"13","author":"Posadzki","year":"2013","journal-title":"Clin Med."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1038\/jid.2009.133","article-title":"Epidermal barrier dysfunction in atopic dermatitis","volume":"129","author":"Cork","year":"2009","journal-title":"J Invest Dermatol."},{"key":"B56","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1111\/j.1600-0536.2010.01800.x","article-title":"Genetic factors in contact allergy - review and future goals","volume":"64","author":"Schnuch","year":"2011","journal-title":"Contact Dermatitis."},{"key":"B57","unstructured":"HSA ADR News Bulletin Dec 2022, Vol. 24.\n          \n          2022"},{"key":"B58","doi-asserted-by":"publisher","first-page":"588","DOI":"10.3390\/ijms17050588","article-title":"Herbal hepatotoxicity: clinical characteristics and listing compilation","volume":"17","author":"Frenzel","year":"2016","journal-title":"Int J Mol Sci."},{"key":"B59","doi-asserted-by":"publisher","first-page":"2414","DOI":"10.3748\/wjg.15.2414","article-title":"Dario di Minno MN, Milone F, Pezzullo LS, Milone M, et al. Drug-induced liver injury due to \u201cnatural products\u201d used for weight loss: a case report","volume":"15","author":"Tarantino","year":"2009","journal-title":"World J Gastroenterol"},{"key":"B60","unstructured":"Review on the toxic effects of radix bupleuri\n          \n          3\n          7\n          \n            \n              Liu Yamin\n              LiZ\n            \n            \n              Liu\n              X\n            \n            \n              Pan\n              R\n            \n          \n          Curr Opin Complement Alternat Med\n          1\n          2014"},{"key":"B61","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1007\/BF02212712","article-title":"Liver injuries induced by herbal medicine, Syo-saiko-to (xiao-chai-hu-tang)","volume":"40","author":"Itoh","year":"1995","journal-title":"Digest Dis Sci."},{"key":"B62","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/S1726-4901(09)70119-4","article-title":"Acute hepatitis induced by Chinese hepatoprotective herb, xiao-chai-hu-tang","volume":"69","author":"Hsu","year":"2006","journal-title":"J Chin Med Assoc."},{"key":"B63","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1002\/hep.28813","article-title":"Liver injury from herbal and dietary supplements","volume":"65","author":"Navarro","year":"2017","journal-title":"Hepatology."},{"key":"B64","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s00204-015-1471-3","article-title":"Hepatotoxicity of herbal and dietary supplements: an update","volume":"89","author":"Stickel","year":"2015","journal-title":"Arch Toxicol."},{"key":"B65","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1111\/j.1365-2125.2012.04395.x","article-title":"Herbal hepatotoxicity: a critical review","volume":"75","author":"Teschke","year":"2013","journal-title":"Br J Clin Pharmacol."},{"key":"B66","doi-asserted-by":"publisher","first-page":"537","DOI":"10.3390\/ijms17040537","article-title":"Hepatotoxicity by dietary supplements: A tabular listing and clinical characteristics","volume":"17","author":"Garc\u00eda-Cortes","year":"2016","journal-title":"Int J Mol Sci."},{"key":"B67","doi-asserted-by":"publisher","first-page":"878","DOI":"10.14309\/ajg.0000000000001259","article-title":"Clinical guideline: Diagnosis and management of idiosyncratic drug-induced liver injury","volume":"116","author":"Chalasani","year":"2021","journal-title":"Am J Gastroenterol."},{"key":"B68","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1517\/14740338.2013.828032","article-title":"Idiosyncratic drug-induced liver injury: an update on the 2007 overview","volume":"13","author":"Hussaini","year":"2014","journal-title":"Expert Opin Drug Saf."},{"key":"B69","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s00228-012-1353-z","article-title":"Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews","volume":"69","author":"Posadzki","year":"2013","journal-title":"Eur J Clin Pharmacol."},{"key":"B70","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/j.clnesp.2023.09.919","article-title":"Association between potential supplement-drug interactions and liver diseases in patients with cancer: a large prospective cohort study","volume":"58","author":"Lam","year":"2023","journal-title":"Clin Nutrit ESPEN."},{"key":"B71","doi-asserted-by":"publisher","first-page":"e1144","DOI":"10.7759\/cureus.1144","article-title":"Cardiovascular risk of nonsteroidal anti-inflammatory drugs: an under-recognized public health issue","volume":"9","author":"Varga","year":"2017","journal-title":"Cureus."},{"key":"B72","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1177\/1715163513481569","article-title":"Cardiovascular risk: are all NSAIDs alike?","volume":"146","author":"Pawlosky","year":"2013","journal-title":"Can Pharm J."},{"key":"B73","first-page":"203","article-title":"Steroids: pharmacology, complications, and practice delivery issues","volume":"14","author":"Ericson-Neilsen","year":"2014","journal-title":"Ochsner J."},{"key":"B74","doi-asserted-by":"publisher","first-page":"258","DOI":"10.7861\/clinmedicine.17-3-258","article-title":"Adrenal insufficiency - recognition and management","volume":"17","author":"Pazderska","year":"2017","journal-title":"Clin Med."},{"key":"B75","unstructured":"European\n              Medicines Agency\n            \n          \n          European Medicines Agency Recommends Suspension of Marketing Authorisations for Sibutramine\n          \n          2010"},{"key":"B76","unstructured":"FDA Drug Safety Communication: FDA Recommends Against the Continued Use of Meridia (Sibutramine)\n          \n          2010"},{"key":"B77","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1080\/14740338.2020.1806234","article-title":"The risk of cardiovascular complications with current obesity drugs","volume":"19","author":"Chao","year":"2020","journal-title":"Expert Opin Drug Saf."},{"key":"B78","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/j.jpba.2011.08.028","article-title":"X-ray powder diffractometry and liquid chromatography studies of sibutramine and its analogues content in herbal dietary supplements","volume":"56","author":"Stypulkowska","year":"2011","journal-title":"J Pharm Biomed Anal."},{"key":"B79","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1080\/19440049.2013.861934","article-title":"Screening and determination of sibutramine in adulterated herbal slimming supplements by HPTLC-UV densitometry","volume":"31","author":"Mathon","year":"2014","journal-title":"Food Addit Contam: Part A."},{"key":"B80","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1007\/s40264-022-01180-5","article-title":"Analysis of reports on adverse drug reactions related to herbal medicinal products and herbal supplements in the Netherlands received by the National Pharmacovigilance Centre Lareb","volume":"45","author":"van Hunsel","year":"2022","journal-title":"Drug Saf."},{"key":"B81","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.2165\/00003495-200565090-00005","article-title":"Herb-drug interactions: a literature review","volume":"65","author":"Hu","year":"2005","journal-title":"Drugs."},{"key":"B82","doi-asserted-by":"publisher","first-page":"829","DOI":"10.2165\/00002018-200326120-00001","article-title":"Pharmacovigilance of herbal medicines: a UK perspective","volume":"26","author":"Barnes","year":"2003","journal-title":"Drug Saf."},{"key":"B83","doi-asserted-by":"publisher","first-page":"112762","DOI":"10.1016\/j.fct.2021.112762","article-title":"Unpredictable adverse effects of herbal products","volume":"159","author":"Basaran","year":"2022","journal-title":"Food Chem Toxicol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1872698\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:38:18Z","timestamp":1783661898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1872698\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":83,"alternative-id":["10.3389\/fmed.2026.1872698"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1872698","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]},"article-number":"1872698"}}