Counterfeit PDE5 Inhibitors and Rogue Online Pharmacies
Fake Viagra, Cialis, and Unregulated Online Sales
Evidence grade 5 of 5, Settled. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- FDA and NABP repeatedly warn against rogue online pharmacies
Reference only. Not medical advice.
What can go wrong
Documented hazards include unpredictable dosing, undisclosed nitrate interactions, and contaminants reported in seized samples such as printer ink, drywall, talc, and commercial paint. Because the buyer bypasses a clinician, the most dangerous risk is taking an unknown vasoactive dose without screening for cardiovascular contraindications.
This is something to take to a clinician. The Atlas can tell you what is known about counterfeit pde5 inhibitors and rogue online pharmacies in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
Erectile dysfunction drugs are among the most counterfeited medications in the world. Investigations have found that the large majority of sildenafil ordered from unverified internet sources is counterfeit, with active-ingredient content ranging from none to far above the labeled dose, plus contaminants. The National Association of Boards of Pharmacy has reported that the overwhelming majority of online pharmacy sites it reviews fail to meet safety and licensing standards.
Most of what is sold as Viagra online is not Viagra.
What people take it for
What it is taken for. Approval, where it exists, covers only some of these.
How it works
Counterfeit tablets are manufactured without quality control. Some contain no active drug, some contain unpredictable amounts of sildenafil or tadalafil, and some are adulterated with the wrong drug or with contaminants. Unknown dosing means a buyer cannot predict effect or safety, including dangerous interactions if the buyer also takes nitrates or other vasodilators.
Safety in detail
PDE5 inhibitors require screening for nitrate use and cardiovascular contraindications. Obtaining them from unverified online sources bypasses that screening and exposes the user to counterfeit, contaminated, or mis-dosed product. Use only licensed pharmacies under physician oversight.
What has to be monitored
The bloodwork this needs, and the reason it belongs with a clinician rather than a website.
- Verification of pharmacy licensing before any purchase
- Cardiovascular and nitrate screening before PDE5 use
- Reporting of suspected counterfeits to FDA MedWatch
What people get wrong
Often saidA cheap online deal is the same generic, just cheaper
ActuallyVerified generic sildenafil exists, but unverified sites overwhelmingly sell counterfeits with unknown contents. Price is not a reliable signal of authenticity.
Often saidIf it gives an effect, it must be safe
ActuallyAn unpredictable dose of active drug from an unregulated source can still cause dangerous hypotension, especially combined with nitrates the buyer was never screened for.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
At a glance
- Counterfeit rate
- About three-quarters of internet-ordered Viagra in one study was counterfeit
- Active ingredient
- Ranges from 0% to well over labeled dose in seized samples
- Rogue sites
- NABP has found the vast majority of reviewed online pharmacy sites non-compliant
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Counterfeit PDE5 Inhibitors and Rogue Online Pharmacies. A short entry is not a safe entry.
- Timeline. We have not built the dated record of research and regulatory events.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- How it compares. We have not set it against the alternatives.
- Children and teenagers. We have not checked what is known about younger people.
- Where we land. We have not taken a position on this yet.
Sources
The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.
The studies that matter
Internet-ordered Viagra analysis (Campbell et al.)2012
Majority of sildenafil ordered from internet sites was counterfeit with variable active ingredient
Counterfeit PDE5 inhibitor safety review2011
Counterfeit samples showed inconsistent active ingredient and contaminants posing safety risks
NABP internet pharmacy reviewsestablished
Overwhelming majority of reviewed sites failed licensing and safety standards