Illegal imports of medicines: Swissmedic warns against the risk of dependence associated with the long-term use of nasal sprays and laxatives

Swissmedic has recently noticed an increase in imports of large quantities of decongestant cold remedies and laxative drugs (laxatives containing the active substance bisacodyl). Both nasal sprays and laxatives should be taken only for short periods, since their long-term use involves the risk of habituation with dependence.

Over the last few years, Swissmedic has regularly seized illegal imports of nasal sprays or certain laxatives. Recently there has been a rise in confiscated shipments with large quantities of medicines ordered by Swiss customers from foreign online pharmacies.

Because of the potential for dependence, Swiss pharmacies and druggists do not dispense multiples of these over-the-counter nasal sprays or large quantities of laxatives and inform their customers of the possible side effects and risks of long-term use. Since Swiss therapeutic products legislation is not generally applicable in other countries, it is more difficult to enforce measures designed to protect health for imports than for domestic medicines.

Swissmedic notifies the competent foreign regulatory authorities of mail-order pharmacies that supply Swiss customers with harmful quantities of nasal sprays or certain laxatives and that therefore act irresponsibly. Nevertheless, alarming quantities of over-the-counter preparations can still be obtained from certain foreign mail-order pharmacies without any consultation or limit.

Anyone using decongestant nasal preparations for longer than about 10 days can become dependent on them. The long-term use of nasal sprays or drops can trigger a chronic form of rebound congestion known as rhinitis medicamentosa. As a result, the individuals concerned have to take the sprays or drops constantly and at ever shorter intervals in order to feel that they can breathe freely.

Laxatives should also always be used for short periods only, since they can have serious side effects in the long term. Most laxatives are not intended to be taken for longer than one or two weeks without medical supervision. Over-the-counter laxatives containing the active substance bisacodyl can lead to a vicious circle: the constant taking of bisacodyl tablets upsets the water and electrolyte balance (with potassium deficiency in particular), which can lead to a reduction in bowel movements and, in turn, further use of these same laxatives. Possible risks to health include malnutrition, chronic inflammatory bowel disease and other illnesses caused by electrolyte imbalances.

Swissmedic therefore repeats its warning not to order medicines from other countries. People who do so can expect to have to pay costs and, in serious cases, may even face criminal proceedings. Purchasing medicinal products from controlled sources is the only way of guaranteeing that their quality complies with requirements and expectations, that medical advice is provided and that there is no risk to health.