Alert on pills with high salt content

VITAMIN C with other vitamins and mineral supplements in the form of effervescent tablets have become very popular among the public, especially those suffering from chronic diseases. They take these, believing that they are good for boosting their health.

These products became very popular after the image of our Prime Minister Tun Dr Mahathir Mohamad taking an effervescent tablet after a meal went viral on social media soon after the last general election.

There are two popular brands in the market. One is packaged in orange cylindrical containers while the other is in green. Both are readily available over the counter in retail pharmacies and Chinese medical halls.

Consumers, especially those with chronic medical conditions like heart and kidney problems, in general are quite alert to the contents of the product they are buying.

They usually scrutinise the amount of calories, fat, sugar and salt (in the form of sodium) in the product based on the information on the label. This is actually a good practice.

But what if the labels on the package do not give such information but only list the active ingredients? This can lead to detrimental medical consequences if consumed for a long time.

I am a senior citizen with high blood pressure over the last 15 years. I am taking anti-hypertensive medications, supervised by my cardiologist. My blood pressure has been acceptable until last week when my systolic level shot up to 160 mm Hg (the ideal should be 130 mm Hg or below). I consulted my usual cardiologist who opined that this could be due to my diet, particularly my salt intake.

Looking back, I remembered that I started to take the orange effervescent tablets about six months ago. I then looked at the insert that came in the package and, to my horror, I read that each effervescent tablet contains 304.1mg of sodium.

Honestly, how many consumers actually look for such details in package inserts in tiny print? Can the product be returned after the consumer finds out that it is not suitable for long-term consumption due to his/her underlying medical condition?

I scoured the Internet for information on the product I was using. On its official website, it is stated that each effervescent tablet contains between 273mg and 287mg of sodium, which is equivalent to about 0.7g (682.5mg – 717.5mg) of salt.

The official website of the National Health Service in the United Kingdom ( has this advisory on salt in diets: “If you routinely take a dissolvable (effervescent) vitamin supplement or effervescent painkillers, it’s worth remembering that these can contain up to 1g of salt per tablet.

“You may want to consider changing to a non-effervescent tablet, particularly if you have been advised to watch or reduce your salt intake.”

A study published in the British Medical Journal in 2013 titled “Association between cardiovascular events and sodium-containing effervescent, dispersible, and soluble drugs: nested case-control study” (available at ) concluded, among other findings, that those taking effervescent products were 7.2 times more likely to have high blood pressure than those taking standard tablets. The study involved 1.3 million matched subjects with a follow up of 7.23 years published in a credible medical journal.

I stopped taking the effervescent Vitamin C and over the next several days, my blood pressure became more manageable, albeit not back to the baseline as before.

I do not dismiss that other factors may be involved in the sudden surge in my blood pressure. However, the fact remains that the additional salt is certainly bad for hypertensives and kidney patients.

The point I am trying to make here is that all products must have a comprehensive listing of the important ingredients and their amount so that consumers will be able to make a wise choice.

This is especially pertinent to the so-called effervescent health supplements and dissolvable painkillers that are often taken by individuals with chronic medical conditions.

Manufacturers have a moral obligation to disclose such information on the label to warn individuals who are on a restricted salt intake to be cautious of these products. They should not hide such facts just to generate money from the sale of these products.

In the meantime, the National Pharmaceutical Regulatory Authority (NPRA) must enforce these requirements. I also suggest that the licence holders of the products share the information with consumers through a public awareness campaign.


Petaling Jaya

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