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Is "Herbal Viagra" Safe?

Think an herbal supplement that promises to enhance male sexual performance is too good to be true? You’re probably right. According to the federal Food and Drug Administration (FDA), many of them are tainted with the real thing. The products—with names like “Herb Viagra,” “Viagra 007” and other, more suggestive names—have been found by the FDA to contain sildenafil, Viagra’s active ingredient. 

A 2013 study tested nearly 100 samples in total from about 60 herbal sexual performance supplements. It found that more than four out of five contained sildenafil or related chemicals (collectively called PDE5 inhibitors). These chemicals work by opening up the blood vessels to increase blood flow in the body. Another study from 2015 found that of 150 different supplement brands tested, 61 percent contained PDE5 inhibitors. PDE5 inhibitors are most likely added to get the effect the consumer is looking for while duping him into thinking he’s taking an all-natural product

Headaches and a flushed face are the most common side effects of sildenafil. Other side effects include gastrointestinal distress, dizziness, visual disturbance and insomnia. In rare cases, the drug can cause priapism, which is a prolonged, painful erection lasting for hours that can lead to permanent damage to and disfigurement of the penis.

Sildenafil can also cause dangerous drops in blood pressure, especially for those who take nitroglycerin or other nitrate medications for heart problems. Both nitrates and PDE5 inhibitors open up the arteries, allowing blood to flow more easily. So if a heart patient on nitrates uses what he believes to be a natural, herbal supplement that instead contains sildenafil, his blood pressure could plummet, leading to dizziness or even unconsciousness.

And that’s not all. In a case cited in the Annals of Pharmacology, a man taking three different nitrate medications used an herbal supplement tainted with PDE5 inhibitors. The result? An erection lasting 5 days that required a trip to the hospital. A month after, he still could not achieve a full erection.

It’s not just men who are at risk. In April 2017, the FDA pulled several herbal supplements marketed to women because they contained the drug flibanserin, which treats low libido in women. Flibanserin may cause low blood pressure, sleepiness, fainting and nausea. Some of these effects can be magnified by alcohol, birth control, herbal supplements and even grapefruit juice.

Bottom line: Avoid the knockoffs. See your doctor and talk about getting the real thing.

Medically reviewed in November 2019.

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