Unauthorized products may pose serious health risks

Acetaminophen is a drug that can pose serious health risks, including liver damage, if too much is taken. This may lead to liver failure or, in the most severe cases, death. Early signs of taking too much acetaminophen include nausea, vomiting, lethargy, sweating, loss of appetite and pain in the upper part of the abdomen or stomach. Abdominal pain may be the first sign of liver damage and may not be apparent for 24 to 48 hours. Acetaminophen may also cause serious skin reactions. Symptoms include blistering, skin reddening and rash.

Betamethasone dipropionate and clobetasol propionate are highly potent corticosteroid prescription drugs that are applied to the skin to treat inflammatory skin conditions. Side effects include skin irritation and, with prolonged use, skin weakening or deterioration. Adverse effects from using too much include decreased ability to fight infection, symptoms of adrenal gland suppression (i.e., low blood pressure, low blood sugar, weight loss, muscle pain, gastrointestinal problems and severe fatigue) or Cushing's syndrome (i.e., high blood pressure, high blood sugar, weight gain, muscle weakness, bone loss and severe fatigue), depending on how much has been absorbed. These drugs should not be used by pregnant or nursing people.

Ciprofloxacin in oral format (taken by mouth) is a prescription antibacterial drug used to treat bacterial infections of the lungs and airways, urinary system, prostate, skin, soft tissues, bones, and joints. It can also be used to treat diarrhea and certain sexually transmitted diseases caused by bacterial infections. Side effects may include nausea, diarrhea, joint pain, itching, and poor kidney function. Rare but serious side effects include disabling and possibly long-lasting tendonitis (tendon inflammation), tendon rupture (including the Achilles Tendon), nerve damage, neurological problems (including seizures), life-threatening heart issues (including heart electrical problems), myasthenia gravis (muscle disease), liver injury, and serious allergic reactions, including death. It is important to use this drug as directed by a health care professional. Misuse or overuse could lead to bacteria growth that will not be killed by ciprofloxacin, and could lead to bacterial resistance (the drug may not work in the future).

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation (for example, pain and swelling associated with certain types of arthritis). In oral format (taken by mouth), it is a prescription drug. Diclofenac increases the risk of serious heart-related events (such as heart attack and stroke), high blood pressure, stomach or intestinal bleeding or ulcers, severe kidney or liver problems, and bleeding or clotting problems. It should not be used by patients who have: severe heart problems; stomach or intestinal conditions; bleeding disorders; a history of asthma or allergic-type reactions after taking diclofenac, acetylsalicylic acid (ASA) or other NSAIDs; severe kidney or liver problems; or high potassium. It should also not be used by children less than 16 years old, or by people in the third trimester of pregnancy or who are breastfeeding. Use in the first and second trimester of pregnancy must be carefully weighed by a doctor and may require increased monitoring. Diclofenac risks may be higher for patients taking other medications, as well as elderly patients.

Glyburide is a prescription drug used to treat patients with type 2 diabetes. Side effects may include severely low blood sugar (which can be life-threatening), stomach or intestinal problems, and serious skin and hypersensitivity reactions. Glyburide should not be used by people who: are less than 18 years of age; have type 1 diabetes; are pregnant or breastfeeding; or have liver disease or kidney impairment. It should also not be used during times of severe stress, such as during infection, mental stress, physical injury, or surgery. Risks may be higher for patients taking other medications, as well as elderly patients.

Hydroquinone is a prescription drug when it is greater than a 2% concentration and a natural health product at a concentration of 2% and under. It is used topically (applied to the skin) to lighten areas of darkened skin caused by different conditions (e.g., sun exposure, skin damage, pregnancy, medications or age). It should not be used by people who are allergic to hydroquinone or who are taking medicines that make their skin more sensitive to light. Hydroquinone is not recommended for pregnant or breastfeeding people, or for children. It should be used with caution in those who have previously had cancer. Side effects include skin reactions such as redness, dryness, cracked skin, burning, stinging, peeling, itching, increased sensitivity to sunlight, sunburn, blisters and scarring. It may cause skin discolouration (i.e., blue or black discolouration or white patches or spots) that, in some cases, can be disfiguring. In laboratory animals, it has been associated with cancer after long-term exposure.

Ketoconazole is a prescription antifungal drug typically used to treat skin and scalp infections. It should be used only under the supervision of a health care professional. When applied to skin, common side effects include severe irritation, itchiness and stinging. Contact dermatitis (an itchy or painful rash) and painful allergic reactions have been reported more rarely. Ketoconazole should not be used by pregnant or breastfeeding people unless directed by a health care professional.

Levodopa, also known as L-dopa, is a prescription drug that is combined with other drug ingredients in anti-Parkinson's medications. It should be used only under the supervision of a health care professional. Levodopa may interact with drugs prescribed for high blood pressure, and should not be used by breastfeeding or pregnant individuals. Among other contraindications or precautions, it should not be taken by people with narrow angle glaucoma, with untreated heart, liver, blood, kidney, lung (bronchial asthma) or hormonal diseases, with a history of melanoma or suspicious skin lesions, or those recently treated with monoamine oxidase (MAO) inhibitor drugs. Side effects requiring medical attention include: sudden onset of sleep; uncontrollable and abnormal movements of the face, eyelids, mouth, tongue, neck, arms, hands, or legs; severe or persistent nausea or vomiting; an irregular heartbeat or fluttering in the chest; hallucinations; feeling lightheaded when standing quickly; or unusual changes in mood or behaviour.

