Advice Buying Viagra Online

Viagra from Online Sources Mostly Fake

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • In an analysis of pills from 22 different websites claiming to sell sildenafil, 77% of samples were counterfeit.

CHICAGO — Most of the sildenafil (Viagra) sold online is fake and contains far less of the active ingredient than the real thing, researchers said here.

In an analysis of pills from 22 different websites claiming to sell the drug, 77% of samples were counterfeit and contained only between 30% and 50% of the levels of active ingredient advertised on its label, Irwin Goldstein, MD, of San Diego Sexual Medicine in California, and colleagues reported during a poster session at the World Meeting on Sexual Medicine.

“The fastest growing drug class in the world is counterfeit drugs,” Goldstein said. “It’s not just the phosphodiesterase 5 (PDE5) inhibitors [like sildenafil], but they are the vast bulk. It’s a huge problem.”

Irwin said fake drugs have been a burgeoning problem largely because of their increased online availability. In 2010, worldwide sales of counterfeit drugs was estimated to be $75 billion, and in that year in the U.S. $5.6 million in illegal pharmaceutical products were seized, up from $2.1 million in 2005.

He noted that one in six Americans purchased prescriptions online last year, translating to some 36 million consumers who may have been exposed to fake drugs. That includes all fake drugs, not just the PDE5 inhibitors, but he noted erectile dysfunction [ED] drugs are a target of counterfeiters because of the stigma some patients feel about the disorder and have to purchase drugs in-person.

To assess the black market for sildenafil, Goldstein and colleagues at Pfizer Global Security ordered drugs from the top 22 websites that came up in searches for “buy Viagra” in March 2011.

None of the websites required a prescription, and 91% claimed to sell “generic Viagra,” which is not yet authorized by the FDA.

The cost per tablet ranged from $3.28 to $33, and the postal origins of the purchases were most commonly Hong Kong, the U.S. and the U.K. with only a few shipments from Canada, India, and other parts of China.

Irwin noted that the four Internet pharmacies claiming to be Canadian didn’t ship medication from Canada; most came from Hong Kong instead.

They found that of the 22 sample tablets examined, 77% were counterfeit, 18% were authentic, and one was an illegal generic.

The authentic medications shipped from the U.S. and the U.K. and were apparently diverted from their original market, he said. The illegal generic, on the other hand, which closely resembled real sildenafil, shipped from India.

The counterfeit tablets only contained between 30% and 50% of the labeled amount of the active ingredient, sildenafil citrate. Goldstein said the drugs are largely made by “illicit narcotic labs.”

There were also clear visual clues that the counterfeit tablets weren’t real, Goldstein said. The packaging was different, and the pills were darker blue, heavier, and thicker than normal.

They were also found to contain undeclared ingredients such as gypsum — the main ingredient in drywall — as well as commercial paint and printer ink, he said.

Fakes could also contain other harmful active ingredients, such as other antihypertensive medications: “That’s when it gets dangerous,” Goldstein said.

Hartmut Porst, MD, a private practitioner in Hamburg, Germany, who moderated the discussion during which the poster was presented, said the problem is rampant in his country and it’s nearly impossible to prevent patients from ordering their ED drugs online.

“They say, ‘I’m getting a good erection and I don’t get any side effects, and I pay only 20% of the normal cost,'” Porst said. “How can you convince them otherwise?”

Goldstein responded that doctors should ask patients how they are obtaining their medications, and that emergency departments “seeing patients getting sick from these medications must ask where they are getting them from.”

Jim Wook Kim, MD, of Korea University Medical Center, said his country’s sexual medicine society has been running an anti-fake drug campaign for years and its research has shown that four of 10 patients who go to the doctor’s office for ED treatment had tried a fake ED drug at one point in their lives.

Edgardo Becher, MD, PhD, president of the International Society of Sexual Medicine, said in an email that his organization has published a position statement against fake PDE5 inhibitors in the Journal of Sexual Medicine .

“It is a widespread problem, totally uncontrolled, and nobody knows what those pills contain,” he said in an email to MedPage Today .

