Ordering Viagra Over The Internet

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Atorvastatin 40mg (generic equivalent to Lipitor) United Kingdom

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Buying ED Drugs Online: What’s the Risk?

“You can get hard without expensive prescription drugs that have dangerous side effects!”

It’s a familiar claim among sellers of online erectile dysfunction (ED) drugs — and there are a lot of them. A search for “buy erectile dysfunction drugs” brings up nearly 22 million web sites.

On these sites, you can order medications like Cialis (tadalafil), Levitra and Staxyn (vardenafil), Stendra (avanafil), and Viagra (sildenafil) without a prescription. Or, you can get a “natural” herbal remedy that promises to give you the same results. Often these drugs cost far less than they would at your local pharmacy. Buying online also lets you bypass the embarrassment of having to discuss your erection problems with a doctor.

But are ED drugs purchased online safe? Experts say think twice before you buy.

The Truth About ED Drugs Sold Online

The erectile dysfunction drugs and herbal remedies you buy online aren’t always what they seem. An FDA investigation found that more than one-third of “dietary supplements ” sold for ED actually contained prescription drugs, including sildenafil, the active ingredient in Viagra. Some ED drugs sold online contained entirely different medicines, such as the antibiotic metronidazole and the fertility drug clomiphene.

Even if a drug contains the right medicine, it may not be the right dosage. When samples of 100-milligram Viagra tablets purchased online were tested, only 10% were even close to the advertised strength.

When you buy from an unknown company, you run the risk of getting counterfeit medicines. By some estimates, more than half of all ED drugs sold online are fakes. Some of these drugs include ingredients you wouldn’t want to put in your body — things like talcum powder, paint, and printer ink.

The FDA warns of several products in particular that have contained potentially harmful or undeclared ingredients. Included among them are

  • 4EVERON
  • Actra-Rx
  • Actra-Sx
  • Adam Free
  • Blue Steel
  • Energy Max
  • Erextra
  • Hero
  • HS Joy of Love
  • Lady Shangai
  • Libidus
  • Liviro3
  • Lycium Barbarum L.
  • Nasutra
  • Naturalë Super Plus
  • NaturalUp
  • Neophase
  • Rhino V Max
  • Shangai Regular, also marketed as Shangai Chaojimengnan
  • Shangai Ultra
  • Shangai Ultra X
  • Strong Testis
  • Super Shangai
  • True Man
  • V.Max
  • Vigor-25
  • Xiadafil VIP tablets (Lots 6K029 and 6K209-SEI only)
  • Yilishen
  • Zimaxx

Continued

Health Risks of Online Drugs

Erectile dysfunction drugs such as Cialis, Levitra, Staxyn, Stendra, and Viagra work by increasing blood flow to the penis. Just like any other medicine, these drugs can have side effects.

A real drug masquerading as an herbal remedy can be dangerous — even life-threatening. Take the drug sildenafil, which the FDA says is hidden in some natural ED treatments sold online; if you’re already using nitrates for heart disease. sildenafil can lead to a dangerous drop in blood pressure. In 2008, 150 people in Singapore were hospitalized for low blood pressure after taking ED drugs. Doctors discovered that the drugs actually contained a large dose of the diabetes medicine, glyburide .

ED drugs can be especially dangerous for people with certain conditions, especially heart disease. They can also cause side effects or interact with other medicines you’re taking, such as blood thinners and some alpha blockers, which are used to treat high blood pressure and prostate conditions. Even mixing them with grapefruit juice can worsen side effects. These are issues your doctor needs to discuss with you when you get a prescription.

Buying Safely Online

Before buying ED drugs online, see your doctor to find out exactly what’s causing the problem. It may turn out that you don’t need to take these drugs at all. Health conditions that contribute to ED, such as diabetes or high blood pressure. can be treated. If ED is a side effect of a medicine you’re taking, your doctor may suggest that you stop taking the drug or take a lower dose.

The FDA is trying to stop the flow of illegal ED drugs, but these medicines still circulate freely on the Internet. Legitimate online pharmacies do exist. It just takes a little bit of sleuthing to find them.

Here’s what to look for when you buy ED drugs online:

  • A licensed pharmacy with an address in the U.S. (Check with your state board of pharmacy or the National Association of Boards of Pharmacy.)
  • A pharmacy that requires a prescription from your doctor
  • Drugs that are approved by the FDA
  • Containers that are clearly labeled with the name of the drug and the dosage
  • A licensed pharmacist who is available to answer your questions
  • A contact phone number to call if you have questions or problems
  • A clearly stated privacy policy that protects your credit card number and other personal information

WebMD Medical Reference Reviewed by Stuart Bergman, MD on August 12, 2015

Sources

FDA: “Hidden Risks of Erectile Dysfunction ‘Treatments’ Sold Online.”

FDA: “The Possible Dangers of Buying Medicines over the Internet.”

National Kidney & Urologic Diseases Information Clearinghouse: “Erectile Dysfunction.”

American Academy of Family Physicians: “Erectile Dysfunction — Overview.”

Jackson, G. International Journal of Clinical Practice. March 2010.

Anonymous. Bulletin of the World Health Organization. April 2010.

News release, FDA.

© 2015 WebMD, LLC. All rights reserved.

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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