by Kristina Fiore

Diet pills that are adulterated with undeclared pharmaceutical ingredients can be addictive, researchers say.

In a case report, a 29-year-old female patient became addicted to Brazilian diet pills that contained unlabeled ingredients, and suffered subsequent psychiatric comorbidities, Benjamin R. Smith, BS, and Pieter A. Cohen, MD, of Harvard Medical School reported in The American Journal on Addictions.

“Given the rising prevalence of adulterated diet pills, increasing awareness among clinicians of their use and addictive potential is critical,” they wrote.

The FDA has issued several warnings on diet pills with undeclared ingredients, specifically amphetamine-based ones from Brazil.

In this most recent case, the woman’s Brazilian diet pills contained amphetamine and a selective serotonin reuptake inhibitor.

The woman presented with feelings of hopelessness, inability to sleep, and dependence on the pills. She had a history of emotional and physical trauma, as well as depressive symptoms and paranoia with auditory and visual hallucinations.

One month prior to presentation, she took an unknown amount of acetaminophen and ibuprofen and superficially cut her wrist in a suicidal gesture.

She reported taking the Brazilian diet pills for four years, and had gone into debt to purchase the pills from an acquaintance, spending $160 per month.

She reported various symptoms that she attributed to the pills, including trembling, sweating, and excessive sleepiness. When she tried to quit, she would experience cravings, tremor, headache, and anxiety.

The researchers said she exhibited all the symptoms of dependence — tolerance, increasing use at significant financial cost, inability to stop despite adverse effects, and withdrawal.

So they analyzed the pills via gas chromatography and mass spectrometry, finding fenproporex (a precursor to amphetamine), chlordiazepoxide, and fluoxetine. They said all these components could have contributed to the woman’s depression, anxiety, and hallucinations, as well as her dependence on the pills.

She was treated with a regimen of fluoxetine and aripiprazole, and subsequently showed improvement, the researchers said. Three months later, she was able to discontinue her diet pill use.

“This case highlights the importance of incorporating screening for [use of nonprescription diet pills] into evaluations by primary care providers, psychiatrists, and addiction specialists,” they wrote. “These products may cause dependence, exacerbate existing psychiatric symptoms, and complicate the management of psychiatric disorders.”

Diet pills with unlabeled ingredients are nothing new, the researchers said. In the 1960s, “rainbow pills” contained amphetamines, diuretics, thyroid hormone, and cardiac glycosides. They were banned after their use was linked to sudden cardiac deaths.

In the 1980s, diet pills comprised of amphetamines, benzodiazepines, thyroid hormone, and diuretics appeared in Europe and South America. They’ve long been banned but remain widely available, the researchers said.

They also cautioned about the potential for adulterated pill use to lead to drug-drug interactions and supratherapeutic dosing.

Kristina Fiore is a MedPage Today staff writer.

Originally published in MedPage Today. Visit MedPageToday.com for more nutrition news.