Low Blood Sugar, Fatalities Linked To Illegal Sexual Enhancers
Opportunities to buy sexual enhancers abound on the Internet. Illegal herbal preparations for treating impotence and counterfeit Cialis tablets are readily available to anyone with a credit card. A study from a team at the University Hospital in Singapore published in the Feb 12, 2009 New England Journal of Medicine describes an epidemic of hypoglycemia related to illegal sexual enhancers contaminated with the diabetes drug glyburide.
From January 1 to May 26, 2008, 149 men and 1 woman without a history of diabetes were admitted to Singapore hospitals with dangerously low blood sugar levels. The ages of these patients ranged from 19 to 97. Records show that seven patients remained comatose as a result of prolonged neuroglycopenia, and four patients subsequently died.
The diabetes drug glyburide was detected in the urine of 85 percent of these patients. Upon questioning, 30 percent of the patients admitted to ingesting illegal sexual enhancing agents before the onset of hypoglycemia.
Using high-performance liquid chromatography, toxicologists analyzed drug samples obtained from these patients, along with drugs seized in police raids. Four preparations were found to be contaminated with the hypoglycemic drug glyburide in amounts ranging from 13 to 100 mg per tablet. Drugs contaminated with glyburide included a counterfeit pill sold as Cialis (tadalafil) and three different herbal preparations for the purported treatment of erectile dysfunction (Power 1 Walnut, Santi Bovine Penis Erecting Capsule, and Zhong Hua Niu Bian). All four products were also found to contain the drug sildenafil (Viagra) in amounts ranging from 0.5 to 110.0 mg per tablet. The herbal preparations Santi Bovine Penis Erecting Capsule and Zhong Hua Niu Bian were also found to contain trace amounts of the phosphodiesterase-5 inhibitor drug tadalafil, which is reported to increase blood flow to the penis during sexual intercourse and the weight loss drug sibutramine (Meridia).
Batches of Power 1 Walnut and Santi Bovine material manufactured before January 2008 were also tested and found to contain only sildenafil, suggesting that the contamination with glyburide was recent. The Singapore researchers surmised that simultaneous contamination of several brands of drugs is consistent with a common manufacturing source. The drug packaging listed fictitious overseas factories as the manufacturers, making it impossible to determine if the contamination was deliberate or accidental. Similar reports of hypoglycemia occurring between January and June 2008 were reported in the Hong Kong press that implicated other brands of sexual enhancers.
The study concludes that more effective collaboration between national and international drug-regulatory bodies and enforcement agencies is needed to address clandestine manufacturing processes, the cross-border movement of drugs, the quality of products, and the subsequent spread of these adulterated medications online. The researchers also caution that physicians need to be aware of this phenomenon when evaluating patients with severe unexplained hypoglycemia, particularly if a clustering of cases is noted. In addition, consumers who purchase medications online should be warned about the risks associated with these illegally produced drugs.