The pooled data and postmarketing surveillance analysis after FDA approval of sildenafil revealed a finite risk of adverse cardiovascular outcomes, including acute myocardial infarction (MI) and sudden cardiac death, especially after completing sexual activity . The most commonly reported adverse effects of sildenafil are headaches, dyspepsia, and facial flushing. The products, which are often sold on the internet, can be dangerous to health, and we therefore warn consumers against using them. At the Danish Medicines Agency, we routinely analyse products that we suspect contain active pharmaceutical ingredients which are not declared in the product information. If you are taking erection medications, avoid treatment at rhino pill and other risky centers and make an appointment with your doctor. ED medications will be discreetly delivered to your home after examination and prescription by your physician. Getting high-quality prescription ED medications online is easier than ever. Currently, the FDA has approved four types of prescription ED drugs. Turning to a healthcare professional is a safer and more effective route for addressing sexual health concerns. Side effects can range from mild to severe and include headaches, heart palpitations, dizziness, and in extreme cases, life-threatening drops in blood pressure. The risks are particularly high for individuals with underlying health conditions or those taking other medications. The U.S. Food and Drug Administration (FDA) has frequently warned about these and similar products due to their potentially harmful hidden ingredients. The allure of these products lies in their promise of quick, noticeable results without the need for a prescription. Other side effects include headache, dyspepsia, flushing, myalgia/back pain, visual disturbances, and nasal congestion. There are numerous known side effects of PDE-5i, some of which may be life threatening. PDE-5i have been shown to be safe medications and may ultimately be available over the counter. Furthermore, as mentioned earlier, embarrassment with potency issues leads patients to avoid physician visits. With such significant profits to be made at a relatively low risk, there is a tremendous incentive for counterfeiters to tap into the growing market for PDE-5i. Meanwhile, while the punishment for buying 1 kilo of cocaine would be a minimum of 5 years to a maximum of 40 years in jail, the punishment for buying 1 kilo of sildenafil is typically 3 years (11). Many factors contribute to the disproportionately large market of counterfeit PDE-5i. In one study attempting to estimate illicit sildenafil use, concentrations of sildenafil and sildenafil metabolites were measured in sewage treatment centers in the Netherlands. Two separate analyses in Europe estimated that 0.6 to 2.5 million men are being exposed to illicit sildenafil compared to approximately 2.5 million users of legal sildenafil (8). We strive to provide you only with the best authentic products. Do not disregard or avoid professional medical advice due to content published within Cureus. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. The presence of V8 in the market poses a serious threat to public health because of its potentially life-threatening adverse effects. That said, really ANY supplement has the potential to produce side effects, so it’s best to check with your doctor to be sure. I’ve used products containing L-Arginine, Tribulus, and many of the other ingredients they list with varying degrees of success. Pharmaceutical drugs like Viagra do the same thing, just through the use of chemical substitutes rather then all natural ingredients. There are some excellent options out there, and the top three ranked supplements are VERY exciting. These are vasodilators that dilate (open) blood vessels in the body. Viagra (sildenafil) is not commercially available but as you’ve read before, there’s a good reason for that. Some of these drugs can be taken with Viagra and Cialis, but a doctor must be involved in the decision. The FDA identifies potential side effects when taking Rhino tablets. The large market for counterfeit medications is not equally distributed in size or class of medications worldwide. Some sources estimate that the market for counterfeit medications ranges between 75 and 200 billion dollars (5,6). Regardless, it is clear that counterfeit medications have reached an industrial level scale. In 2006, the WHO estimated that 10% of drugs worldwide were counterfeit, with the figure at 25% in developing countries, and as high as 50% in certain African and Asian countries (3). These patients with higher socioeconomic statuses having the resources to pay for pharmaceuticals out-of-pocket, combined with the stigma of ED, creates an environment ripe for an illicit market. Increasing household income and availability of a sexual partner positively correlate with their legal use (15). Predictive factors for obtaining PDE-5i while avoiding interaction with healthcare professions were embarrassment and the perception that it would be cheaper to get the medicine through alternative means. In two large surveys, 23–32% of PDE-5i users had no prior interactions with healthcare professionals (13,14). Besides the high profit margins, the underlying characteristics of consumers of PDE-5i make it a prime target for counterfeiters. Blood from three patients was analyzed for the presence of glyburide, and all three tested positive. The laboratories confirmed that all tablet samples contained sildenafil in amounts ranging from 55 to 156 mg per tablet, and that most tablets contained 90 to 100 mg of glyburide, a dose 5 to 10 times higher than that used in the treatment of diabetes. Tablets were independently analyzed by the Virginia Division of Consolidated Laboratory Services, the state public health laboratory using liquid chromatography with high-resolution mass spectrometry, and the University of Virginia Department