Blue Pills in the Mail

Should you trust erectile dysfunction drugs sold online?

By Deborah Jeanne Sergeant

Beginning with Viagra in 1998, erectile dysfunction medication has offered men relief from impotence — just pop a little blue pill, and problem solved. 

Viagra (sildenafil) is an FDA-approved medication that requires a prescription. But the cost, along with the stigma of needing help to achieve erections, has caused men in recent years to seek ED medication online.

Online pharmacies are nothing new. Many insurance companies have covered doctor’s prescriptions filled by online pharmacies for years. Some brick-and-mortar stores also provide online options. 

While these can be reputable means of obtaining medication, Dave Albala, an urologist with Crouse Hospital, said that solely online sellers can be difficult to evaluate.

“A lot of people advertise ED medication online,” Albala said. “If you go through a large drug company, look for brick and mortar locations. A study showed that 50% of medication sold through online sources contained any Viagra. Only 30% – 50% of those contained enough of it. Buying through an online pharmacy is a problem. Ninety-seven percent of sites aren’t recommended. It’s cheap, but they’re not helpful.”

Albala said that seeking medication through a drug manufacturer’s website can prove helpful.

Entities selling ED treatments from other countries lack the same scrutiny and regulations as in the United States. Even those shipping from a US address may source from countries without the same laws as the US.

“Avoid anything that appears to be coming from anywhere outside the United States,” said J.C. Trussell, an urologist with SUNY Upstate Urology.

Untrustworthy sites may sell preparations that do not match their labels.

“It is misleading,” Trussell said. “A patient should get precisely what they’re paying for and without any other chemical that’s not known to the patient. Taking too little or too much of the PD5 inhibitor has minimal consequences, but the other chemicals that may be slipped in to make the product work better could be harmful unaddressed by the patient.”

Trussell expressed hesitation about some online sources which do not fill doctor’s prescriptions but simply offer a questionnaire for buyers to complete.

“Most of those that are legitimate ask important questions for contraindications for having nitrates available for angina and making sure there are no current use or availability of nitro glycerin, which can cause low blood pressure or death,” Trussell said. “There are other relative contraindications, like inability to walk up a flight of stairs, heart attack within two weeks, untreated angina. Typically, internet questionnaires should cover these questions and not prescribe medication until that patient has seen a doctor. Once those are met, it’s safe to prescribe these medications.”

Treating erectile dysfunction without a prescription may overlook other health issues causing the problem. Trussell said that he insists patients see a primary care provider to rule out high blood pressure, high cholesterol, low testosterone or other things.

“They may have undiagnosed vascular issues that if untreated that can compromise their long-term health,” he said. “If someone has depression and ED, treating one can eliminate the others.”

While he understands that people want to be discreet and pay less, self-prescribing is a bad idea, he said.

Buyers should also be aware that some fraudsters spoof legitimate websites to bilk unsuspecting customers. Patients should avoid following links in advertisements and search for websites by entering the address directly.

Some men with ED consider nutritional supplements. Trussell said that he believes some of them work, but with caveats.

“Saw palmetto works quite well for a slow urinary stream for treating enlarged prostate,” he said as an example. “But no over-the-counter supplement for ED has any value or merit. I’m not aware of any that work. For that reason, I recommend that they avoid that option.”