Belize tainted supplements: hidden steroids and tadalafil alerts

A patient with joint pain buys a herbal capsule from a vendor. Months later the patient has a round face, high blood sugar and fragile bones, or collapses with adrenal crisis after stopping it. That is the pattern clinicians have documented with a family of "arthritis supplements" sold across the Americas, and in 2025 the Ministry of Health and Wellness (MoHW) of Belize found them on the market¹²⁴.

The March 2025 alert: Artri King and Vitafer in four districts

On 24 March 2025 the Ministry warned about tainted dietary supplements circulating in the Cayo, Orange Walk, Stann Creek and Belize districts, based on alerts from the US Food and Drug Administration (FDA), Mexico's COFEPRIS and Spain's AEMPS and on its own investigation². The products named were Artri King, Artribion, Artri Ajo King and Vitafer, which "have been found to contain undeclared substances that may pose health risks"². Dr. Melissa Diaz, Director of Public Health and Wellness, told 7 News that the problem surfaced when a clinician noticed symptoms and found "that patients were taking these supplements." Her advice on Vitafer: "do not take it, it can have side effects that can be very severe"; the other products "can cause a lot more long term side effects"¹.

What is inside? FDA laboratory analysis found that "Artri King contains diclofenac and dexamethasone not listed on the product label"; the agency has received adverse-event reports including liver toxicity and death linked to Artri King and similarly named products, and warns that long-term or high-dose corticosteroid use can suppress the adrenal glands, so stopping abruptly can cause withdrawal³.

What the case series show

The clinical literature is consistent. In a series of 12 patients who used over-the-counter arthritis supplements (eight of them Artri King), 10 (83.3 %) had Cushing syndrome, 8 (66.7 %) had symptoms of adrenal insufficiency, and 10 initially needed glucocorticoid replacement; four still required it at follow-up⁵. A 2025 systematic review and case series of 16 patients found Cushing syndrome in 75 %, with fragility fractures the most common presentation at the authors' institution, and serious effects including adrenal insufficiency and worsening hyperglycemia; the authors "advise against its use"⁴. Endocrinologists have also described hypothalamic-pituitary-adrenal axis disruption in three Artri King users¹³. For the physician, the practical point is the history: patients rarely volunteer a "natural" product unless asked⁴⁵.

The June 2025 alert: Royal Honey

On 2 June 2025 the Ministry warned the public against "a product in circulation labelled as Royal Honey," marketed for sexual enhancement⁶. Alerts from the FDA and Costa Rica's Ministry of Health had found through laboratory analysis that it "contains undeclared pharmaceutical ingredients"; the product "is falsely promoted as 'natural'" and "sold primarily through online platforms and informal vendors"⁶⁸. The FDA identified the hidden drug in Royal Honey VIP as tadalafil and warned that it "may interact with nitrates found in some prescription drugs" and lower blood pressure to dangerous levels⁷⁹.

Royal Honey is not an outlier. Of 776 adulterated dietary supplements flagged by FDA warnings from 2007 to 2016, 45.5 % were sold for sexual enhancement and 40.9 % for weight loss; sildenafil was found in 47.0 % of the sexual enhancement products, and 20.2 % of all products had more than one unapproved ingredient¹⁰.

What the law of Belize says, and the pharmacovigilance gap

Under the Food and Drugs (Registration, Licensing and Inspection) Regulations, 2017, any substance sold or represented for treating a disease or "restoring, correcting or modifying organic functions in man" is a drug, and no person may commercialize a drug without registration and a product licence; the offence carries a fine of up to $10,000 on summary conviction (regulations 2 and 3)¹². The Ministry's advice in both alerts was the same: buy health products only from licensed pharmacies and authorized distributors, avoid social media and street vendors, and report suspect products by email (drugalerts@health.gov.bz in the March alert, drugalert@health.gov.bz in the June alert) or by phone to +501-880-2363²⁶.

Detection is the weak link. In August 2026 the Ministry and PAHO/WHO ran a two-day workshop in Belize City for the Drug Inspectorate Unit, hospital and private pharmacists, importers, wholesalers, academia and patient representatives on adverse-reaction reporting, suspected substandard and falsified products and the VigiFlow and VigiMobile reporting tools¹¹. PAHO/WHO Representative Dr. Karen Lewis-Bell called it "an important step in a longer effort to strengthen regulatory capacity"¹¹.

What it means for Belizean physicians

Ask every patient with unexplained Cushingoid features, adrenal symptoms, uncontrolled glucose or hypotension on nitrates about supplements, honey sachets and "natural" capsules³⁴⁵⁹. Report what you find: each report feeds the national system Belize is now building¹¹.