of Pathology’s Laboratories using LC-QTOF-MS. Samples of V8 were obtained from the patients’ personal inventories and from several stores throughout Virginia. However, we feel cordyceps is inferior to other nitric oxide boosting ingredients. Erections are all about proper blood flow, so any ingredient that can optimize blood flow is a good ingredient. Cordyceps is a mushroom that is believed to help improve blood flow and circulation. The dangers of sexual enhancement supplements and counterfeit drugs to “treat” erectile dysfunction Although we are very confident in our ability to analyze supplement labels, we still find it beneficial to take user experiences into consideration before drawing a conclusion about a supplement… Tons of research shows that supplementation with Saw Palmetto can really dramatically boost sex drive, and it has actually been used in the past to help treat impotency. It has been shown across clinical trials to be able to increase the amount of free testosterone in the male body, which can help with sex drive as well as overall better focus and energy. It is believed to convert directly into nitric oxide upon ingestion, which can be huge in terms of opening up your blood vessels and allowing blood to flow more efficiently. Increasing blood flow AND desire could very well be exactly what you need. The risks are particularly high for individuals with underlying health conditions or those taking other medications.The capsules could be tainted with sildenafil and Tadalafil, which renders them unapproved drugs for which safety and efficacy have not been established, said the FDA.Just because a supplement is popular does not mean it works, and this is one of the many male enhancement pills out there that I do NOT recommend, despite its popularity…In fact, PDE5 medications make up the most commonly counterfeited medicine in Europe, and it’s just as popular in low-income countries.Erections are all about proper blood flow, so any ingredient that can optimize blood flow is a good ingredient.In addition to the intellectual property rights that counterfeiters violate, the products they make can place consumers in danger.It is believed to convert directly into nitric oxide upon ingestion, which can be huge in terms of opening up your blood vessels and allowing blood to flow more efficiently. FDA said the capsules are used for the treatment of erectile dysfunction. Your healthcare provider will create a safe and effective treatment plan to help you achieve a fulfilling sex life. Viagra (sildenafil) is not sold in stores. One study showed an effect, but another study on the same supplement did not show the same effect. This supplement includes L-arginine, DHEA, ginseng, L-carnitine, yohimbe and more. Our recommendation is to check out our Male Enhancement page in order to discover some supplements we are very confident in. In our opinion, it would be in your best interest to explore some other supplements before spending your money on this one. Purple Rhino is one of many natural remedies for erectile dysfunction that was invented to attempt to mimic Viagra and eliminate the need for a prescription. The capsules could be tainted with sildenafil and Tadalafil, which renders them unapproved drugs for which safety and efficacy have not been established, said the FDA. Some small scientific studies suggest that certain herbs and dietary supplements may be effective in achieving erections. Many Rhino products are listed as containing the active ingredients found in Viagra or Cialis, but these ingredients are not declared or licensed. However, because they are not fully regulated, they may contain very few active ingredients or so many that they cause dangerous effects and there is no way to know. The problem is that the substances and dosages of the active ingredients of Rhino tablets are unstudied, unregulated, and their sale without a prescription is prohibited. Quantities of active ingredients are also highly variable, as seen in Table 2.Furthermore, as mentioned earlier, embarrassment with potency issues leads patients to avoid physician visits.At worst, Rhino tablets may contain counterfeit, unregulated and unmeasured ingredients and may be dangerous.They are not FDA-approved and do not require a prescription.A 40-year-old male called the emergency medical services immediately after experiencing an unrelenting headache, nausea, and chest pain, that evolved shortly after consuming rhino and completing intercourse.The robust market for illegal sexual enhancers is attributed to profit margins, often 1000% more than with other street drugs, while penalties are usually less harsh .He denied having a medical history, experiencing anginal symptoms in the past and denied using any medications, including herbal supplements. My Top Choice For Male Enhancement Don’t get me wrong, Rhino 7 is a decent supplement…it’s simply not the best, and we only recommend the best on this site. If you need help with sexual dysfunction, contact your doctor who will help diagnose you and provide you with the right treatment. Contact your healthcare practitioner to know which treatment might suit you the best. These treatments are tested and guarantee safer and healthier erections. To be safe, speak to your doctor if you are suffering from any sexual dysfunction so that they can find the right treatment for it. Unknowingly ingesting tadalafil or sildenafil is dangerous because the drugs can have negative interactions with other medications or with alcohol. Not long after, herbal supplements hiding those ingredients became popular worldwide. The FDA also said that dietary supplements tainted with drugs are considered drugs under the law and the agency “does not have mandatory recall authority” over them. In a statement, the FDA said that “the agency faces several challenges in deterring fraudulent marketing of these types of products.” Within the FDA there is a lot of bureaucratic arguing