Goldstein reported relationships with Absorption Pharmaceuticals, AMS, Auxilium, BioSante, Boehringer-Ingelheim, Emotional Brain, Endoceutics, Medtronic Vascular, Neogyn, Palatin, Repros, Target Health, Trimel, Apricus, Eli Lilly, Fabre Kramer, Ironwood, Slate, Sprout, Vivus, Ascend, Abbott, Coloplast, Endo, Meda, Merck, and Pfizer.

  • Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Primary Source

World Meeting on Sexual Medicine

Source Reference: Campbell N, et al “Viagra ordered on the Internet is rarely genuine” WMSM 2012; Abstract 187.

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Viagra FAQs

  • How does Viagra work?

How does Viagra work?

Viagra causes the arteries supplying blood to the penis to dilate. This increases the blood flow, creating a firmer and longer-lasting erection.

Viagra is an oral treatment for erectile dysfunction. It helps enhance your body’s reaction to sexual stimuli, but it will not automatically produce an erection, so arousal is still essential for penetrative sex.

Viagra belongs to a class of medicines known as PDE-5 inhibitors. Viagra and the other PDE-5 inhibitors can help men with erectile dysfunction (or impotence) by increasing the blood flow into the erectile tissue in the penis when you are aroused.

When the brain gets aroused, it sends a signal to the penis. Nerve cells in the erectile tissue in the penis start producing nitric oxide, and this leads to the creation of a chemical called cGMP. This chemical relaxes the smooth-muscle cells that line the arteries in the erectile tissue of the penis. This allows more blood to flow into the penis, which helps to create an erection. This pathway is disrupted in men with erectile dysfunction.

PDE-5 is an enzyme found in the penis which breaks down cGMP when you stop having sex. As the level of cGMP falls, the penis returns to its non-erect state. Viagra works by selectively inhibiting this enzyme, which leads to a temporary increase in the level of cGMP when aroused, and allows extra blood flow to the penis to help create an erection. The greater the amount of cGMP, the greater the blood flow, and the firmer the erection.

  • How effective is Viagra?

    How effective is Viagra?

    Viagra is effective in around 60-70% of men with ED.

    Viagra’s effectiveness depends upon the cause and severity of the user’s erectile dysfunction. Viagra usually comes in doses of 50mg tablets, but some users may require 25mg or 100mg. For men with diabetes or a BMI over 34, doses of 100mg are most commonly prescribed as a starting dose. This ensures a high chance of Viagra working, but also increases the chance and possible severity of some side effects.

    It should be taken on an empty stomach, and ideally without alcohol to get the best effects. You should not consume more than one prescription dose of Viagra in a 24 hour period.

    If Viagra doesn’t work for you first time round, it could nevertheless be more effective next time. Indeed, doctors advise trying all erectile dysfunction medicines eight times before giving up.

  • Can I take other medicine with Viagra?

    Can I take other medicine with Viagra?

    Yes, but your doctor will inform you of any exceptions.

    Viagra can interact with some medicines, especially those containing nitrates used in the treatment of some heart conditions. It is important that you let us know which prescription and over-the-counter medicines and recreational drugs you are taking so that our doctors can prescribe you Viagra safely.

  • Is it safe to order Viagra online?

    Is it safe to order Viagra online?

    Yes. Our GPs are NHS accredited, and all our medicines are licensed by the government’s Medicines & Healthcare Products Regulatory Agency (MHRA).

    Our team of London-based doctors are all NHS accredited, and will only administer prescriptions to those patients for whom Viagra is safe to take. Furthermore, we are a medical organisation regulated by the Care Quality Commission and all our medicines have passed rigorous testing before being clinically approved for patient consumption.

    In addition to professional, safe and expert care, we are also firm believers in transparency at LloydsPharmacy Online Doctor. Therefore, every prescription we provide will be accompanied by a confidential message in your Patient Record, with the name and General Medical Council (GMC) registration number of your doctor. Click here to meet our doctors.

  • How do I take Viagra?

    How do I take Viagra?

    Orally, about an hour before sex.

    Viagra is an oral tablet taken with water on an empty stomach, at least an hour before you plan to have intercourse. The pills are blue, and shaped like a diamond – hence the nickname ‘the blue diamond’. All doses will have Pfizer written on one side, and on the other VGR 25/50/100. The 25mg tablet is 9mm long, the 50mg is 11mm, and the 100mg is 14mm in length.

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