Updated 05 July 2013

Diet pill ban welcomed

For once, DietDoc is pleased with our Health Minister's actions: her banning of over-the-counter sales of diet pills is a step in the right direction.

The actions and pronouncements of our health minister have often puzzled me, particularly in relation to HIV/Aids. But for once I am pleased with Dr Manto Tshabalala-Msimang: she has banned over-the-counter sales of all medications containing ephedrine or nor-pseudo-epinephrine.

Although the amendment to the schedules of the Medicines & Related Substances Act, 101 of 1965, published on 25 April 2008, aims to prevent the direct sale of cold and flu medications that contain any form of epinephrine, so that these products can’t be turned into tik (a highly addictive drug that's widely abused in South Africa), this piece of legislation has also led to the banning of over-the-counter sales of diet pills and potions that contain these substances.

Schedule 2 to Schedule 6
Medications used to treat colds, flu and sinus congestion, plus many diet pills and potions that were previously classified as Schedule 2 products and which could therefore be sold without prescription to consumers, have now been classified as Schedule 6 medicines (CCP, 2008).

Schedule 6 medications can only be purchased if you have a doctor’s prescription.

I'm relieved that diet pills and drops have been made less accessible to the public, as they're extremely addictive and can cause many negative side effects. Just the other day, one of my readers confessed that she's been taking one of these diet products for 16 years! This is a frightening scenario and one that clearly illustrates how addictive ephedrine-containing diet pills can be.

A host of negative side effects
Medications (such as diet pills) that contain ephedrine or pseudo-epinephrine can potentially cause any of the following side effects:

  • dependence
  • addiction
  • tremors
  • insomnia
  • heart palpitations and arrhythmias, which can be fatal
  • irritability
  • psychotic reactions
  • problems with urination, including urine retention
  • sweating
  • dry mouth or excessive secretion of saliva or thirst
  • altered metabolism, particularly of glucose metabolism
  • muscle weakness

(MIMS, May 2008)

No wonder these products have been banned in many countries.

In addition to all the side effects and the potential for abuse, medications that contain ephedrine or pseudo-ephedrine are contra-indicated (this means that they should not be used) by anyone with the following conditions:

  • During pregnancy
  • Patients using medications classed as mono-amine oxidase inhibitors (MAOIs)
  • Patients with heart problems and high blood pressure
  • Individuals suffering from hyperthyroidism (overactive thyroid)
  • Diabetics
  • Patients with closed-angle glaucoma (increased pressure in the eye)

(MIMS, May 2008)

I'm sure that many pregnant women and people suffering from any one of the listed contra-indications, who have been using diet pills containing ephedrine to suppress their appetite, were not aware of the fact that these products are potentially dangerous and even fatal if combined with certain other medications or conditions.

Now at least, such diet pills can only be obtained by first visiting your GP. Your doctor will hopefully take into account that you're diabetic or suffer from heart problems or hypertension and recommend diet and exercise, or prescribe other appetite or slimming products that are less dangerous, to help you lose weight.

Diet dilemma
Anyone who has previously relied on over-the-counter diet pills to suppress their appetite and assist with weight loss will now be faced with a dilemma: if you're seriously hooked on ephedrine-containing pills, you may need to visit a drug dependence clinic to help you through this difficult period.

If you're not yet hooked on diet pills, then for most people your best road to sustained weight loss is to use a low-fat, low-GI (glycaemic index) diet, and exercise daily.

The reason why I would suggest a low-GI diet is that such diets help to keep cravings at bay and also suppress the appetite by ensuring that your blood glucose and insulin levels remain steady throughout the day.

Exercise should be included in your slimming regimen, because it promotes weight loss and helps you stick to your diet. It can also give you that positive ‘lift’ that you used to get from your diet pills by producing chemicals called endorphins in your body.

If you are obese, and need an initial weight-loss boost, discuss the use of Xenical with your doctor. Xenical prevents the uptake of fat from food and thus reduces energy intake.

This is, however, an expensive medication and your doctor should try and motivate that you can obtain Xenical as part of your chronic medication benefit. Xenical is used with a very-low-fat diet and according to feedback from specialists at obesity congresses, patients can achieve highly positive weight-loss results with this product – if it is combined with the correct low-fat diet.

- (Dr I.V. van Heerden, aka DietDoc, June 2008)

(MIMS, 2008. Monthly Index of Medical Specialities. Vol 48, No 5; CCP, 2008 Rescheduling of Ephedrine.


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