about who is responsible for taking these products off store shelves,” Cohen said. In most cases, the FDA has just issued alerts telling consumers to avoid the products. Hiding pharmaceuticals in over-the-counter products is already illegal, and some researchers question why the FDA hasn’t cracked down further on products it knows are in violation of the law. The FDA typically tests products only after getting complaints from consumers or if products are seized by customs agents. As stated, counterfeit PDE-5i rarely are packaged with the appropriate warning labels. The effects of widely variable amounts of active ingredient range from low efficacy at a minimum to severe side effects and negative drug interactions at the worst. Quantities of active ingredients are also highly variable, as seen in Table 2. A substantial market for sexual enhancers exists across the US to augment this. The calculated Naranjo score that estimates the probability of adverse drug reactions using aspects of this case is 4, ruling out the possibility that the STEMI was not due to rhino. In the presentation paralleled by our patient, he began experiencing symptoms shortly after completing intercourse, which was considered the trigger factor in reports indicting sildenafil to MI. Additionally, studies describe the relationship between the occurrence of an MI and sexual intercourse, with the risk being the highest within the first few hours after completion. Another concern is that the pills may be made with analogues, or experimental variations of existing drugs that have not been tested for safety. Viagra, the brand name for sildenafil, made history in 1998 as the first drug approved to treat erectile dysfunction. Some consumer groups, as well as the FDA, have argued that the agency should have more legal authority to review supplements before they are sold to consumers. But recently, other sex supplements were still for sale on Walmart.com, including a pill called the Rhino 17 Plus 5000 that retailed for $17.98. He was admitted to a hospital, where his overnight blood glucose levels dropped as low as 42 mg/dL despite intravenous infusion of dextrose-containing fluids and frequent dextrose boluses. On arrival to the emergency department, his blood glucose level was in the normal range, but hypoglycemia recurred 1 hour later. On August 13, 2019, VPC was consulted by an emergency physician at an academic medical center about a man aged 57 years who did not have diabetes and was noted by his wife to have been diaphoretic and agitated the previous day. The public health implications of V8 use include the potential for substantial morbidity from hypoglycemic episodes and the potential for mortality if health care services are not accessed in a timely manner when hypoglycemia occurs. Collaborative and timely surveillance and prompt intervention are required to remove products known to cause substantial morbidity. Its primary ingredient was yohimbe extract, which comes from an African tree and apparently helps with erectile dysfunction AND promotes weight loss. I felt more comfortable with these because there weren't any ingredients that could get someone kicked out of the Olympics. I moved on to my second package of pills, Ageless Male TONIGHT. In an era where quick fixes and over-the-counter solutions are increasingly popular, many men turn to products like Rhino pills for sexual enhancement and performance. By bypassing the legitimate healthcare system, users of counterfeit PDE-5i bypass screening for concurrent medical comorbidities, as well as proper education and warnings of PDE-5i use. Strategies to limit counterfeiting should be multi-faceted and target prescribing healthcare professionals, pharmaceutical companies, regulatory authorities, and patients. Unsuspecting patients often seek alternative treatments of ED due to embarrassment and lower cost, but also because of the perception that “all natural” products are somehow safer than synthetic medications. Recently, in January of 2016, the FDA announced warnings against 40 products marketed as dietary supplements that contained undeclared PDE-5i (33) (Table 3). The next day, my boyfriend asked if he could have the Ageless Male TONIGHT pills. I concluded that these were just caffeine pills with a vegetable blend. But I don't think that had anything to do with the pills. "Do you feel like an ageless male tonight?" I asked. "What if I'm allergic to one of the things in here?" I asked, googling ingredients. Take these two characteristics out of the picture, and Rhino pills won’t be as popular as they are now. The FDA has received reports of men experiencing severe headaches after taking a Rhino enhancement pill. The unregulated nature of these ingredients is concerning because it could mean an overdose or the consumption of harmful ingredient combinations. These erections last more than 4 hours and can occur even without sexual stimulation. If it lasts for longer than 4 hours, you could be suffering from an acute health emergency. While the perceived benefits of these products are appealing, don’t be tempted without doing your due diligence. These pills can also be found in gas stations and convenience stores under the brand name “Rhino”. One factor which arouses this train of thought is the bombardment of Internet advertisements that market products claiming to induce erections. If you’re suffering from weak erections, you may have at least once thought of using quick remedies to help you gain sexual satisfaction and pleasure with your partner. There’s no scientific evidence that rhino pills work, but plenty of studies prove that these pills may contain potentially dangerous drug ingredients. Rhino pills are male enhancement pills that can be found across many retail and pharmaceutical shelves. FDA-approved prescription medications offer safer and more effective alternatives for treating erectile dysfunction and improving sexual performance. Other