Fluoxetine contamination in Dietary/Nutritional Supplements (un)bridges the quality of life for the youth to the elderly consumer.

Main Article Content

Gary Gabriels Mike Lambert Pete Smith Lubbe Wiesner Yoga Coopoo


Dietary/Nutritional supplements have become popular in use by a spectrum of different consumers, including the elderly, those aged 65 and over, as a ‘new’ market. In the USA, their numbers have been increasing from 35 million in 2000, to a projected 69 million by 2030. Dopamine, serotonin, epinephrine neurotransmitter homeostasis is important in the ‘healthy’ physiological continuum of all ages. Imbalance in these neurotransmitters, over time, manifests in various ‘disease’ states, such as Obsessive Compulsive Disorder, Parkinson’s Disease, and Schizophrenia. In context, dietary/nutritional supplements may contain contaminants/adulterants that could distort the ‘normal’ equilibrium of neurotransmitters. Therefore, for this investigation fluoxetine a Schedule 5 (South Africa) selective serotonin reuptake inhibitor (SSRI) drug was investigated. The extent of fluoxetine as contaminant/adulterant in dietary/nutritional supplements is not widely known. Further, fluoxetine prescriber caution for treatment (elderly), are adverse effects, particular CNS effects, such as nervousness, agitation, anxiety or excessive sedation, and insomnia. The aim of this study was to determine whether commercially available dietary/nutritional and traditional supplement products contained fluoxetine, even though the manufacturer may not declare this on the product label. A total of 138 dietary/nutritional supplements products formed part of the assessment. The products were laboratory analysed for fluoxetine, as part of an extensive multi-compound ‘screen’, using Tandem Liquid Chromatography Mass Spectrometry. The concentration of fluoxetine was then estimated via calibration curve standards that formed part of the extraction and analysis. The number of ‘positives’ for the tested products for fluoxetine in the overall sample was 54%, for South African produced products 67%, and, for imported products, bought in South Africa 56%. The median concentration estimate for fluoxetine in the products were, 3.9 µg/g for the overall sample, 5.2 µg/g for South African produced products, and 20.1 µg/g for imported products, bought in South Africa.

Article Details

How to Cite
GABRIELS, Gary et al. Fluoxetine contamination in Dietary/Nutritional Supplements (un)bridges the quality of life for the youth to the elderly consumer.. Medical Research Archives, [S.l.], v. 6, n. 2, feb. 2018. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/1616>. Date accessed: 28 nov. 2021. doi: https://doi.org/10.18103/mra.v6i2.1616.
Research Articles


