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Dangers of 'herbal Viagra': What every man should know
In this 2012 file photo, Los Angeles Clippers’ player Lamar Odom brings the ball up in an NBA basketball game against the Phoenix Suns in Los Angeles. Odom, the former NBA star and reality TV personality embraced by teammates and fans alike for his humble approach to fame, was hospitalized and his estranged wife Khloe Kardashian is by his side, after being found unresponsive in a Nevada brothel where he had been staying for days. (Photo: Jae C. Hong, AP)
Basketball player Lamar Odom’s collapse this week вЂ“ after allegedly using cocaine and sexual supplements вЂ“ has raised questions about the supplements and their safety and whether they could increase the dangers posed by illegal drugs. Odom is now on life support at a Nevada hospital.
USA TODAY’s Liz Szabo talked to medical experts about these products.
Q. What is in a sexual performance supplement?
A. Although these supplements are often called “herbal Viagra” вЂ“ suggesting that they contain a safer or more natural form of the little blue pill вЂ“ many contain the active ingredient in real Viagra, according to the Food and Drug Administration.
Odom apparently took supplements called Reload 72-hour Strong and Libimax, according a spokesman for the legal Nevada brothel where he collapsed, who spoke to the Associated Press.
Lamar Odom's sex enhancement supplements may have been spiked
Tests by the FDA in 2013 found sildenafil, Viagra’s active ingredient, in Reload. In 2009, the manufacturer of LibiMax recalled the product after tests found that it contained tadalafil, another drug for erectile dysfunction.
Problems aren’t limited to LibiMax and Reload. The FDA has found that 300 sexual supplements contain unidentified ingredients.
“Not only do these products contain undisclosed drug ingredients,” the FDA says on its website, “but they also sometimes may include combinations of undisclosed ingredients or excessively high doses, both potentially dangerous situations.”
Some herbal sexual supplements also contain saw palmetto, ginseng and horny goat weed, used for centuries in China to treat low libido and erectile dysfunction. Others contain yohimbine,made from the bark of a type of evergreen tree, said Pieter Cohen, an assistant professor at Harvard Medical School.
Taking a sexual supplement “is like playing Russian roulette,” said Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. “You don’t know what you’re getting any time you open a bottle of ‘herbal Viagra.'”
Q. Why would supplement makers put an expensive drug like Viagra, which can sell for $5 to $10 a pill, into an herbal supplement?
A. Although Viagra is expensive in the USA, it’s dirt cheap in China, which makes many of these supplements, Cohen said. Chinese companies sell sexual supplements for a fraction of the cost of Viagra, but can still make a profit. Unlike Viagra, however, which comes in a standard dose, supplements may not have a standard dose of medication. So men could get much less of the active ingredient they’re looking for — or much more.
Q. How risky are these supplements?
A. According to the FDA, the hidden ingredients in these supplements can pose life-threatening risks.
That’s because the active ingredients in erectile dysfunction drugs can interact with prescription drugs such as nitroglycerin, used to treat chest pain and other heart problems, according to the FDA. That’s a big risk, given that the older men who seek out erectile dysfunction drugs are often the same ones who take nitroglycerin, including men with diabetes, high blood pressure, high cholesterol or heart disease.
Both Viagra-like drugs and nitroglycerin lower blood pressure, Glatter said. Taken together, the combination can cause heart rhythm problems, heart attacks and strokes.
In its 2013 warning about Reload, the FDA said: “Consumers should stop using this product immediately and throw it away. Consumers who have experienced any negative side effects should consult a health care professional as soon as possible.”
Even prescription erectile dysfunction drugs such as Viagra, which are regulated much more tightly than herbal supplements, can cause heart attacks, Glatter said.
Sexual supplements that contain Viagra-like drugs are especially risky if men take large doses, Glatter said. Odom reportedly took 10 of the pills.
Consumers should be skeptical about claims that appear too good to be true, said Craig Hopp, program director of extramural research the National Center for Complementary and Integrative Health, part of the National Institutes of Health. Some herbal sexual supplements promise results in 30 minutes, for example. While pharmaceuticals can work that quickly, Hopp said that plants don’t. Supplements that claim to work as quickly as drugs are probably laced with drugs.
Q. Do sexual supplements work?
A. No supplements have ever been shown to be effective for erectile dysfunction, according to the National Center for Complementary and Integrative Health .
Unlike prescription drugs, which must prove they’re safe and effective before being approved by the FDA, supplement makers don’t have to prove that their products work before selling them, said Charles Bell, programs director for Consumers Union, the advocacy arm of Consumer Reports magazine. Because supplements aren’t tested through a rigorous scientific process, consumers have no way to know if they really work.
