Citation

Bertholee D, Ter Horst PGJ, Wieringa A, Smit JP. Ned. Tijdschr. Geneeskd. 2014; 158(2).

Copyright

(Copyright © 2014, Erven Bohn)

DOI

unavailable

PMID

unavailable

Abstract

Introduction In some countries and on the internet are numerous weight loss products freely available, which can be contaminated with compounds not mentioned on the label, such as sibutramine, possibly causing severe side-effects. Case description We describe a 43-year-old woman who was brought into the emergency ward of our hospital after stabbing herself in the stomach with a knife, because of severe psychosis. The patients' psychiatric history and family history were blank and she did not use any kind of medication. She was admitted to the psychiatric ward and diagnosed according to the DSM-IV criteria as paranoid psychotic disorder with imperative acoustic and visual hallucinations. During the first three days of her admission she repeatedly tried to commit suicide again. She was treated with antipsychotic and sedative medication and nursed in separation. A few days after admission her symptoms were completely gone. The most likely explanation for the psychosis is the use of sibutramine contaminated weight loss coffee (Brazil Potent Slimming Coffee). We analysed a sample of the coffee and confirmed the presence of sibutramine with liquid chromatography tandem mass spectrometry in a concentration of 1.6-2.5 mg/g. We estimated the daily intake of our patient at 40 mg, since she consumed 2 cups of Brazil Potent Slimming Coffee á 10 g per day during a period of 2 weeks. Sibutramine used to be registered as a weight loss drug in a standard daily dose of 10-15 mg. Sibutramine has been withdrawn from the Dutch market in 2010 due to the increased risk of cardiovascular complications. In addition, several case-reports describe neuro-psychiatric adverse effects as a consequence of sibutramine use.

CONCLUSION Brazil Potent Slimming Coffee and possibly also other weight loss products can be contaminated with sibutramine in high doses and as a result cause severe adverse reactions. It is always important to collect information about patients' use of herbal supplements and other freely available medicines.

Language: nl

Keywords

adult; human; suicide; female; case report; psychiatry; disease severity; article; stab wound; weight reduction; mass spectrometry; hospital admission; automutilation; hallucination; emergency ward; paranoid psychosis; DSM-IV; medical history; coffee; visual hallucination; sibutramine; acoustic hallucination