Revised: 29 August 2023

Safety Information

Cheng Kum/Shen Loon Letter to Doctors

14 December 2001

 

 

Dear Doctor

Corticosteroid found in Cheng Kum and Shen Loon herbal medicine capsules

Cheng Kum and Shen Loon capsules have been adulterated with the corticosteroid betamethasone.

Background

In December 2000, the Ministry of Health removed the product Cheng Kum, which was being sold as a dietary supplement, from the New Zealand market after it was found to contain the antihistamine chlorpheniramine. The Ministry is aware that a number of people have imported Cheng Kum, and a similar product Shen Loon, for their personal use in joint pain, skin problems, colds, menopausal symptoms and dysmenorrhoea. Recent testing has indicated that both products contain betamethasone. To date doses in the range of 0.1mg to 0.3mg of betamethasone per capsule have been detected; this is equivalent to 0.7mg to 2mg of prednisone.

According to the Cheng Kum package the recommended daily dose is 1 to 3 capsules per day (less in children) so most people will only be exposed to a small amount of corticosteroid. However there have been reports of corticosteroid-induced side effects in patients taking Cheng Kum and Shen Loon who were not taking other exogenous corticosteroids.

Because of the risk of adrenal suppression with corticosteroid use, consumers known to be importing these products are being sent a letter advising them to continue taking the capsules and to see their General Practitioner as soon as possible for instructions on how to stop taking the capsules safely. Consumers will not be able to order further supplies of Cheng Kum and Shen Loon, as importation will be stopped at Customs. The Director-General of Health will also be releasing a privileged statement providing the same advice to other consumers.

Actions

Medsafe advises doctors to determine if patients taking Cheng Kum or Shen Loon are at risk of adrenal suppression by

• estimating the potential total dose of corticosteroid (from Cheng Kum or Shen Loon plus any exogenous steroid) and duration of use,
• examining the patient for signs of corticosteroid excess (e.g. plethoric moon-face, hypertension, easy bruising, purple abdominal striae, truncal obesity, hirsutism),
• and ascertaining if other risk factors for adrenal suppression are present (e.g. elderly; chronic daily use of Cheng Kum or Shen Loon for over 3 months; other conditions associated with adrenal insufficiency or Addison's disease, such as AIDS and polyglandular autoimmune syndrome).

In situations of doubt, a short Synacthen test may be performed. This can be arranged with the local laboratory or endocrinology unit.

If a patient is suspected to have been exposed to significant corticosteroid (e.g. the equivalent of over 7mg of prednisone per day), or there are signs of corticosteroid excess, or the patient is at risk of adrenal suppression for another reason, then the patient should be transferred to an equivalent dose of prednisone (reducing to zero over at least two weeks or possibly longer, depending on the initial dose and duration of therapy) and the Cheng Kum or Shen Loon stopped.

If a patient is not suspected to have been exposed to significant corticosteroid and has no signs of corticosteroid excess and is only taking 1-2 capsules a day then the Cheng Kum or Shen Loon capsules can be stopped immediately. Advise the patient to seek medical advice if they feel unwell after stopping.

Please report any patients seen with corticosteroid excess from Cheng Kum or Shen Loon to the Centre for Adverse Reactions Monitoring. Download the reporting form from telperion.otago.ac.nz/carm/reporting.html.

Yours sincerely

 

Dr Stewart Jessamine
Principal Technical Specialist (Medicines Regulation and Pharmacovigilance)