INAPPROPRIATE use of clenbuterol, long banned for use by elite sports players, is on the rise among amateur bodybuilders and those seeking to lose weight quickly, but users are playing a lottery with their health, say leading physicians.
Research published in the MJA, based on data from the NSW Poisons Information Centre over 9 years to December 2012, showed a “dramatic increase” in calls related to clenbuterol exposure, from three in 2008 to 27 in 2012. (1)
The most commonly reported symptoms were tachycardia, gastrointestinal disturbance and tremor. One young male patient was reported to have had a cardiac arrest while playing sport.
“The potential for misuse of this substance requires reconsideration of its current poison schedule registration and its availability”, the authors wrote.
Clenbuterol is a β2-adrenergic drug not registered for human use in Australia but used as a Schedule 4 medicine for bronchodilation and as a tocolytic in veterinary practice. It is given to animals in some parts of Asia to increase lean meat yield via its anabolic properties.
Professor Ric Day, director of clinical pharmacology and toxicology at St Vincent’s Hospital in Sydney, said it was important to raise public awareness of the dangers of clenbuterol misuse.
“The prescribed dose for clenbuterol as a bronchodilator is 20-40 µg”, Professor Day told MJA InSight. “But bodybuilders and people using this for weight loss are taking doses in orders greater than that.
“There is total chaos in terms of dosages. People need to know about the hazards — particularly the cardiac hazards — of this drug.”
Associate Professor Michael Kennedy, from St Vincent’s Clinical School at the University of NSW, said clenbuterol was easy to acquire but there was no guarantee that what was on the label was what was in the bottle.
“Most abuse of [clenbuterol] happens in the gym by the guy who wants to do a personal best”, Professor Kennedy told MJA InSight.
“It’s easy to buy over the internet and it might have the right label on it but there’s no guarantee that’s what you’re getting. It could be clenbuterol, it could contain no clenbuterol at all, or it could be clenbuterol combined with who knows what else.”
Dr Andrew Garnham, vice-president of the Australasian College of Sports Physicians, told MJA InSight that GPs concerned about clenbuterol use by their patients needed to be aware of telltale signs.
“If they have a patient who is obsessed with their body image and are indicating some kind of willingness to try anything, then they are susceptible to abuse of clenbuterol.”
The dangers of steroid use were highlighted in Australian research published last month in the Journal of Forensic Sciences. The researchers investigated the sudden or unnatural deaths of 24 young men who had used anabolic-androgenic steroids. (2)
The researchers found the typical case was a polydrug user aged in his 30s with extensive physical evidence of steroid misuse, particularly testicular atrophy and muscular overdevelopment. They also found evidence of extensive cardiovascular disease.
Dr Garnham told MJA InSight clenbuterol was very easy to buy online. “There is a lot of information online about it, a lot of it is very misleading and you can bet that it is putting profit in someone’s pocket.
“Most of it is coming out of an agricultural drum somewhere in eastern Europe.
“There are many questions that should be asked about how easily this drug can be imported after buying it online.”
An import permit is required for clenbuterol to be brought into Australia, which can be applied for once the substance is already in the country, but it does not require an import licence. (3)
A spokesperson for the Department of Health told MJA InSight import permits for clenbuterol were issued by the Office of Chemical Safety if an applicant could provide a Schedule 4 licence issued under state or territory law, or through a special access scheme where the import application must be made by prescribing doctor.