Online pharmacy weblog

Dr. Andrew Kramer recently looked over the medical history of one of
his patients who had been in the emergency department complaining of
chest pains.

Kramer was surprised by what he read: The patient had been taking
three to four dietary supplements for erectile dysfunction — every day.

“I would have never given him Viagra,” said Kramer, a urologist at the
University of Maryland Medical Center. “He was on the cardiac
transplant list.”

Heart patients are potentially at risk for a heart attack and an early
death when they combine erectile dysfunction drugs, such as Viagra,
with heart medications that contain nitrates, like nitroglycerine.

Both drugs lower blood pressure and together can lower it to deadly
levels.

Normally doctors won’t prescribe Viagra or Levitra to these men, but
they can look elsewhere — specifically, the Internet, where herbal
supplements of all sorts are available for sale.

While some of these supplements may contain harmless ingredients, many
are indeed as potent as the real thing.

A recent Food and Drug Administration study showed that some of these
herbal remedies actually contained the active compound in prescription
brands as Viagra, Levitra and Cialis, making them potentially deadly
compounds.

The FDA issued a health advisory last week against these supplements.

“These products are promoted and sold on Web sites as ‘dietary
supplements’ for treating erectile dysfunction and enhancing sexual
performance, but they are in fact illegal drugs that contain
potentially harmful undeclared ingredients.”

“These companies are promoting medications that we would never give to
men with heart disease,” said Dr. Dragan Djordjevic, an internist
specializing in male sexual health at Rush University Medical Center
in Chicago.

The FDA specifically targeted the herbal supplements Zimaxx, Libidus,
Neophase, Nasutra, Vigor -25, Actra-Rx and 4EVERON, all of which do
not list the prescription ingredients on their labels.

For this reason, a patient may not realize the risks.

Erectile Dysfunction Common Among Older Men

“If they are not eligible for one of the classic drugs, they may go to
the supplements, and for this reason, it’s more poignant to let the
patient know that they can be harmful,” said Dr. Yair Lotan, an
assistant professor of urology at the University of Texas Southwestern
Medical Center in Dallas. “They may buy the supplement and not know
they are in danger.”

Doctors can’t estimate how many men have suffered from this drug
interaction because many patients don’t reveal that they are on
supplements.

In many cases, erectile dysfunction and heart disease are linked. Both
are caused by decreased blood flow due to buildup in the arteries.

“A person can come in with severely low blood pressure and die of a
heart attack, and not know they should have reported taking
supplements,” said Dr. Ira Sharlip, a clinical professor of urology at
the University of California at San Francisco and spokesman for the
American Urological Association.

Given that a large majority of Americans have erectile dysfunction,
however, doctors estimate that there are many who have taken or are
using these supplements.

It affects about 30 million U.S. men, including more than half of men
older than 40, according to Dr. Dominic Carbone, assistant professor
of surgery in urology at Wake Forest University Baptist Medical Center
in North Carolina.

May Help Some Men, However

Carbone estimates that he has at least six to 10 patients per month
ask him about supplements for erectile dysfunction.

They wonder whether the supplements are just as good as Viagra, he said.

He also recalls a patient coming in who had erectile dysfunction for
years without treatment and was taking eight to 10 supplements per day.

“The guy buying the supplements in a gas station is probably not
taking the recommended dose,” Carbone said.

Doctors say that some male patients feel forced to turn to the Internet.

Often they are still shy about bringing up the subject with their
doctors and prefer the anonymity of buying online.

Also, at about $10 a pill, Viagra can be too expensive for some men,
whereas supplements can go for a variety of prices, usually for less
than prescription drugs.

That isn’t always a bad thing, one doctor noted.

“The other side of the coin is we have made these drugs unavailable to
the poor. Medicaid does not cover Viagra. If something is off market
and is cheap, it may meet a need,” said Dr. Robert Davis, professor of
urology at the University of Rochester.

Many doctors agree, however, that the advisory is important to public
health.

“Not everyone on nitrates will see the sky fall when they take [these
supplements], but enough will to warrant an advisory,” Davis said.