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96. WRIGLEY, E.A. et S.A. Hutchinson. Longterm breastfeeding: the secret bond, Journal of Nurse-Midwifery, 1990, 35 1 ; : 35-41. Jaunisse et allaitement 1. BROWN, L.P. Breastfeeding and jaundice: cause for concern?, NAACOGS Clinical Issues in Perinatal & Women's Health Nursing, 1992, 3 4 ; : 613-9. BROWN, L.P., L. Arnold, D. Allison, M.E. Klein et B. Jacobsen. Incidence and pattern of jaundice in healthy breast-fed infants during the first month of life, Nursing Research, mars-avril 1993, 42 2 ; : 106-10. DE STEUBEN, C. Breast-feeding and jaundice. A review [compte rendu], Journal of Nurse-Midwifery, mars-avril 1992, 37 2 suppl. ; : 59S-66S. GARTNER, L.M. On the question of the relationship between breastfeeding and jaundice in the first 5 days of life [compte rendu], Seminars in Perinatology, dcembre 1994, 18 6 ; : 502-9. JAMES, J.M., S.D. Williams et L.M. Osborn. Discontinuation of breast-feeding infrequent among jaundiced neonates treated at home, Pediatrics, juillet 1993, 92 1 ; : 153-5. MAISELS, M.J., N. Vain, A.M. Acquavita, N.V. de Blanco, A. Cohen et J. Di Gregorio. The effect of breast-feeding frequency on serum bilirubin levels, American Journal of Obstetrics & Gynecology, mars 1994, 170 3 ; : 880-3. MARTINEZ, J.C., M.J. Maisels, L. Otheguy, H. Garcia, M. Savorani, B. Mogni et J.C. Martinez Jr. Hyperbilirubinemia in the breast-fed newborn: a controlled trial of four interventions, Pediatrics, fvrier 1993, 91 2 ; : 470-3. NEWMAN, J. Breastfeeding and jaundice: what exactly is the problem?, Canadian Pediatric Quarterly, printemps 1991, 237-44 and zyban. Available as a Prescription Generic Drug? No No Yes No * No * No Other cholesterol-lowering medicines are available, but they are less widely prescribed. Talk to your doctor about whether these other medicines such as niacin or ezetimibe ; may be useful for you, possibly in combination with a statin. We'd also recommend talking with your doctor or a nutritionist about dietary changes that could help lower your cholesterol. Even after years of attention to this issue, many people remain confused about what constitutes a heart-healthy diet. For example, many Americans still believe that cutting eggs out of their diet will do the trick. It won't if the rest of your diet is high in saturated fats from meat, margarine, butter, and other high-fat dairy products. This report is based on a systematic analysis of the medical evidence on the effectiveness of statins. There's more information on page 16 and at CRBestBuyDrugs about how we conducted our analysis. This report was last updated in January 2006.

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Dizziness, dry mouth, and insomnia.8 Because of its pressor effect, sibutramine use is associated with a slight increase in heart rate and blood pressure, but in recent years, more severe adverse effects including psychotic and manic episodes, panic attacks, and mood changes have also been reported.9-13 In Hong Kong, sibutramine is registered as a prescription-only medicine. Although the use of fenfluramine is banned and the use of sibutramine controlled, illicit use of these two drugs takes place locally; very likely via OTC slimming products. Since For registered medications, uncommon, 2002, at least 17 slimming products were found to be idiosyncratic toxicity may only manifest after a drug is adulterated with sibutramine, and eight with fenfluramine marketed, for which post-marketing surveillance and : psdh.gov.hk ; . adverse drug reaction reporting and monitoring systems We believe that some manufacturers adulterate have been specifically developed. Thalidomide-induced their slimming products with anti-obesity drug analogues, congenital malformations and more recently rofecoxibinstead of the original molecules in an attempt to evade associated cardiovascular toxicity provide spectacular interception by regulatory authorities. Since analogues examples of such toxicity.19, 20 Accordingly, even if Nare structurally modified, they might not be detected nitrosofenfluramine were to have become a registered by ordinary laboratory methods. These analogues are pharmaceutical, it would no doubt have been withdrawn presumed to exhibit pharmacological properties similar soon after marketing. Being a concealed adulterant to the original parent compound. However, by and large without any known pharmaceutical company association, there have been no formal animal or human studies to the usual monitoring and regulatory mechanisms cannot support these presumptions. Moreover, the adverse effects effectively control the use of such illicit pharmaceutical of such analogues may be significantly different from analogues. those of the original drug. Therefore, the unperceived Herbal slimming products adulterated with use of such analogues could be very dangerous and sibutramine, N-desmethyl-sibutramine, N-bisdesmethylassociated with unpredictable risks. sibutramine, and an analogue of sibutramine named N-nitrosofenfluramine is an analogue of fen- homosibutramine were first reported by Zou et al in 2007.21 fluramine Fig 2 ; . This chemical, used as an adulterant N-desmethyl-sibutramine was detected in the slimming in slimming products, was associated with more than product consumed by patient 4, before the onset of acute 800 cases of liver damage in Japan.3 Similar cases psychosis. In contrast to the fact that N-nitrosofenfluramine have also been reported in Singapore and the United is a synthetic analogue of fenfluramine, N-desmethylKingdom.14, 15 The majority of affected patients showed sibutramine is a natural metabolite of sibutramine the complete recovery after discontinuation of the offending parent compound ; . N-desmethyl-sibutramine possesses agents. However, a few died or developed fulminant the same pharmacological properties as sibutramine, and hepatic failure.14-16 An animal study performed by a is least partially responsible for the observed adverse Japanese group demonstrated the hepatotoxic and effects of sibutramine.8 Patient 4 described in this report potential nephrotoxic effects of N-nitrosofenfluramine.17 developed a reversible acute psychotic episode after This study also concluded that the slimming effect of taking N-desmethyl-sibutramine for 1 week. Without.