1. van der Merwe, PJ, Grobbelaar E. Inadvertent doping through nutritional supplements is a reality. South African Journal of Sports Medicine 2004; 16:2 3-7.
2. Gabriels G, Lambert M, Smith P, Wiesner L, Hiss D. Melamine contamination in Nutritional Supplements - Is it an alarm bell for the general consumer, athletes, and ‘Weekend Warriors’? Nutrition Journal.2015,14:69DOI:10.1186/s12937-015-0055-7
3. Cohen PA, Travis JC, Keizersc PHJ, Deusterd P, Venhuise BJ. 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).Clinical Toxicology, 2017; https://doi.org/10.1080/15563650.2017.1398328
4. Sumpter,JP, Donnachie RL, Johnson AC. The apparently very variable potency of the anti-depressant fluoxetine. Aquatic Toxicology 2014; 151 57–60
5. Stewart AM, Grossman L, Nguyen M, Maximino C, Rosemberg DB, Echevarria DJ, Kalueff AV. Aquatic toxicology of fluoxetine: Understanding the knowns and the unknowns. Aquatic Toxicology 2014; 156 269–273
6. Erman H, Guner I,Yaman MU, Uzun DD, Gelisgen R, Aksu U, Yelmen N, Sahin G, Uzun H. The effects of fluoxetine on circulating oxidative damage parameters in rats exposed to aortic ischemia–reperfusion. European Journal of Pharmacology, 2015; 749 56-61
7. Jedynak P, Kos T, Sandi C, Kaczmarek L, Filipkowski RK. Mice with ablated adult brain neurogenesis are not impaired in antidepressant response to chronic fluoxetine. Journal of Psychiatric Research, 2014; 56 106-111
8. Hansen LK, Frost PC, Larson JH, Metcalfe CD. Poor elemental food quality reduces the toxicity of fluoxetine on Daphnia magna. Aquatic Toxicology 2008; 86 99–103
9. Stewart AM, Grossman L, Nguyen M, Maximino C, Rosemberg DB, Echevarria DJ, Kalueff AV. Aquatic toxicology of fluoxetine: Understanding the knowns and the unknowns. Aquatic Toxicology 2014; 156 269–273
10. Mennigen JA, Lado WE, Zamora JM, Duarte-Guterman P, Langlois VS,Metcalfe CD,Chang JP, Moon TW, Trudeau VL. Waterborne fluoxetine disrupts the reproductive axis in sexually mature male goldfish, Carassius auratus. Aquatic Toxicology100 2010; 354–364
11. Xiong GJ, Yang Y, Cao J ,Mao RR, Xu L. Fluoxetine treatment reverses the intergenerational impact of maternal separation on fear and anxiety behaviors. Neuropharmacology 2015; 92 1-7
12. Frick LR, Rapanelli M, Cremaschi GA, Genaro AM. Fluoxetine directly counteracts the adverse effects of chronic stress on T cell immunity by compensatory and specific mechanisms. Brain, Behavior, and Immunity 2009; 23 36–40
13. Peselow ED, Tobia G, Karamians R, Pizano D, IsHak WW. Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: Outcome after long-term follow-up. Psychiatry Research 2015; 225 680–686
14. Bonde SL, Bhadane RP, Gaikwadb A, Gavalib SR, Katale DU, Narendiran AS. Simultaneous determination of Olanzapine and Fluoxetine in human plasma by LC–MS/MS: Its pharmacokinetic application. Journal of Pharmaceutical and Biomedical Analysis 2014; 90 64–71
15. Norden DM, Devine R, Bicer S, Jing R, Reiser PJ, Wold LE, Godbout JP,McCarthy DO. Fluoxetine prevents the development of depressive-like behavior in a mouse model of cancer related fatigue. Physiology & Behavior 2015; 140 230–235
16. Khazaie H, Rezaie L, Payam NR, Najafi F. Antidepressant-induced sexual dysfunction during treatment with fluoxetine, sertraline and trazodone; a randomized controlled trial. General Hospital Psychiatry 2015; 37 40–45
17. Sumpter JP, Donnachie RL , Johnson AC. The apparently very variable potency of the anti-depressant fluoxetine. Aquatic Toxicology 2014; 151 57-60
18. Zhu H, Grajales-Reyes GE, Alicea-Vázquez V, Grajales-Reyes JG ,Robinson K, Pytel P, Báez-Pagán CA,Lasalde-Dominicci JA, Gomez CM. Fluoxetine is neuroprotective in slow-channel congenital myasthenic syndrome. Experimental Neurology 2015; 270 88–94
19. Shiha AA, de Cristóbal J, Delgadoa M, de la Rosa RF, Bascunana P, Pozo MA, García-Garcíaa L. Subacute administration of fluoxetine prevents short-term brain hypometabolism and reduces brain damage markers induced by the lithium-pilocarpine model of epilepsy in rats. Brain Research Bulletin 2015; 111 36–47