medications for heart disease and high blood pressure can also have interactions with sildenafil and other ED drugs, potentially resulting in fatal outcomes. Turns out that for virtually every male enhancement product it had analyzed, the FDA concluded that either sildenafil—the active ingredient in Viagra—or tadalafil—the active ingredient in Cialis—was present. Between 2004 and 2008, 35.8 million counterfeit sildenafil tablets were seized in Europe, which is 7 times greater than the amount of all other counterfeited Pfizer products combined. Consumers of illicit PDE-5i often do not realize they are using counterfeit products and placing themselves at an unnecessary health risk. This outbreak has major implications for public health because consumers might purchase and use these supplements without awareness of the potential for substantial morbidity (4). In the outbreak described here, a nonprescription over-the-counter supplement was also documented to contain both sildenafil and glyburide. Patients reported that the supplement was promoted by word of mouth and was purported to enhance male sexual performance. These dynamics are already evident with many pharmacies advertising for generic sildenafil (20 mg), used for pulmonary hypertension, at a significantly lower cost. This in turn could lead to a decreased demand for cheaper alternative counterfeit options. As the patents for PDE-5i will be expiring soon, it is conceivable that the cost of these drugs may be reduced significantly. Internet pharmacies have made it easier for PDE-5i users to bypass the healthcare system, as 16.5% of PDE-5i users obtained the medicine through the Internet (13). The situation is a testament to the largely unregulated nature of the $45 billion a year U.S. supplement industry. This story was produced by FairWarning, a nonprofit news organization based in Southern California that focuses on public health, consumer, labor and environmental issues. Any products found to be recalled or tainted by FDA will be removed and refunded. You assume all liability when purchasing products from RhinoPills.com. The drugs were illegally imported from China, packaged at warehouses in Southern California and shipped all over the country.He would acquire rhino for $8 from multiple gas stations and endorsed being a chronic user of rhino, usually consuming one 950 mg pill before the intended use, but this particular time he took three pills.Companies like Alpha MD specialize in providing medically-approved treatments for issues like erectile dysfunction (ED) and low testosterone.But he was just one of many players profiting from the sale of sex pills with hidden drugs, and his products were a fraction of the questionable supplements still for sale in the U.S.Within the FDA there is a lot of bureaucratic arguing about who is responsible for taking these products off store shelves,” Cohen said.Furthermore, 11.5% of patients being evaluated for a PDE-5i prescription had a new underlying disease detected (26).For instance, sildenafil can interact with nitrates and other medications used to treat high blood pressure, angina, and other cardiovascular conditions. Physicians who treat ED should warn patients against purchasing PDE-5i via alternative means, especially the Internet. Patients embarrassed by their condition or seeking less expensive alternatives to legitimate pharmaceuticals have fueled the market, and the growth of Internet pharmaceuticals have made counterfeit pharmaceuticals easy to obtain. Even though 57 of 58 products were labeled as “all natural” and no sample claimed to include synthetic substances, 81% contained PDE-5i. Just because a supplement is popular does not mean it works, and this is one of the many male enhancement pills out there that I do NOT recommend, despite its popularity… These male sexual enhancement pills may lead to severe problems like low blood pressure, priapism, and permanent impotence. According to a study by the FDA, all counterfeit supplements ordered by them contained a plethora of hidden ingredients that are normally only taken under a prescription. Based on these concerns, most of these authors suggest a cardiac screening in patients considering PDE5i therapy. A reasonable rationale suggested by other authors from similar cases is the possibility of sildenafil contributing to acute thrombosis in the absence of a cardiac history by inducing platelet aggregation based on in-vitro studies and canine models . Pricing constraints are an essential factor with prescription PDE5i costs rising due to active patents. Sellers can easily register new dietary supplements with the FDA without submitting any safety data. At least one product claims the pills were made in a “FDA registered facility” using such ingredients as “proprietary blend” and “horny goat weed.” But users have also described troubling side effects like headaches, a common enough problem that some packages boast of a “new formula” that comes with “no headache.” In rare cases, people who took the pills have suffered life-threatening injuries. Rhino pills, as the many products named for the horned beast are known, are a familiar sight at gas stations all over the country. Lee is now awaiting sentencing after pleading guilty to illegally importing bulk quantities of prescription drugs and faces up to three years in prison. Despite these potential dangers, the market for counterfeit products has grown astronomically. In addition to the intellectual property rights that counterfeiters violate, the products they make can place consumers in danger. For the purposes of this paper, the term “counterfeit” will be used to encompass all forms of SSFFC medications. Currently, the WHO is using the term “Substandard, Spurious, Falsely labeled, Falsified, and Counterfeit (SSFFC)” for medical products until a new definition is agreed upon (1). This can include products with bona fide ingredients, but with insufficient or excessive