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Viagra from Online Sources Mostly Fake

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • In an analysis of pills from 22 different websites claiming to sell sildenafil, 77% of samples were counterfeit.

CHICAGO — Most of the sildenafil (Viagra) sold online is fake and contains far less of the active ingredient than the real thing, researchers said here.

In an analysis of pills from 22 different websites claiming to sell the drug, 77% of samples were counterfeit and contained only between 30% and 50% of the levels of active ingredient advertised on its label, Irwin Goldstein, MD, of San Diego Sexual Medicine in California, and colleagues reported during a poster session at the World Meeting on Sexual Medicine.

“The fastest growing drug class in the world is counterfeit drugs,” Goldstein said. “It’s not just the phosphodiesterase 5 (PDE5) inhibitors [like sildenafil], but they are the vast bulk. It’s a huge problem.”

Irwin said fake drugs have been a burgeoning problem largely because of their increased online availability. In 2010, worldwide sales of counterfeit drugs was estimated to be $75 billion, and in that year in the U.S. $5.6 million in illegal pharmaceutical products were seized, up from $2.1 million in 2005.

He noted that one in six Americans purchased prescriptions online last year, translating to some 36 million consumers who may have been exposed to fake drugs. That includes all fake drugs, not just the PDE5 inhibitors, but he noted erectile dysfunction [ED] drugs are a target of counterfeiters because of the stigma some patients feel about the disorder and have to purchase drugs in-person.

To assess the black market for sildenafil, Goldstein and colleagues at Pfizer Global Security ordered drugs from the top 22 websites that came up in searches for “buy Viagra” in March 2011.

None of the websites required a prescription, and 91% claimed to sell “generic Viagra,” which is not yet authorized by the FDA.

The cost per tablet ranged from $3.28 to $33, and the postal origins of the purchases were most commonly Hong Kong, the U.S. and the U.K. with only a few shipments from Canada, India, and other parts of China.

Irwin noted that the four Internet pharmacies claiming to be Canadian didn’t ship medication from Canada; most came from Hong Kong instead.

They found that of the 22 sample tablets examined, 77% were counterfeit, 18% were authentic, and one was an illegal generic.

The authentic medications shipped from the U.S. and the U.K. and were apparently diverted from their original market, he said. The illegal generic, on the other hand, which closely resembled real sildenafil, shipped from India.

The counterfeit tablets only contained between 30% and 50% of the labeled amount of the active ingredient, sildenafil citrate. Goldstein said the drugs are largely made by “illicit narcotic labs.”

There were also clear visual clues that the counterfeit tablets weren’t real, Goldstein said. The packaging was different, and the pills were darker blue, heavier, and thicker than normal.

They were also found to contain undeclared ingredients such as gypsum — the main ingredient in drywall — as well as commercial paint and printer ink, he said.

Fakes could also contain other harmful active ingredients, such as other antihypertensive medications: “That’s when it gets dangerous,” Goldstein said.

Hartmut Porst, MD, a private practitioner in Hamburg, Germany, who moderated the discussion during which the poster was presented, said the problem is rampant in his country and it’s nearly impossible to prevent patients from ordering their ED drugs online.

“They say, ‘I’m getting a good erection and I don’t get any side effects, and I pay only 20% of the normal cost,'” Porst said. “How can you convince them otherwise?”

Goldstein responded that doctors should ask patients how they are obtaining their medications, and that emergency departments “seeing patients getting sick from these medications must ask where they are getting them from.”

Jim Wook Kim, MD, of Korea University Medical Center, said his country’s sexual medicine society has been running an anti-fake drug campaign for years and its research has shown that four of 10 patients who go to the doctor’s office for ED treatment had tried a fake ED drug at one point in their lives.

Edgardo Becher, MD, PhD, president of the International Society of Sexual Medicine, said in an email that his organization has published a position statement against fake PDE5 inhibitors in the Journal of Sexual Medicine .

“It is a widespread problem, totally uncontrolled, and nobody knows what those pills contain,” he said in an email to MedPage Today .

Goldstein reported relationships with Absorption Pharmaceuticals, AMS, Auxilium, BioSante, Boehringer-Ingelheim, Emotional Brain, Endoceutics, Medtronic Vascular, Neogyn, Palatin, Repros, Target Health, Trimel, Apricus, Eli Lilly, Fabre Kramer, Ironwood, Slate, Sprout, Vivus, Ascend, Abbott, Coloplast, Endo, Meda, Merck, and Pfizer.

  • Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Primary Source

World Meeting on Sexual Medicine

Source Reference: Campbell N, et al “Viagra ordered on the Internet is rarely genuine” WMSM 2012; Abstract 187.

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Can you share your background with the OP so that he may better gauge his opportunities. Sporadically from August to the end of September (5 hours a week)I went to college at UNC – Chapel Hill and graduated in Decemeber '07 with degrees in biology and astrophysics. Individual viagra cialis attendings have databases, but that seems cialis to be about it. If a cialis vs viagra woman viagra cialis changes her last name she is no less a member of her extended family. In fact, there was one attending which I went to the school and voiced my concerns viagra cialis about the illegal and potentially deadly actions he took in his 'supervision' of me during a rotation.

The American Academy of Ophthalmology has outlined a policy relating to co-management:Ortho: 1 Case presentation, viagra cialis Complete tx of 2-3 patients, and a 5-10 page reportOur problem is more of affordability and finding someone who needs exactly what your reqs for graduation demandScripps College Post Baccalaureate Premedical Program viagra cialis – Class of 2010Tough call, i'm in a similar boat (v-13,b-10,p7,w-R).

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Podriamos reunirnos si estamos todos en Capital, o hacerlo via Skype (al parecer tiene muy buenas cosas el programita ese, recien lo instale ayer y estoy chocha con el)What are some of the things that drew you into VMRCVM as an IS. Going to canada for a while and I'm thinking of studying for the Mcat again. There was a nursing manager position listed at k/year. Theroadtomed, Jul 13, 2009, in forum: What Are My Chances.

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It actually wasn't as terribly hot as I was expecting.

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I'm their only daughter and they're stuck with me, lol. Don't take my word on it though, I'm just an applicant, same as you. Usmlesuccess, Jan 28, 2014, in forum: Ophthalmology: Eye Physicians & SurgeonsEarn a maximum of 56 AMA PRA Category 1 Credits' from Johns Hopkins University School viagra of Medicine cialis vs viagra with your 14-issue (one year) subscription with Gastroenterology continuing medical education. Of course students can supplement it with other tools as you all know, but med schools do provide some type of training for that test. In staters will get an email in a month or soo. On the billing side, I'm not how well that would work either.

And word of advice to others traveling to Oakland (especially out-of-staters) during the winter season. Any of those times might be proper or appropriate, but I wouldn't blame anyone that in a moment of weakness (and 3 months is absolutely "a moment" in an emotional sense) decided to leave that particular skeleton in the closet.

And not so much in second year either.

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