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Are over-the-counter appetite suppressants safe in South Africa?

Healthnews24 editorial deskUpdated 3 min read
Answer first

Phentermine is an appetite suppressant prescribed by doctors, and a South African claims study found about a quarter of patients stayed on it longer than the 12-week limit. Over-the-counter products on supplement shelves are not SAHPRA-approved medicines and often rely on stimulants. Safety depends on the ingredients, so see a doctor or pharmacist first.

  • SAMJ analysis (2015–2019): 3 361 South African patients received phentermine; about 26% stayed on it long term despite a 12-week label limit.
  • Mean phentermine therapy lasted 57 days at 15 mg and 67 days at 30 mg in that private-sector dataset.
  • As of August 2026 SAHPRA had registered no complementary medicines; several local fat burners state they are not SAHPRA-evaluated.
  • Duiven 2021: 38% of 66 Dutch products marketed for fat loss, muscle, energy or hormones contained undeclared doping substances.

What counts as an "appetite suppressant" in South Africa?

Two very different groups get lumped together:

Group Examples Legal status
Prescription medicines phentermine and other prescription anti-obesity drugs Prescribed by doctors, with a recommended short-term limit; ask a pharmacist about the schedule
Supplement-aisle products fat burners, caffeine blends, glucomannan, herbal or "thermogenic" capsules Sold as foods or as unregistered Category D complementary medicines

Nobody should treat the second group as equivalent to the first. Pharmacy shelf position or a Dis-Chem or Clicks logo does not equal SAHPRA approval.

What do we know about prescription appetite suppressants?

Phentermine is an amphetamine-derived drug. A retrospective analysis of private-sector claims in South Africa (2015 to 2019, published in the South African Medical Journal) covered 3 361 patients. The study notes that US FDA labelling limits use to 12 consecutive weeks. Mean therapy lasted 57 days at 15 mg and 67 days at 30 mg, but about 26% of patients (889) received it long term, so use was not restricted to short courses. The authors flagged the risks associated with long-term therapy. Phentermine can raise heart rate and blood pressure and cause insomnia, dry mouth and anxiety. It is not suitable for people with heart disease, uncontrolled hypertension, anxiety disorders or pregnancy, and a doctor should decide whether it is appropriate.

What about over-the-counter slimming products?

  • No pre-approval. As of August 2026 (the latest report we found), no complementary medicine had been registered by SAHPRA, and Dis-Chem Living Fit pages for several local fat burners say the product has not been evaluated by SAHPRA (what Category D means).
  • Stimulant stacks. Caffeine, synephrine (bitter orange), yohimbine and others raise heart rate and blood pressure and disturb sleep. The AIS puts synephrine, DMAA, DMBA and ephedrine in Group D (banned or high contamination risk).
  • Contamination. A 2021 Dutch study found 38% of 66 products marketed for fat loss, muscle gain, energy or hormone modulation contained undeclared doping substances. Our evidence library lists sibutramine, a drug withdrawn from the international market over cardiovascular risk, among documented contaminants of fat-burner products.
  • Weak benefit. Our evidence review rates thermogenics as weak for real-world fat loss (do fat burners work).
  • Fibre-based products such as glucomannan have a different risk profile: choking if taken with too little water (fibre for fullness).

Who must avoid them?

Do not use over-the-counter appetite suppressants if you are pregnant, breastfeeding, under 18, have heart disease, high blood pressure, thyroid disease, an anxiety disorder, a history of eating disorders, or take antidepressants, stimulant medication or blood-pressure tablets. Drug-tested athletes should avoid them entirely because contamination can produce a positive test under strict liability (failed drug tests).

What should you do instead?

  1. Ask a doctor or dietitian whether you qualify for a medically supervised programme.
  2. Use protein (about 1.6–2.0 g/kg) and fibre-rich foods to manage hunger (how much protein to lose fat).
  3. Read the label, and if the product lists a "proprietary blend" without amounts, leave it.
  4. Report suspected side effects to your pharmacist or SAHPRA (how to report a side effect).

Stop immediately and seek urgent care for chest pain, palpitations that do not settle, fainting or severe anxiety.

Sources

  1. The duration of phentermine therapy in the private healthcare sector of South Africa: a retrospective analysis (SAMJ)
  2. Spotlight (14 Aug 2026): Inside the Box with Dr Andy Gray, are complementary medicines effectively regulated in South Africa?
  3. Australian Institute of Sport Supplement Framework: Group D
  4. Duiven E et al. (2021) Undeclared doping substances are highly prevalent in commercial sports nutrition supplements. J Sports Sci Med 20:328

Educational information only, not medical advice. Speak to a doctor, pharmacist or registered dietitian before using supplements if you are pregnant or breastfeeding, under 18, taking medication, or living with kidney, liver or heart disease.

Cite this page: Healthnews24, “Are over-the-counter appetite suppressants safe in South Africa?”, updated 27 October 2026, https://www.healthnews24.co.za/answers/appetite-suppressants-over-the-counter-south-africa/. Plain-text version: /answers/appetite-suppressants-over-the-counter-south-africa.md