quantities, products with the wrong ingredients, or products with deceptive packaging. Similarly, the FDA has launched significant public education campaigns through magazine public service announcements, education leaflets, news articles, a consumer website (/counterfeit), and a pharmacist education program (36). However, by doing so, many of these patients are unknowingly subjecting themselves to significant health dangers. The common link between these patients was the use of an ED supplement that contained glyburide (a sulfonylurea used to treat diabetes), as well as illicit PDE-5i (31). Why Can't You Take Viagra with Blood Thinners? Rhino pills are widely marketed as a natural and effective way to improve sexual function, but what are they exactly, and are they safe? Feel free to ask us any question you would like about TRT, medical weightloss, ED, or other topics related to men's health. Ask us about TRT, medical weightloss, ED, or other men's health topics. Outbreak of Severe Hypoglycemia After Ingestion of a Male Enhancement Supplement — Virginia, August–November 2019 Despite being perceived as over-the-counter alternatives to drugs like Viagra, they lack scientific research and evidence to support their claims. They are not FDA-approved and do not require a prescription. To illustrate his point, he recalled a recent case of a man taking four 100 mg viagra pills—four times the maximum recommended dose—and damaged his kidneys in the process. He denied having a medical history, experiencing anginal symptoms in the past and denied using any medications, including herbal supplements. Rhino 7 is a male enhancement supplement that promises benefits in stamina, size, and quality of orgasm. While there haven’t been many studies on the male enhancement benefits of many of these ingredients individually, it seems as though there seems to be a certain degree of synergy. Rhino male enhancement pills are not recommended by any doctor as they are untested and potentially life-threatening. As seen above, there are a multitude of side effects that men can have when taking rhino pills regularly. Warnings on Rhino Pills and General Male Enhancement Products However, taking illicit PDE-5i may harm consumers directly, as many illicit products contain detrimental contaminants and inaccurate amounts of the active ingredient without the appropriate warnings.The unregulated nature of these ingredients is concerning because it could mean an overdose or the consumption of harmful ingredient combinations.Many “natural supplements” contain illicit PDE-5i, subjecting users to the same risks with even less warning.Rhino tablets, which are often sold as dietary supplements to enhance sexual performance, have received increasing attention in recent years.But questionable brands aren’t the only problem with what are considered sex enhancement pills.This includes blood pressure, angina, and cardiovascular medications.At the Danish Medicines Agency, we routinely analyse products that we suspect contain active pharmaceutical ingredients which are not declared in the product information. Numerous tainted sexual enhancement products remain on the market as over-the-counter products, placing consumers at risk for unknown health complications. As a matter of fact, most male enhancement products have not been evaluated by the FDA. Vigrx plus is my #1 choice for male enhancement pills. The FDA typically tests products only after getting complaints from consumers or if products are seized by customs agents.On arrival to the emergency department, his blood glucose level was in the normal range, but hypoglycemia recurred 1 hour later.In a statement, the FDA said that “the agency faces several challenges in deterring fraudulent marketing of these types of products.”The next day, my boyfriend asked if he could have the Ageless Male TONIGHT pills.Although we are very confident in our ability to analyze supplement labels, we still find it beneficial to take user experiences into consideration before drawing a conclusion about a supplement…Pro Solution Pills are designed to help increase your sexual stamina and drive.Counterfeiters are taking advantage of this growing market by developing illicit and counterfeit PDE-5i products. While the market for counterfeit pro-erectile medications is partially driven by the cost of prescription drugs, this reality could soon change. Over-the-counter supplements have been documented to contain prescription pharmaceuticals or other potentially harmful ingredients (2). He had been unable to fill his usual prescription for sildenafil (used to treat erectile dysfunction) because of health insurance difficulties and reported ingesting one V8 tablet nightly during August 10–12. In a well-known example, 150 non-diabetic patients were hospitalized with hypoglycemia in Singapore. Microbial growth analysis of phosphodiesterase-5 inhibitors (PDE-5i) products (29). Contamination with either adulterants or bacteria poses risks to consumers of counterfeit PDE-5i. They detail this pretty heavily on the pills main site, but I’ll touch on it briefly here. I have used alot of products containing l-arginine and can attest to its relative effectiveness. This process is known as vasodilation, and essentially what happens during it is the smooth muscle tissue surrounding the penile chambers relax, allowing for increased blood flow during erection. If you browse through “his” site you’ll find reviews for 100 products, and when I say reviews I really mean just star ratings. The US Food and Drug Administration (FDA) warns that some tablets may contain ingredients not listed on the label. They are often sold in similar packaging with a large rhino design. Read on to learn more about why you should choose evidence-based treatment for erectile dysfunction (ED). The pill contained a mix of erectile dysfunction drug and glyburide that caused severe hypoglycemia. The drugs were illegally imported from