20. Luo YL, Zhang MY, Wu WY ,Li CB ,Lu Z , Li QW. A randomized double-blind clinical trial on analgesic efficacy of fluoxetine for persistent somatoform pain disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry 2009; 33 1522–1525
21. Tyler CR, Solomon BR, Ulibarri AL,Allan AM. Fluoxetine treatment ameliorates depression induced by perinatal arsenic exposure via a neurogenic mechanism. Neurotoxicology 2014; 44 98–109
22. Gray VC, Hughes RN. Drug, dose and sex-dependent effects of chronic fluoxetine, reboxetine and venlafaxine on open-field behavior and spatial memory in rats. Behavioural Brain Research 2015; 281 43–54
23. Zlatkovic´ J, Todorovic´ N, Tomanovic´ N, Boškovic´ M, Djordjevic´ SA,Lazarevic´-Pašti T, Bernardi RE, Djurdjevic´ A, Filipovic ´ D. Chronic administration of fluoxetine or clozapine induces oxidative stress in rat liver: A histopathological study. European Journal of Pharmaceutical Sciences 2014; 59 20–30
24. Enginar N, Hatipoğlu I, Fırtına M. Evaluation of the acute effects of amitriptyline and fluoxetine on anxiety using grooming analysis algorithm in rats. Pharmacology, Biochemistry and Behavior 2008; 89 450–455
25. Péry ARR, Gust M, Vollat B, Mons R, Ramil’ M,Fink G, Ternes T, Garric J. Fluoxetine effects assessment on the life cycle of aquatic invertebrates. Chemosphere 2008; 73 300–304
26. Szólics M, Chaudhry M, Ljubisavljevic M, Corr P, Samir HA, van Gorkom KN. Neuroimaging findings in a case of fluoxetine overdose. Journal of Neuroradiology 2012; 39 254—257
27. Ten Eyck GR, M. Regen EM. Chronic fluoxetine treatment promotes submissive behavior in the territorial frog, Eleutherodactylus coqui. Pharmacology, Biochemistry and Behavior 2014; 124 86–91
28. Chen H, Zha J, Yuan L, Wang Z. Effects of fluoxetine on behavior, antioxidant enzyme systems, and multi xenobiotic resistance in the Asian clam Corbicula fluminea. Chemosphere 119 2015; 119 856–862
29. Kermorgant M, Lancien F, Mimassi N, Le Méve JC. Central actions of serotonin and fluoxetine on the QT interval of the electrocardiogram in trout. Comparative Biochemistry and Physiology 2015; Part C 167 190–199
30. Carlsson C, Johansson AK, Alvan G, Bergman K, Kuhler T. Are pharmaceuticals potent environmental pollutants? Part I: environmental risk assessments of selected active pharmaceutical ingredients. Sci. Total Environ, 2006; 364, 67–87
31. Morar D, Coopoo Y, Shaw I, Shaw BS. Health and fitness attitudes and lifestyle habits of urban children in South Africa. African Journal for Physical Health Education, Recreation and Dance 2014; Supplement 2 102-112
32. Meltzer S, Kohler R, Jakoet I, Noakes T. A practical guide to the use of nutritional supplements in South Africa. CME 2004; 22(3): 142-144.
33. Lebrón-Milad K, Tsareva A, Ahmed N, Milad MR. Sex differences and estrous cycle in female rats interact with the effects of fluoxetine treatment on fear extinction. Behavioural Brain Research 2013; 253 217–222.
34. Go’mez ML, Marinez-Mota L, Estrada-Camarena E, Ferna’ndez-Guasti A. Influence of the brain sexual differentiation process on despair and anti-depressant-like effect of fluoxetine in the rat forced swim test. Neuroscience 2014; 261 11–22
35. Cheaha D, Sawangjaroen K, Kumarnsit E. Characterization of fluoxetine effects on ethanol withdrawal-induced cortical hyper excitability by EEG spectral power in rats. Neuropharmacology 2014; 77 49-56
36. Faramarzia M, Alipor A,Esmaelzadeh S, Kheirkhah F, Poladi K, Pash H. Treatment of depression and anxiety in infertile women: Cognitive behavioral therapy versus fluoxetine. Journal of Affective Disorders 2008; 108 159–164
37. South African Medicine Formulary - Ninth Edition, ISBN 978-1-875098-43-9, HMPG; 2010
38. Gabriels G, Lambert M, Smith P. Information on labels of nutritional supplements – time for legislation? South African Journal of Clinical Nutrition 2012; 25(1) 22-24
39. Detke HC, DelBello MP, Landry J,Usher RW. Olanzapine/Fluoxetine Combination in Children and Adolescents With Bipolar I Depression: A Randomized, Double-Blind, Placebo-Controlled Trial. Journal of the American Academy of Child and Adolescents Psychiatry 2015; 54 3
40. Chatziefstathiou D,Talentino AK. Sporting Boundaries, Sporting Events and Commodification, ISBN 978-1-84888-388-8, Inter-Disciplinary Press; 2015