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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Pre-workout and weight loss supplements

Pre-workout and weight loss supplements
Supplement category Agent name Alternative name(s) listed on supplement label Proposed mechanism of activity Potential adverse effects
Pre-workout and weight loss supplements Caffeine Caffeine source (eg, black tea, cola nut, green tea, guarana, yerba mate)

Increases levels of 3'5' cyclic AMP by inhibiting phosphodiesterase

CNS stimulant which increases medullary respiratory center sensitivity to carbon dioxide, stimulates central inspiratory drive, and improves skeletal (including diaphragmatic) muscle contractility		 Palpitations, tremor, anxiety/agitation, GI upset[1], diuresis, dependence (chronic use)
Yohimbine Yohimbe, Corynanthe johimbe, coryanthe yohimbe, 11-hydroxy yohimbine Blocks presynaptic alpha-2-adrenergic receptors, resulting in increased cholinergic and decreased adrenergic tone GI distress, tachycardia, anxiety/agitation, hypertension[2,3]
Rauwolscine Rauwolfia vomitoria, yohimbe, alpha-yohimbine Alpha-2-adrenergic receptor blocker Hypotension[3]
Higenamine Aconitum carmichaelii, Nandina domestica, Tinospora crispa, Aconitum japonicum, demethylcoclaurine, norcoclaurine Beta-agonist activity with chronotropic and inotropic properties Tachycardia, increased cardiac demand, potential for significant cardiotoxic effects[4,5]
DMAA (1,3-DMAA) 1,3-dimethylamylamine, Geranium extract, Pelargonium graveolens, dimethylpentylamine, pentylamine, Geranamine, Forthane, 2-amino-4-methylhexane, methylhexanamine, methylhexamine Peripheral sympathomimetic activity Tachycardia, hypertension, hemorrhagic stroke, sudden death[6-9]
DMBA (1,3-DMBA) 1,3-dimethylbutylamine, 2-amino-4-methylpentane citrate, AMP citrate, 1,3-dimethylbutylamine citrate, 4-amino-2-pentanamine, Pentergy, 4-AMP, pouchong tea, Amperall Peripheral sympathomimetic activity Tachycardia, hypertension*[10,11]
Octodrine DHMA, 1,5-dimethylhexylamine, 6-methyl-2-heptanamine, Aconitum kusnezoffii, 2-amino-isoheptane, Aconite extract, Rauwolfia vomitoria, Halostachine Peripheral sympathomimetic activity Increased blood pressure and cardiac demand, CNS stimulation[12]
BMPEA Beta-methylphenethylamine, Acacia rigidula, Vachellia rigidula, blackbrush, blackbush, chaparro prieto Amphetamine analog; peripheral sympathomimetic activity Increased blood pressure and cardiac demand[13]
Phenpromethamine DHMA, 6-methyl-2-heptanamine, phenylpropylmethylamine, Vonedrine Sympathomimetic activity; alpha-adrenergic agonist Increased blood pressure and cardiac demand[14]
Oxilofrine Methylsynephrine, p-hydroxyephedrine, oxyephedrine, 4-HMP, Halostachine Ephedrine analog; sympathomimetic amine Hypertension, increased cardiac demand, nausea, vomiting, agitation, tachycardia, chest pain[15,16]
Deterenol Isopropylnorsynephrine, isopropylnorsynephrine HCl, N-iso-propylnorsynephrine HCl and isopropyloctopamine, Betafrine, Halostachine Beta-agonist; sympathomimetic activity Flushing, anxiety, increased heart rate, hypotension, nausea, vomiting, blurred vision[14,15,17]
DEPEA Dendrobium orchid extract, Dendrobium nobile, Dendrobe Noble Methamphetamine analog; presumed sympathomimetic activity (no animal or human studies) Hypertension, increased cardiac demand[18]
1,4-DMAA 1,4-dimethylamylamine, DHMA, 6-methyl-2-heptanamine, Aconitum kusnezoffii, 2-amino-isoheptane, Rauwolfia vomitoria, Halostachine Sympathomimetic activity Increased blood pressure and pulse[12]
Supplements exclusively for weight loss Sibutramine Noradrenergic sympathomimetic agent; blocks norepinephrine and serotonin reuptake Increased blood pressure, pulse and increased risk of nonfatal MI and nonfatal stroke[19,20]; dry mouth, anxiety, insomnia
2,4-dinitrophenol DNP, "turmeric powder," Sulfo Black, Nitro Kleenup, Caswell No. 392[21] Uncouples mitochondrial oxidative phosphorylation[21]