China, packaged at warehouses in Southern California and shipped all over the country. When combined these ingredients can allow men who may be facing the dreadful side effects of aging to regain their once youthful libido. Natural remedies for erectile dysfunction often consist of a synergistic and diverse combination of many ingredients rather than just one or two. Rhino 7 works by utilizing many different ingredients to increase satisfaction in the bedroom including vitamins as well as herbs that have been proven beneficial for erectile dysfunction. Read this Rhino 7 review to learn more, OR skip ahead to our list of the top 10 best Male Enhancement Supplements to discover the most effective supplements of the year… If you have to take a pill, there are prescription medications like Viagra, Stendra, and Cialis that have been approved by the Food and Drug Administration. Counterfeiters are taking advantage of this growing market by developing illicit and counterfeit PDE-5i products. Alternatively, glyburide may have been used to color the tablet blue to resemble prescription sildenafil. In 2009, an outbreak of hypoglycemia affecting 150 persons in Singapore was linked to counterfeit sildenafil contaminated with glyburide (3). The blue tablets found inside closely resembled prescription sildenafil. The ease and convenience of purchasing counterfeit PDE-5i products via the Internet have contributed to the growth of the illicit market. With the low cost of base materials and the high cost of pills, the profit margin for creating sildenafil is approximately 2,000 times that of cocaine. The total sewage load was back calculated to estimate total sildenafil consumption, and it was found that greater than 60% of identified sildenafil was not accounted for by legal prescriptions (9). Globally, antibiotics comprise the largest class of counterfeit medications, but in Europe, PDE-5i are the most commonly counterfeited medicines (7). Others seek to bypass the legitimate healthcare system due to either embarrassment of the underlying condition or desire for cheaper alternatives. It is unknown whether patient J resumed use of V8 after initial medical care.§ Left against medical advice.¶ Found with altered mental status the same day after leaving against medical advice. Patients D and O resumed use of V8 following their first visit for medical care and suffered recurrent hypoglycemic episodes. However, given that the tablets contained sildenafil doses within the typical therapeutic dosing range, the inclusion of glyburide as a filler appears less likely. It is unclear why glyburide was used in the manufacturing of this supplement. Currently, evidence suggests that ED is not only correlated with cardiovascular disease due to shared medical comorbidities, but is, in fact, an independent risk factor for cardiovascular disease. The Second Princeton Consensus on sexual dysfunction and cardiac risk stated that all men with ED, even in the absence of manifesting cardiac symptoms should be regarded as having potential risks for cardiovascular disease (24). Before PDE-5i are prescribed, patients must be evaluated for potential drug interactions and warned of the absolute contra-indications. Examples of commonly prescribed medications that have interactions with PDE-5i are included in Table 1. Many of these side effects occur because there is cross-reaction with other phosphodiesterase types located throughout the body (18,22). The robust market for illegal sexual enhancers is attributed to profit margins, often 1000% more than with other street drugs, while penalties are usually less harsh . He would acquire rhino for $8 from multiple gas stations and endorsed being a chronic user of rhino, usually consuming one 950 mg pill before the intended use, but this particular time he took three pills. He stated that he began using sildenafil years prior despite not displaying any signs or symptoms of sexual dysfunction and using it solely for recreational purposes. This case aims to provide a brief understanding of rhino and its temporal relationship to adverse cardiovascular risks in the setting of unregulated manufacturing methods, blending excessively high doses of PDE5i and contaminants, posing a substantial public health risk. These medications work by increasing blood flow to the penis, facilitating erections when sexually aroused. For instance, sildenafil can interact with nitrates and other medications used to treat high blood pressure, angina, and other cardiovascular conditions. As a result, the FDA has issued warnings advising against the purchase or use of Rhino enhancement pills and other related products. Rhino pills claim to use a blend of herbal ingredients to improve sexual function. The appeal of these supplements lies in their affordability and the convenience of purchasing them without the need for medical supervision. Rhino 5K male enhancement pills recalled Since 2015, the FDA has identified more than 200 sex supplements with hidden drugs. In 2019, Walmart agreed to remove one rhino supplement from its website after it was flagged by the FDA as containing hidden drugs and highlighted by a local TV news station. Under federal law, supplements are supposed to contain ingredients such as vitamins, minerals and herbs, but not pharmaceuticals, and can be sold over-the-counter. But even with their original creator behind bars, rhino pills continue to be sold nationwide. ED medications, including Viagra, belong to a class of drugs called PDE5 inhibitors. If you’re having trouble getting or maintaining an erection, try erectile dysfunction medications that are proven safe and effective when taken as prescribed. However, supplements have only minimal regulation and research results are modest. However, even in these well-regulated countries, the market for counterfeit PDE-5i has grown. The proportion of falsified drugs ranges from 1% in industrialized countries that have a well-regulated and