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High-risk dietary supplements: Male sexual enhancement supplements

High-risk dietary supplements: Male sexual enhancement supplements
Agent Alternative name(s) listed on supplement label Proposed mechanism of activity Potential adverse effects
PDE-5 inhibitors (eg, sildenafil, tadalafil, others) * PDE-5 inhibitor Flushing, dyspepsia, headache, visual changes, epistaxis; hypotension with concomitant nitroglycerin, alpha blockers, others[1]
PDE-5 inhibitor analogs (more than 80 have been identified) * Presumed PDE-5 inhibitor activity May have unexpected adverse effects due to variable PDE receptor activity or off-target activity[1,2]
Sulfonylureas * Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; increases insulin sensitivity Hypoglycemia, tremor, dizziness
Yohimbine Yohimbe, Corynanthe johimbe, coryanthe yohimbe, 11-hydroxy yohimbine Blocks presynaptic alpha-2-adrenergic receptors, resulting in increased cholinergic and decreased adrenergic tone Gastrointestinal distress, tachycardia, anxiety/agitation, hypertension[3,4]
Testing of dietary supplements often reveals drugs not declared on labeling, labeled drugs/herbs not detected in the product, inaccurate quantities, and adulteration with prescription and experimental drugs. In addition, doses contained in supplements may far exceed pharmaceutical quantities, increasing the risks of adverse effects. For review of health risks and an approach to patient counseling, refer to UpToDate topic reviews of high-risk dietary supplements.

PDE: phosphodiesterase inhibitor.

* Typically not declared/listed on supplement label.
References:
  1. Cohen PA, Venhuis BJ. Adulterated sexual enhancement supplements: More than mojo. JAMA Intern Med 2013; 173:1169.
  2. Kee CL, Ge X, Gilard V, et al. A review of synthetic phosphodiesterase type 5 inhibitors (PDE-5i) found as adulterants in dietary supplements. J Pharm Biomed Anal 2018; 147:250.
  3. Kearney T, Tu N, Haller C. Adverse drug events associated with yohimbine-containing products: A retrospective review of the California Poison Control System reported cases. Ann Pharmacother 2010; 44:1022.
  4. Cohen PA, Wang YH, Maller G, et al. Pharmaceutical quantities of yohimbine found in dietary supplements in the USA. Drug Test Anal 2016; 8:357.
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