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Adulterated Sexual Enhancement Supplements:  More Than Mojo

Pieter A. Cohen, MD1; Bastiaan J. Venhuis, PhD2
[+] Author Affiliations
1Harvard Medical School and Cambridge Health Alliance, Cambridge, Massachusetts
2Department of Pharmaceuticals and Medical Devices, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
JAMA Intern Med. 2013;173(13):1169-1170. doi:10.1001/jamainternmed.2013.854.
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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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Figure.
The Molecular Structures for Sildenafil, Acetildenafil (a Phosphodiesterase [PDE]-5/PDE-6 Inhibitor), and Propoxy-Hydroxyhomo (PHH)-Thiosildenafil (a PDE-1/PDE-5 Inhibitor)
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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