Q. Are supplements riskier than prescription or over-the-counter erectile dysfunction drugs?
A. Unlike prescription and over-the-counter drugs, supplement makers aren’t required to post warnings about such side effects or drug interactions on their product labels, Bell said. Many men may not realize the risks.
Sexual supplements can sometimes be much stronger than regular Viagra, Glatter said. “You take more and more pills thinking it’s safe,” Glatter said. “People think, ‘It’s natural, so it must be safe.'”
A study in The New England Journal of Medicine this week found that at least 23,000 Americans go to the emergency room вЂ“ including 2,000 who are hospitalized вЂ“ after taking dietary supplements. Many of the most common symptoms are heart palpitations.
GENERIC NAME(S): SILDENAFIL CITRATE
Sildenafil is used to treat male sexual function problems (impotence or erectile dysfunction -ED). In combination with sexual stimulation, sildenafil works by increasing blood flow to the penis to help a man get and keep an erection.
OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.
Sildenafil is also available in other brands and strengths for treating high blood pressure in the lungs (pulmonary hypertension ). Do not take this medication with any other product that contains sildenafil or other similar medications for erectile dysfunction -ED or pulmonary hypertension (such as tadalafil, vardenafil).
How to use Viagra
Read the Patient Information Leaflet provided by your pharmacist before you start taking sildenafil and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
To treat erectile dysfunction -ED, take this drug by mouth as directed by your doctor, usually as needed. Take sildenafil at least 30 minutes, but no more than 4 hours, before sexual activity (1 hour before is the most effective). Do not take more than once daily.
A high-fat meal may delay how quickly the drug begins to work.
The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Tell your doctor if your condition does not improve.
Dizziness. headache. flushing, or stomach upset may occur. Vision changes such as increased sensitivity to light, blurred vision. or trouble telling blue and green colors apart may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Sexual activity may put extra strain on your heart. especially if you have heart problems. If you have heart problems and experience any of these serious side effects while having sex. stop and get medical help right away: severe dizziness, fainting. chest/jaw/left arm pain, nausea .
Rarely, sudden decreased vision. including permanent blindness, in one or both eyes (NAION) may occur. If this serious problem occurs, stop taking sildenafil and get medical help right away. You have a slightly greater chance of developing NAION if you have heart disease. diabetes. high cholesterol. certain other eye problems (“crowded disk”), high blood pressure. if you are over 50, or if you smoke.
Rarely, a sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness, may occur. Stop taking sildenafil and get medical help right away if these effects occur.
In the rare event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and get medical help right away, or permanent problems could occur.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction. including: rash. itching /swelling (especially of the face/tongue /throat), severe dizziness, trouble breathing .
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Before taking sildenafil, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as heart attack or life-threatening irregular heartbeat in the past 6 months, chest pain/angina, heart failure), stroke in the past 6 months, kidney disease, liver disease, high or low blood pressure. a severe loss of body water (dehydration), penis conditions (such as angulation, fibrosis/scarring, Peyronie’s disease ), history of painful/prolonged erection (priapism), conditions that may increase the risk of priapism (such as sickle cell anemia. leukemia, multiple myeloma ), eye problems (such as retinitis pigmentosa. sudden decreased vision, NAION).
This drug may make you dizzy or cause vision problems. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
This brand of the drug is usually not used in women. During pregnancy, sildenafil should be used only when clearly needed. Discuss the risks and benefits with your doctor.
It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
A product that may interact with this drug is: riociguat.
Sildenafil can cause a serious drop in your blood pressure when used with nitrates. A serious drop in blood pressure can lead to dizziness, fainting, and rarely heart attack or stroke. Do not use sildenafil with any of the following: certain drugs used to treat chest pain/angina (nitrates such as nitroglycerin, isosorbide), recreational drugs called “poppers” containing amyl nitrate, amyl nitrite, or butyl nitrite.
If you are also taking an alpha blocker medication (such as doxazosin, tamsulosin) to treat an enlarged prostate/BPH or high blood pressure, your blood pressure may get too low which can lead to dizziness or fainting. Your doctor may start treatment with a lower dose of sildenafil to minimize your risk of low blood pressure.
Other medications can affect the removal of sildenafil from your body, which may affect how sildenafil works. Examples include azole antifungals (such as itraconazole, ketoconazole), macrolide antibiotics (such as clarithromycin, erythromycin), HIV protease inhibitors (such as ritonavir, saquinavir), hepatitis C virus protease inhibitors (such as boceprevir, telaprevir), mifepristone, rifampin, among others.
Do not take this medication with any other product that contains sildenafil or other similar medications for erectile dysfunction-ED or pulmonary hypertension (such as tadalafil, vardenafil).
If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include severe dizziness, fainting, painful/prolonged erection.
Do not share this medication with others.
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised October 2015. Copyright(c) 2015 First Databank, Inc.