Dangers of 'herbal Viagra': What every man should know

Liz Szabo | USA TODAY

Basketball player Lamar Odom's collapse this week – after allegedly using cocaine and sexual supplements – has raised questions about the supplements and their safety and whether they could increase the dangers posed by illegal drugs. Odom is now on life support at a Nevada hospital.

USA TODAY's Liz Szabo talked to medical experts about these products.

Q. What is in a sexual performance supplement?

A. Although these supplements are often called "herbal Viagra" – suggesting that they contain a safer or more natural form of the little blue pill – many contain the active ingredient in real Viagra, according to the Food and Drug Administration.

Odom apparently took supplements called Reload 72-hour Strong and Libimax, according a spokesman for the legal Nevada brothel where he collapsed, who spoke to the Associated Press.

Tests by the FDA in 2013 found sildenafil, Viagra's active ingredient, in Reload. In 2009, the manufacturer of LibiMax recalled the product after tests found that it contained tadalafil, another drug for erectile dysfunction.

Problems aren't limited to LibiMax and Reload. The FDA has found that 300 sexual supplements contain unidentified ingredients.

"Not only do these products contain undisclosed drug ingredients," the FDA says on its website, "but they also sometimes may include combinations of undisclosed ingredients or excessively high doses, both potentially dangerous situations."

Some herbal sexual supplements also contain saw palmetto, ginseng and horny goat weed, used for centuries in China to treat low libido and erectile dysfunction. Others contain yohimbine,made from the bark of a type of evergreen tree, said Pieter Cohen, an assistant professor at Harvard Medical School.

Taking a sexual supplement "is like playing Russian roulette," said Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. "You don't know what you're getting any time you open a bottle of 'herbal Viagra.'"

Q. Why would supplement makers put an expensive drug like Viagra, which can sell for $5 to $10 a pill, into an herbal supplement?

A. Although Viagra is expensive in the USA, it's dirt cheap in China, which makes many of these supplements, Cohen said. Chinese companies sell sexual supplements for a fraction of the cost of Viagra, but can still make a profit. Unlike Viagra, however, which comes in a standard dose, supplements may not have a standard dose of medication. So men could get much less of the active ingredient they're looking for -- or much more.

Q. How risky are these supplements?

A. According to the FDA, the hidden ingredients in these supplements can pose life-threatening risks.

That's because the active ingredients in erectile dysfunction drugs can interact with prescription drugs such as nitroglycerin, used to treat chest pain and other heart problems, according to the FDA. That's a big risk, given that the older men who seek out erectile dysfunction drugs are often the same ones who take nitroglycerin, including men with diabetes, high blood pressure, high cholesterol or heart disease.

Both Viagra-like drugs and nitroglycerin lower blood pressure, Glatter said. Taken together, the combination can cause heart rhythm problems, heart attacks and strokes.

In its 2013 warning about Reload, the FDA said: "Consumers should stop using this product immediately and throw it away. Consumers who have experienced any negative side effects should consult a health care professional as soon as possible."

Even prescription erectile dysfunction drugs such as Viagra, which are regulated much more tightly than herbal supplements, can cause heart attacks, Glatter said.

Sexual supplements that contain Viagra-like drugs are especially risky if men take large doses, Glatter said. Odom reportedly took 10 of the pills.

Consumers should be skeptical about claims that appear too good to be true, said Craig Hopp, program director of extramural research the National Center for Complementary and Integrative Health, part of the National Institutes of Health. Some herbal sexual supplements promise results in 30 minutes, for example. While pharmaceuticals can work that quickly, Hopp said that plants don't. Supplements that claim to work as quickly as drugs are probably laced with drugs.

Q. Do sexual supplements work?

A. No supplements have ever been shown to be effective for erectile dysfunction, according to the National Center for Complementary and Integrative Health.

Unlike prescription drugs, which must prove they're safe and effective before being approved by the FDA, supplement makers don't have to prove that their products work before selling them, said Charles Bell, programs director for Consumers Union, the advocacy arm of Consumer Reports magazine. Because supplements aren't tested through a rigorous scientific process, consumers have no way to know if they really work.

Q. Are supplements riskier than prescription or over-the-counter erectile dysfunction drugs?

A. Unlike prescription and over-the-counter drugs, supplement makers aren't required to post warnings about such side effects or drug interactions on their product labels, Bell said. Many men may not realize the risks.

Sexual supplements can sometimes be much stronger than regular Viagra, Glatter said. "You take more and more pills thinking it's safe," Glatter said. "People think, 'It's natural, so it must be safe.'"

A study in The New England Journal of Medicine this week found that at least 23,000 Americans go to the emergency room – including 2,000 who are hospitalized – after taking dietary supplements. Many of the most common symptoms are heart palpitations.

Q. Do sexual supplements add to the risks of cocaine or other illegal drugs?

A. Absolutely, Glatter said.

Cocaine alone is dangerous and can cause a heart attack, Glatter said. Cocaine, a stimulant, raises blood pressure and makes the heart beat faster. But it decreases the blood supply to the coronary arteries, the blood vessels that supply the heart with oxygen.

Cocaine is also particularly dangerous when combined with alcohol, said Glatter, who noted that some people combine the two in order to soften the experience of coming down off cocaine.

Combining cocaine and Viagra can cause a life-threatening, excruciatingly painful condition called an aortic dissection, or tear in the wall of the body's main artery, Glatter said. This causes blood to bleed into the blood vessel wall – instead of flowing out to the body – which deprives the brain and extremities of oxygen. That, in turn, can cause a stroke. People with this condition can also lose a leg.

The results of Odom's toxicology tests have not yet been released.

"God knows what this guy took," Glatter said.

Adding the club drug ecstasy, which is often taken to boost a sexual experience, only increases the risks from Viagra-like drugs, Glatter said. Combining ecstasy with alcohol and Viagra can cause serotonin syndrome, causing confusion, seizures and a high body temperature. That, in turn, also can lead to stroke.