Acute toxicity: Fever, tachycardia, diaphoresis, nausea, vomiting, urticaria, jaundice

Less commonly reported: Taste disturbance, hearing change, arthralgia, mental status change, agitation, kidney impairment, seizures, death

Chronic exposure associated with agranulocytosis, peripheral neuritis, cataracts, skin lesions, cardiotoxicity[21-23]
Phenolphthalein Laxative Carcinogenic in animal models[24]
Benzodiazepines (ie, diazepam) GABA agonist CNS depression [eg, drowsiness, ataxia, impaired driving, confusion], muscle weakness, physical dependence/addiction[25-27]
SSRIs (ie, fluoxetine) Inhibits serotonin reuptake by CNS neurons Sexual dysfunction, nausea, abnormal dreams[25,26]
Diuretics (eg, furosemide, bumetanide) Loop diuretics which inhibit reabsorption of sodium and chloride in kidney

Orthostatic hypotension, hypovolemia, hypokalemia, acute kidney injury, hearing loss, tinnitus[25,26]

Hyperkalemia and metabolic acidosis[28]
Other Yellow oleander Has been found in products labeled as candlenut, "Nuez de la India," tejocote root[30,31] Cardiac glycoside (similar to digoxin) Nausea, vomiting, bradycardia, hypotension, frequent premature ventricular complexes, heart blocks, hyperkalemia, and ventricular dysrhythmias and/or asystole in severe cases
Testing of dietary supplements often reveals drugs not declared on labeling, labeled drugs/herbs not detected in the product, inaccurate quantities, and adulteration with prescription and experimental drugs. In addition, doses contained in supplements may far exceed pharmaceutical quantities, increasing the risks of adverse effects. For review of health risks and an approach to patient counseling, refer to UpToDate topic reviews of high-risk dietary supplements and performance enhancing drugs and hormones in sport.

PDE: phosphodiesterase inhibitor; GABA: gamma-aminobutyric acid; GI: gastrointestinal; CNS: central nervous system; CBD: cannabidiol; THC: delta-9-tetrahydrocannabinol; SARMs: selective androgen receptor modulators; SERMs: selective estrogen receptor modulator; DMAA: 1,3-dimethylamylamine; 1,4-DMAA: 1,4-dimethylamylamine; DMBA: dimethylbutylamine; BMPEA: beta-methylphenethylamine; DEPEA: diethylphenethylamine; MI: myocardial infarction; SSRIs: selective serotonin reuptake inhibitors.

* Based upon animal studies; no human data available.

