Over the last 5 years the US Food and Drug Administration (FDA) has identified more than 330 dietary supplements adulterated with active pharmaceuticals.1 Although the FDA has recalled some of these products, recent research suggests that, even after the recalls, products remain available over the Internet and on store shelves.2 One of the largest categories of tainted supplements are those sold to enhance sexual performance. A combination of manufacturer lack of scruples and consumer demand has created a huge market for dangerous sexual enhancement supplements. One recent example, Rock Hard for Men (manufacturer unknown), sold as a “natural” supplement, actually contains 2 potent prescription drugs—a phosphodiesterase-5 (PDE-5) inhibitor, tadalafil, and a sulfonylurea, glyburide.3 This combination of medications is of particular concern because a very similar combination discovered in other sex supplements has already led to more than a dozen deaths.4 If physicians, legislators, and regulators do not act decisively soon, more deaths may follow.
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