controlled drug market to as high as 60% in some developing countries (6). Then, all sanctioned medications are manufactured under heavily monitored conditions. The use of dietary supplements for treatment of ED should be screened for and given due precautions. Many “natural supplements” contain illicit PDE-5i, subjecting users to the same risks with even less warning. Furthermore, counterfeit PDE-5i often contain improper dosing and contaminants that may place patients at direct risk. Counterfeiters do not declare these ingredients or warnings of possible deleterious interactions on their packaging. Non-declared pharmaceuticals can have drug interactions and side effects such as gastrointestinal symptoms and nausea when combining metronidazole and alcohol. PDE-5i products purchased from Internet pharmacies rarely contain the stated amount of active ingredient (17). Male enhancement pills are known to cause priapism due to higher doses of vasodilators and interactions between the ingredients. Priapism, or painful prolonged erections, is a risky side effect of rhino pills. Rhino pills do result in erections, mainly due to the presence of sildenafil and tadalafil, or the active ingredients in Viagra and Cialis. Marketed with names like “Krazzy Rhino 25000” and “Rhino 7 Platinum 3000”, these pills contain sildenafil and tadalafil—two ingredients that help restore erections. Let’s take a look at what these Rhino pills are, their side effects, and alternative ways to treat erectile dysfunction. The packaging of Rhino tablets does not contain any risks or side effects (this is a red flag). Rhino pills may illegally contain the active ingredient in Viagra. There is no evidence that Rhino tablets are an effective or safe treatment for erectile dysfunction. So, you may be able to achieve an erection, but there may be unpredictable and dangerous side effects. Also, once you get a prescription for legit erectile dysfunction medication, you actually know how much you’re taking. While regarded as being quite well-tolerated, both sildenafil and tadalafil require a prescription from a doctor. He fell into the federal crosshairs in 2018, when customs agents seized a package of white powder from China addressed to him and labeled as “Acrylic Paint.” Lab tests revealed that the powder actually contained erectile dysfunction drugs. So I originally learned about Red Rhino when I was “researching” on some porn sites for some new products to write about. Like so many others I’ve tested before, Red Rhino promises EXTREME gains in penis size from just simply popping one of their pills. While Purple Rhino does have some excellent ingredients and an overall very comprehensive formula, there are a few too many red flags for us to be able to confidently recommend this stuff. However, these active ingredients, in combination with other ingredients, may lead to a dangerous increase in blood flow in other parts of your body. Additionally, due to the unregulated nature of the supplement market, the composition of these pills may change anytime. This includes blood pressure, angina, and cardiovascular medications. Many men grab these pills as they appear to be a more affordable form of Viagra and other prescription ED medication. In one study, the ingredients of 58 products available for the treatment of ED without a prescription were analyzed. Perhaps even more dangerous than the counterfeit PDE-5i that is marketed as legitimate pharmaceuticals, however, are those marketed as “natural” supplements. There is also an indirect risk of missing potential medical conditions in patients that bypass the healthcare system to purchase illicit PDE-5i. Of these users, 68% did so without a prescription, as patients often do not realize that they are getting false and possibly dangerous products, and 60% of these users believed they received the same product as from a legitimate pharmacy (13). Familiarity with sildenafil has revealed that tolerance develops, and non-responders often resort to higher dosages or illegal enhancers to achieve satisfying results . ED has a temporal relationship to poor male vitality and early CAD, while PDE5i seems to have the highest rates of compliance and satisfaction . During his years of sexual enhancer use, he did endorse to frequently experiencing similar headaches in the past after use, although it was never to this degree, nor was it ever un-interrupting. Rhino pills are, in essence, over-the-counter male enhancement medications. Also known as male enhancement products, these pills are sold in various corners of the internet. Rhino pills are male sexual enhancement products commonly found in gas stations, drug stores, and online. But he was just one of many players profiting from the sale of sex pills with hidden drugs, and his products were a fraction of the questionable supplements still for sale in the U.S. Unlike pharmaceuticals requiring prescriptions, there is little Food and Drug Administration (FDA) regulation of health supplements. But I will say this…I have personally taken close to 100 different male enhancement pills and NOT one of them have given me a permanent increase in size. One thing I can’t seem to wrap my head around is whether or not it’s a male enhancement or testosterone boosting supplement. It’s modestly priced when compared to some of the other male enhancement pills we’ve tested on the market, with a one month supply costing about $39.95. A video starts to auto-play with Danny welcoming us to his blog, telling us he has the insider scoop on which male enhancement pills really work, and which are a waste of money. Our advice would be to explore some of our other male enhancement reviews to view some more highly ranked products. While Lee was spiking his supplement with real erectile dysfunction drugs, other manufacturers have used analogue or experimental variations of existing drugs that have not been tested for safety. Lee illegally spiked his herbal