4 Things Pharmacists Should Know About Rattlesnake Pills

DECEMBER 20, 2017
Rattlesnake pills have received media attention due to their link with Salmonella infection. Salmonella infection is a common bacterial disease that affects the intestinal tract and is usually caused by eating raw or undercooked meat, poultry, or eggs.1 Signs and symptoms of infection include nausea, vomiting, abdominal cramps, diarrhea, fever, chills, headache, and bloody stool. Certain patient populations, such as individuals who are immunocompromised, are more likely to develop a severe Salmonella infection.
 
Here are 4 things pharmacists should know about rattlesnake pills:

Rattlesnake pills are marketed as supplements for various conditions.
Rattlesnake pills are often marketed as remedies for certain conditions such as HIV infection, cancer, acne, anemia, and diabetes. Additionally, these products are often sold online and purchased in Mexico. It is important to educate patients that dietary supplements are not regulated by the FDA. Therefore, the contents of the rattlesnake pills and safety of these products is questionable. Dietary supplements do not have to be proven safe by the FDA before they are marketed. The FDA plays more of a role in monitoring dietary supplements after they are available on the market.
 
One Salmonella case in Kansas has been linked to rattlesnake pills.
The CDC and the Kansas Department of Health and Environment have linked one person’s Salmonella infection to consuming rattlesnake pills purchased in Mexico.2 The patient reported ingesting rattlesnake pills in the week before becoming ill.  Information regarding the medical history is not currently available to determine whether the patient was immunocompromised. Additionally, advanced laboratory testing known as genome sequencing demonstrated that the Salmonella from the infected patient matched the rattlesnake pills.2 Reptiles and their meat can carry Salmonella.  Rattlesnake pills contain dehydrated rattlesnake meat ground into powder.
 
Rattlesnake pills have previously been linked to Salmonella infection.
CDC officials reported a case in 1983 of a 61-year-old woman undergoing chemotherapy who was hospitalized in California with symptoms of abdominal discomfort and fever.3  The patient was taking rattlesnake pills daily, and laboratory analysis discovered that the capsules contained Salmonella.3  Three patients in Arizona developed Salmonella infection in 1988 after ingesting rattlesnake pills.4  All patients had chronic medical conditions including acquired immunodeficiency syndrome, lupus, and congestive heart failure.4
 
Certain patient populations are at an increased risk of a severe Salmonella infection from rattlesnake pills.
Individuals in the following groups are at an increased risk of developing a severe Salmonella infection: Individuals who are immunocompromised, especially those receiving chemotherapy or with HIV; pregnant women; children younger than 5 years; and older adults.2  These groups should be counseled to avoid rattlesnake pills.
 
These products will hopefully be monitored closely by the FDA since they are marketed towards patients with life-threatening conditions who are immunocompromised. There is a new risk-based enforcement approach to homeopathic drug products, but rattlesnake pills may fall outside of this guidance.5   

References
  1. Mayo Clinic.  Salmonella infection.  https://www.mayoclinic.org/diseases-conditions/salmonella/symptoms-causes/syc-20355329.  Accessed December 20, 2017.
  2. Centers for Disease Control and Prevention.  Investigation of a Salmonella infection linked to rattlesnake pills.  .  Accessed December 20, 2017.
  3. Arizona hinshawii septicemia associated with rattlesnake powder-California.  MMWR September 9, 1983/32(35);464-5.
  4. Riley KB, Antoniskis D, Maris R.  Rattlesnake capsule-associated Salmonella Arizona infections.  Arch Intern Med.  1988;148(5):1207-1210.
  5. U.S. Food and Drug Administration.  FDA proposes new, risk-based enforcement priorities to protect consumers from potentially harmful, unproven homeopathic drugs.  .  Accessed December 20, 2017.


Jennifer Gershman, PharmD, CPh
Jennifer Gershman, PharmD, CPh, received her PharmD degree from Nova Southeastern University (NSU) College of Pharmacy in 2006 and completed a 2-year drug information residency. She served as a pharmacy professor at NSU’s College of Pharmacy for 6 years, managed the drug information center, and conducted medication therapy management reviews. Dr. Gershman has published research on prescription drug abuse, regulatory issues, and drug information in various scholarly journals. Additionally, she received the Sheriff’s Special Recognition Award for her collaboration with the Broward, Florida Sheriff’s Office to prevent prescription drug abuse through a drug disposal program. She has also presented at pharmacist and physician continuing education programs on topics that include medication errors, prescription drug abuse, and legal and regulatory issues. Dr. Gershman can be followed on Twitter @jgershman2
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