¶ Typically not declared/listed on supplement label.
References:
  1. Gunja N, Brown JA. Energy drinks: health risks and toxicity. Med J Aust 2012; 196:46.
  2. Kearney T, Tu N, Haller C. Adverse drug events associated with yohimbine-containing products: A retrospective review of the California Poison Control System Reported Cases. Ann Pharmacother 2010; 44:1022.
  3. Cohen PA, Wang YH, Maller G, et al. Pharmaceutical quantities of yohimbine found in dietary supplements in the USA. Drug Test Anal 2016; 8:357.
  4. Cohen PA, Travis JC, Keizers PHJ, et al. The stimulant higenamine in weight loss and sports supplements. Clinical Toxicol (Phila) 2019; 57:125-130.
  5. US Food and Drug Administration. Warning letter: Supplement Science Corp. d/b/a Condemned Labz. September 2021. Available at: https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/supplement-science-corp-dba-condemned-labz-613165-09222021 (Accessed on July 13, 2022).
  6. Cohen PA. DMAA as a dietary supplement ingredient. Arch Intern Med 2012; 172:1038.
  7. Cohen PA. DMAA as a dietary ingredient—reply. JAMA Intern Med 2013; 173:594.
  8. Archer JR, Dargan PI, Lostia AM, et al. Running an unknown risk: a marathon death associated with the use of 1,3-dimethylamylamine (DMAA). Drug Test Anal 2015; 7:433.
  9. Young C, Oladipo O, Frasier S, et al. Hemorrhagic stroke in young healthy male following use of sports supplement Jack3d. Mil Med 2012; 177:1450.
  10. Rohrmann E, Shonle HA. Aminoalkanes as pressor substances. J Am Chem Soc 1944; 66:1516.
  11. Swanson EE, Chen KK. Comparison of pressor action of aliphatic amines. J Pharmacol Exp Ther 1946; 88:10.
  12. Cohen PA, Travis JC, Keizers HJ, et al. Four experimental stimulants found in sports and weight loss supplements: 2-amino-6-methylheptane (octodrine), 1,4-dimethylamylamine (1,4-DMAA), 1,3-dimethylamylamine (1,3-DMAA) and 1,3-dimethylbutylamine (1,3-DMBA). Clin Toxicol (Phila) 2018; 56:421.
  13. Cohen PA, Bloszies C, Yee C, Gerona R. An amphetamine isomer whose efficacy and safety in humans has never been studied, β-methylphenylethylamine (BMPEA), is found in multiple dietary supplements. Drug Test Anal 2016; 8:328.
  14. Cohen PA, Travis JC, Vanhee C, et al. Nine prohibited stimulants found in sports and weight loss supplements: deterenol, phenpromethamine (Vonedrine), oxilofrine, octodrine, beta-methylphenylethylamine (BMPEA), 1,3-dimethylamylamine (1,3-DMAA), 1,4 dimethylamylamine (1,4-DMAA), 1,3-dimethylbutylamine (1,3-DMBA) and higenamine. Clin Toxicol (Phila) 2021; 59:975.
  15. Venhuis B, Keizers P, van Riel A, de Kaste D. A cocktail of synthetic stimulants found in a dietary supplement associated with serious adverse events. Drug Test Anal 2014; 6:578.
  16. Cohen PA, Avula B, Venhuis BJ, et al. Pharmaceutical doses of the banned stimulant oxilofrine found in dietary supplements sold in the USA. Drug Test Anal 2017; 9:135.
  17. Marsh DF, Herring DA. The comparative pharmacology of the N-alkyl-1-(p-hydroxyphenyl)-2-aminoethanols. Arch Int Pharmacodyn 1949; 78:489.
  18. Cohen PA, Travis JC, Venhuis BJ. A methamphetamine analog (N,α-diethyl-phenylethylamine) identified in a mainstream dietary supplement. Drug Test Anal 2013.
  19. Scheen AJ. Cardiovascular risk-benefit profile of sibutramine. Am J Cardiovasc Drugs 2010; 10:321.
  20. US Food and Drug Administration. FDA drug safety communication: FDA recommends against the continued use of Meridia (sibutramine). February 2018. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-recommends-against-continued-use-meridia-sibutramine (Accessed on July 13, 2022).
  21. Potts AJ, Bowman NJ, Seger DL, Thomas SHL. Toxicoepidemiology and predictors of death in 2,4-dinitrophenol (DNP) toxicity. Clin Toxicol (Phila) 2021; 59:515.
  22. Kamour A, George N, Gwynnette D, et al. Increasing frequency of severe clinical toxicity after use of 2,4-dinitrophenol in the UK: a report from the National Poisons Information Service. Emerg Med J 2015;32:383.
  23. Good Standards Industry. 2,4-dinitrophenol (DNP). Available at: https://www.food.gov.uk/safety-hygiene/24-dinitrophenol-dnp (Accessed on August 4, 2022).
  24. Dunnick JK, Hailey JR. Phenolphthalein exposure causes multiple carcinogenic effects in experimental model systems. Cancer Res 1996; 56:4922.
  25. US Food and Drug Administration. Questions and answers about FDA's initiative against contaminated weight loss products. Available at: https://www.fda.gov/drugs/questions-answers/questions-and-answers-about-fdas-initiative-against-contaminated-weight-loss-products (Accessed on July 13, 2022).
  26. Cohen PA, Goday A, Swann JP. The return of rainbow diet pills. Am J Public Health 2012; 102:1676.
  27. FDA News. FDA warns of undisclosed drugs in weight loss supplement. Available at: https://www.fdanews.com/articles/184580-fda-warns-of-undisclosed-drugs-in-weight-loss-supplement (Accessed on July 13, 2022).
  28. van de Koppel S, Ekhart C, Roelen C, et al. An Indonesian slimming drug with undeclared ingredients causing harm. Drug Test Anal 2023.
  29. Cohen PA, Avula B, Katragunta K, et al. Presence and quantity of botanical ingredients with purported performance-enhancing properties in sports supplements. JAMA Netw Open 2023.
  30. Berland N, Kababick J, Santos C, Calello DP. Notes from the Field: Online Weight Loss Supplements Labeled as Tejocote (Crataegus mexicana) Root, Substituted with Yellow Oleander (Cascabela thevetia) - United States, 2022. MMWR Morb Mortal Wkly Rep 2023; 72(37):1016-1017.
  31. Shin D, Kang HS, Park E, et al. Authentication of tejocote (Crataegus mexicana) dietary supplements based on DNA barcoding and chemical profiling. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2021. 38(12):1985-1994.
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