Why is the “affordable miracle drug” compound licorice tablets no longer available for purchase?

Song Bo, 65 years old, had been taking nifedipine sustained-release tablets to keep his blood pressure stable at 140/90 mmHg. In the past few days, his blood pressure rose to 180/110 mmHg, and he felt dizzy and felt dizzy, so he went to the community hospital for treatment.

At the hospital, the doctor asked Song Bo if he had any changes in sleep or mood, but he denied it one by one. When he asked him if he had taken any other medicine, Song Bo remembered that he had an unexplained cough half a month ago. He went to several pharmacies, but they all said they didn't have compound licorice tablets. Finally, he bought it at a small pharmacy in the village. After buying the medicine, he took 4 tablets 3 times a day for a week.

The doctor said that the problem lay with the compound licorice tablets.

For patients with high blood pressure, long-term excessive use of compound licorice tablets can cause "pseudo-aldosteronism", which can cause a sudden increase in blood pressure. In addition, licorice tablets are likely to cause other problems, so it is not safe to buy and eat them yourself.

1. Licorice tablets were once a common household medicine

Compound licorice tablets were once everywhere, especially when the seasons changed. Almost every family had a small bottle of it. They would take it for a few days when they had a cough, and it would work quickly. Compound licorice tablets were cost-effective and effective in relieving coughs, and were called "cheap magic medicine" by the people.

Licorice is not actually a kind of grass, but the rhizome of plants such as Licorice, Licorice inflata, and Licorice glabra, which are dried and processed. Licorice has been used as an ingredient in medicine for a long time.

"Shennong's Herbal Classic" records that licorice: "It can eliminate cold, heat, evil spirits from the five internal organs, strengthen tendons and bones, grow muscles, double strength, heal metal wounds, and detoxify. Long-term use can make the body light and prolong life." "Compendium of Materia Medica" also mentions: "Licorice is the king of all medicines," pointing out that licorice can not only relieve cough, relieve pain, and detoxify, but also neutralize the toxicity of other medicines.

From ancient times to the present, licorice has been widely circulated among the people.

2. Why are compound licorice tablets no longer available for purchase?

People who take medicine frequently may find that in the past, compound licorice tablets could be bought in any pharmacy. Later, compound licorice tablets gradually disappeared from the market and almost no pharmacy sold them. Why is this?

Compound licorice tablets are a compound preparation containing special drugs. Each tablet contains 112.5 mg of licorice extract powder, 4 mg of opium powder, 2 mg of camphor, 2 mg of star anise oil, and 2 mg of sodium benzoate.

In fact, as early as 2005, compound licorice tablets were classified as prescription drugs by the Food and Drug Administration. They cannot be purchased on your own and must be used under the guidance of a doctor.

In 2014, the media reported that a Chinese person was detained when he tried to travel to the United States with compound licorice tablets. The person was eventually sentenced to be banned from entering the country for five years because the compound licorice tablets contained banned ingredients that were not approved for use by the U.S. Food and Drug Administration (FDA), which caused an uproar.

In 2020, in order to further ensure the safety of medication, the State Food and Drug Administration issued the "Announcement on the Revision of the Instructions for Compound Licorice Tablets", revising the "Adverse Reactions" and "Precautions" in the instructions for compound licorice tablets.

The biggest controversy about compound licorice tablets stems from its addictiveness. Clinical studies and cases show that long-term use of compound licorice tablets may lead to drug dependence and addiction. Once the drug is stopped, withdrawal symptoms such as runny nose, cold sweats, and irritability will appear, and it will take 2 to 3 months to return to normal. Therefore, doctors generally recommend that it should not be taken continuously for more than 1 week.

The "culprit" behind the addictive nature of compound licorice tablets is opium powder, which has a strong antitussive effect, but ordinary people know little about it.

In addition, long-term excessive use of compound licorice tablets can also induce pseudoaldosteronism, a secondary hypertension manifested by high blood pressure, low blood potassium, metabolic alkalosis, etc. If not treated in time, it can lead to renal failure, heart failure, and even periodic paralysis.

3.4 People should not take it at will

Even though compound licorice tablets are listed as prescription drugs and cannot be purchased at will, there are still many people who are obsessed with its cough-suppressing effect and try every means to take it on their own.

Ouyang Hua, director of the Department of Pharmacy at Xiamen University Zhongshan Hospital, said that drug dependence is as serious as drug addiction, and the loss of greed for cheapness may be greater. If the following four types of patients take drugs without authorization, serious consequences may occur.

1. Infants, young children and the elderly

Some ingredients in compound licorice tablets are metabolized slowly in infants and the elderly, with a long half-life. Excessive blood drug concentrations may cause breathing difficulties and endanger life. If infants and the elderly need to take compound licorice tablets, they must be guided by a doctor and take the medicine according to the doctor's instructions.

2. Patients with peptic ulcer

It is not suitable for patients with peptic ulcers such as chronic bronchitis and duodenal ulcer. Compound licorice tablets have a glucocorticoid-like effect, which can increase the secretion of gastric acid and reduce the secretion of gastric mucus, aggravating the condition.

3. Diabetes patients

Similarly, compound licorice tablets have glucocorticoid-like effects. When used in combination with antidiabetic drugs, an antagonistic effect will occur, affecting the efficacy of antidiabetic drugs, which is not conducive to the stability of blood sugar and may even aggravate the condition.

4. Hypertension patients

The glycyrrhizic acid contained in licorice will inhibit the activity of 11β-hydroxysteroid dehydrogenase, which promotes the metabolism of cortisol into inactive corticosteroids. After taking compound licorice tablets, hypertensive patients will experience symptoms such as high blood pressure and low blood potassium, which is not conducive to blood pressure stability.

Reminder again:

The opium in compound licorice tablets can be addictive, and the glycyrrhetinic acid in licorice has glucocorticoid-like effects. Long-term use can increase blood pressure!

Source: Combined medication