supplements with Sildenafil or Tadalafil, the drugs used in Viagra and Cialis. Rhino Pills and other herbal sex supplements for men often contain hidden ingredients that have caused injuries and even, in rare cases death to consumers. A new product named rhino contains up to 200 times the standard enhancement dose, which primarily comprises of sildenafil or tadalafil. Lastly, rhino and other sexual enhancers are often blended with impure substances, such as talcum powder, inks, and paint with the possibility of numerous adverse effects (Figure 6) . Despite lacking FDA approval and containing undisclosed ingredients, these unlicensed erectile dysfunction (ED) products continue to attract consumers. Gas station supplements, particularly those marketed under the Rhino brand, have gained significant popularity among men seeking enhanced sexual performance. The issue with store-bought supplements is that they don’t comply with the same rules that drugs do, says Landon Trost, a urologist at the Mayo Clinic. Lee was arrested in 2018, and the rhino pills being sold today were probably made by someone else. Lee was not the first to sell adulterated sex pills in the U.S., but prosecutors say he was the first to market rhino pills specifically. RhinoPills.com is not the manufacturer or distributor of any products on this site and we assume no liability for inaccuracies or misstatements about or related to such products. For more products shop on Nimbus Imports. The information should not be considered complete and should not be used in place of a visit, phone or telemedicine call, consultation or advice of your physician or other healthcare provider. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. Discuss this information with your own physician or healthcare provider to determine what is right for you. This is because the FDA does not regulate dietary supplements, such as prescription drugs.There are some caveats here. These commercially available sexual enhancement products are not FDA approved and do not require a prescription. In 2019, 17 men from Virginia were hospitalized after consuming an herbal supplement sold under the name “V8 male enhancement”. But of all the things you can find at a gas station, nothing feels more lawless than those "male enhancement" pills. A search of the phrase “pop a rhino” on Twitter turns up dozens of jokes about their effects. The distinctive design of a holographic rhino staring back at buyers has made the pills synonymous with over-the-counter sex pills. Officials with the Virginia Department of Public Health seized the supplements from local stores, a spokesman for the agency says. For reasons that are unclear, supplement manufacturers have also mixed erectile dysfunction medicine with glyburide, a drug normally used in diabetes medication The combination can be toxic and was linked to more than a dozen deaths in Hong Kong and Singapore in 2007 and 2008. As of 2012, at least 46 analogues of erectile dysfunction drugs were in use worldwide, according to researchers in the Netherlands. In fact, PDE5 medications make up the most commonly counterfeited medicine in Europe, and it’s just as popular in low-income countries. These headaches may be caused by increased blood flow in your brain, due to the vasodilatory effect of the ingredients found in the product. For instance, Rhino pills contain an ingredient called nitroglycerin, which can lower blood pressure levels to dangerous levels in men with diabetes and low blood pressure. Many variants of these pills such as Rhino SE7EN are also unregulated and not approved by the FDA.This story was produced by FairWarning, a nonprofit news organization based in Southern California that focuses on public health, consumer, labor and environmental issues.Despite being perceived as over-the-counter alternatives to drugs like Viagra, they lack scientific research and evidence to support their claims.“We will change the name on the product label to make it easier to pass the USA customs,” the Chinese seller wrote, adding that the drugs would be shipped via FedEx, “just like we always do.”As the patents for PDE-5i will be expiring soon, it is conceivable that the cost of these drugs may be reduced significantly.Consult with your doctor before taking ED supplements—rhino pills, prescription drugs, dietary supplements, or otherwise.Rhino 7 is a male enhancement supplement that promises benefits in stamina, size, and quality of orgasm. On the insistence of his friends and looking for cost-effective methods, he switched to rhino in 2016, stating that the potency was producing satisfying results with lower costs compared to PDE5i. He denied a tobacco or alcohol history but endorsed to using alprazolam and various sexual enhancers for years. A significant limitation is its use in patients with known coronary artery disease (CAD) using nitrates, regardless of spatial frequencies. The counterfeit drug has gained traction for its high user satisfaction and low cost among recreational customers. You can see an image of most of the products on the list. Sildenafil and tadalafil are phosphodiesterase-5 inhibitors (PDE5i) approved to treat erectile dysfunction (ED), one of the more common types of sexual dysfunction in males. Rhino was first reported as a sexual enhancer with tainted sildenafil and tadalafil properties by The Food and Drug Administration (FDA) by a series of public notifications through its medical product safety reporting program known as MedWatch program . We report a case of right coronary artery ST-segment elevation and complete heart block in a nitrate-free patient shortly after consuming three 950 mg pills of a sexual enhancer known as rhino and completing sexual intercourse. It is used in the context of male enhancement formulas to help boost sex drive. That said, many people with pre-existing health conditions may not react positively to these PDE5 medications and can experience severe side effects. