Tamoxifen Found in Some Dietary Supplements

Simon D. Brandt, PhD Reader in Bioactive Drug Chemistry School of Pharmacy & Biomolecular Sciences Liverpool John Moores University Liverpool, L3 3AF, UK Associate Editor "Drug Testing and Analysis" (Wiley)MedicalResearch.com Interview with:
Simon D. Brandt, PhD
Reader in Bioactive Drug Chemistry
School of Pharmacy & Biomolecular Sciences
Liverpool John Moores University
Associate Editor “Drug Testing and Analysis” (Wiley)

Author’s background comment:

This type of work represents one of our areas of activity related to multi-disciplinary approaches to harm reduction which combines public health work with research on various properties of bioactive substances.

MedicalResearch.com: What are the main findings of the study?

Answer: As part of our work related to so-called lifestyle and image-enhancing drugs and legal highs/bath salts, we became interested in a particular “food/dietary supplement” called “Esto Suppress” because it was discussed on some Internet forums dedicated to the topic of bodybuilding. Some forum members were speculating that tamoxifen might be present in this particular product. The reason for this speculation came from the chemical name that was written on the label which pointed in that direction. This particular product was also widely available from a number of online retailers and while some indications existed that the same chemical name was mentioned, others were seen to list a modified version of that name which did not always make much chemical sense. We test purchased four “Esto Suppress” samples in a local fitness store and confirmed that three of them contained the breast cancer drug tamoxifen.

MedicalResearch.com: Were any of the findings unexpected?

Answer: Yes, but perhaps in a slightly twisted way. The presence of prescription medicines and/or non-medicinal chemical analogues has been increasingly observed throughout the world within the last 10 years and reflects how trade and manufacturing has developed in a globalised world. “Herbal” or “natural supplements” are popular targets for being spiked with synthetic and biologically active drugs but the problem is that these are not mentioned on the list of ingredients which causes tremendous concern about adverse drug reactions and these have been frequently reported by regulatory agencies in the United States and Europe. In this particular case, however, one could think of it as a “hidden in plain sight” situation since one of the chemical names that can be used for tamoxifen was actually present on the label. In other words, we did not expect that the label was actually telling the truth. Given the anti-estrogen properties of tamoxifen, one could see why the product was actually called “Esto Suppress”.

For obvious reasons, tamoxifen is by its very nature a medicinal product which means that it would fall under medicines regulation so it should not be available as a “food”, “herbal” or “dietary supplement” in the first place.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer:  Across the globe growing numbers of people are turning to potent drugs in the hope of getting a better body, empowering themselves, and increasing their well-being. There has also been an explosive growth in products sold as ‘all natural’ food or herbal supplements aimed at the ‘enhancement’ market. Tamoxifen and, of course, all medicines are prescribed for a particular purpose within a tightly regulated system to ensure quality of care and protection. The potential exposure to prescription-only medicines without any knowledge of their presence in a “supplement” is therefore concerning, especially since this exposure tends to occur without professional supervision. From a more general perspective, it might be useful for healthcare providers obtain an increasing awareness with the idea to obtain information from their patients regarding use of any kind of “supplement”.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: I suspect that different problems may require different questions. For example: a) it sometimes seems that there is an increasing tendency to turn to a range of substances and products in the attempt to improve image and performance and there is a need to understand who is using these products, what the patterns of use are and what the causes are; b) what are the potential harms to users in order to develop prevention programmes and harm reduction measures? c) life and trade within a globalised word places significant challenges to regulatory systems and law and this makes it difficult to address questions about supply and demand as well; d) dissemination of findings related to substances being present in those products may help to facilitate information-exchange and monitoring to support regulators and policy makers. In addition, it might also help to engage health care professionals who deal with front line exposure to patients who might be able to share their own experiences with these type of products too.


Is the breast cancer drug tamoxifen being sold as a
bodybuilding dietary supplement?

Michael Evans-Brown, Scientific Analyst

Andreas Kimergård, Jim McVeigh, Martin Chandler, Simon D. Brandt

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
MJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e468 (Published 2 February 2012)

Cite this as: BMJ 2012;344:e468