Lorcaserin was a prescription weight-loss drug that was never authorised for sale in Canada and was withdrawn from the United States market due to an increased occurrence of cancers among clinical trial participants. Other side effects include fatigue, headache, cough, sore throat, breathing difficulties, nausea, abdominal discomfort, back pain, irregular heartbeat, leg swelling, anxiety, mood change and depression. In diabetic patients, severe low blood sugar may occur.

Neomycin sulfate is an antibiotic prescription drug and should be used only under the supervision of a health care professional. Side effects include allergic reactions that range from mild skin reactions (itching, rash and hives) to severe, life-threatening allergic reactions (anaphylaxis). Side effects such as damage to nerve tissue or the central nervous system, inner ear, and organs responsible for hearing and balance, and reduced kidney function have occurred in patients taking neomycin orally (by mouth) or when applied on the skin to open wounds or damaged skin. As well, when not used as directed, neomycin sulphate could increase the risk of infections resistant to neomycin or other antibiotics. Neomycin sulphate should not be used by pregnant or breastfeeding people unless directed by a health care professional.

Prasterone is a controlled substance in Canada. It is approved as a prescription steroid hormone for vaginal insertion for the treatment of postmenopausal vulvovaginal atrophy, a medical condition characterized by the thinning and drying of the vaginal walls that may occur at menopause. It is illegal to sell controlled substances without proper authorization from Health Canada. Prasterone has not been approved in Canada for any other use, or in an oral (i.e., taken by mouth) format. Prasterone is transformed in the body into androgen and estrogen hormones. Androgens may increase the risk of liver damage, heart attack, stroke, reduced fertility, hardening of the arteries, the development of male characteristics in women (e.g., increased facial hair), and enlargement or tenderness of male breasts or nipples. Estrogens may increase the risk of high blood pressure, headache, breast and uterine cancer, and blood clots. People with a history of breast cancer, abnormal vaginal bleeding, or who are pregnant or breastfeeding should not use prasterone. Prasterone risks increase with the dose. The long-term health consequences of prasterone use are unknown.

"Poppers" is a slang term for products that contain alkyl nitrites. Despite being labelled for various uses such as leather cleaners, room odourizers or liquid incense, these products are inhaled or ingested by consumers for recreational purposes.

Alkyl nitrites, such as amyl nitrite, butyl nitrite and isobutyl nitrite are prescription drugs and should be used only under the supervision of a health care professional. Products containing alkyl nitrites may pose serious risks, including death, depending on the amount used, how frequently they are used and how long they are used for, as well as the person's health and the other medications they may be taking. Since it is difficult to control how much is inhaled, people can accidentally overdose. Swallowing these products can lead to serious medical complications and may be fatal. People with certain medical conditions (including recent head trauma, bleeding into the head, glaucoma, or heart disease) and those taking certain medications (particularly drugs used to treat erectile dysfunction, and other drugs such as high blood pressure medications, certain migraine drugs, and high doses of aspirin) or illicit drugs are at particular risk.

Sibutramine was previously used to treat obesity but is no longer authorized for sale in Canada because of its association with an increased risk of cardiovascular side effects such as heart attack and stroke. Other side effects include increased blood pressure and heart rate, dry mouth, difficulty sleeping and constipation.

Sildenafil is a prescription drug used to treat erectile dysfunction and should be used only under the supervision of a health care professional. It should not be used by individuals taking any kind of nitrate drug (e.g. nitroglycerine) as it can cause potentially life-threatening low blood pressure. Individuals with heart problems are at increased risk of cardiovascular side effects such as heart attack, stroke, chest pain, high blood pressure and abnormal heartbeat. Other possible side effects include headache, facial flushing, indigestion, dizziness, abnormal vision, and hearing loss.

Desmethyl carbodenafil and dithiodesmethyl carbodenafil, and Hydroxythiohomosildenafil are unauthorized substances that are similar to sildenafil and may pose similar health risks.

Tadalafil is a prescription drug used to treat erectile dysfunction and should be used only under the supervision of a health care professional. It should not be used by individuals taking any kind of nitrate drug (e.g., nitroglycerine) since it can cause potentially life-threatening low blood pressure. Individuals with heart problems are at increased risk of cardiovascular side effects such as heart attack, stroke, chest pain, high blood pressure and abnormal heartbeat. Other possible side effects include headache, facial flushing, indigestion, dizziness, abnormal vision, and hearing loss. Nortadalafil is an unauthorized substance that is similar to tadalafil and may pose similar health risks.

Tretinoin in topical format (applied to the skin) is a prescription drug used to treat acne. Topical tretinoin should not be used during pregnancy as it has been associated with birth defects. It should also not be used by those who are breastfeeding or by children under 12 years old, or by individuals who have inflamed or irritated skin, have a previous skin cancer or undiagnosed skin lesions, who are taking medicines that make their skin more sensitive to light, or who have an allergy to tretinoin. Tretinoin may cause pain, irritation, itchiness, redness, or swelling at the site of application. It may damage skin, change skin colour, and increase sensitivity to sunlight or tanning beds, causing sunburns. Using tretinoin in combination with hydroquinone may increase some of the side effects of tretinoin.

Yohimbine is a prescription drug and should be used only under the supervision of a health care professional. Yohimbine is derived from yohimbe, a bark extract. The use of yohimbine or yohimbe may result in serious adverse reactions particularly in people with high blood pressure, or heart, kidney or liver disease. Side effects include increased blood pressure and heart rate, anxiety, dizziness, tremors, headache, nausea and sleep disorders. It should not be used by people who are pregnant or breastfeeding.