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Unable to ensure the safety of drugs bought online or from foreign sources, the Food and Drug Administration (FDA) expressed concern about this growing trend among Americans. The potential health risks include:


* Concerns about quality assurance. Medications that haven't been approved for sale in the United States may not have been manufactured under quality assurance procedures designed to produce safe and effective products.


* Potential for counterfeiting. Some imported medications-even those that bear the name of a U.S. approved product-may, in fact, be counterfeit versions that are ineffective or unsafe.


* Presence of untested substances. Imported medications and their ingredients, even if legal in foreign countries, may not have been evaluated for safety and effectiveness in the United States. These products may contain addictive drugs or other dangerous substances.


* Risks of unsupervised use. Some medications, whether imported or not, are unsafe when taken without adequate medical supervision. You may need a medical evaluation to ensure that the medication is appropriate for you and your condition. Or, you may require medical checkups to make sure that you're taking the drug properly, it's working for you, and that you aren't having serious adverse reactions.


* Issues about labeling and language. The medication's label, including instructions for use and possible adverse reactions, may be in a language you don't understand or may make unproven medical claims or suggest uses that haven't been adequately evaluated for safety and effectiveness.


* Lack of information. An imported medication may lack information that would prompt you to seek treatment for a dangerous adverse reaction to it.



Because of the risk of bypassing important safeguards that protect your health, the FDA has issued specific warnings not to buy the following drugs online: Accutane (isotretinoin), Actiq (fentanyl citrate), Clozaril (clozapine), Lotronex (alosetron hydrochloride), Mifeprex (mifepristone or RU-486), Thalomid (thalidomide), Tikosyn (dofetilide), Tracleer (bosentan), Trovan (trovafloxacin mesylate or alatrofloxacin mesylate injection), and Xyrem (sodium oxybate).


Direct your patients who want to know more about this to read "Buying Prescription Medicines Online: A Consumer Safety Guide," available at http://www.fda.gov/cder/drug/consumer/buyonline/guide.htm.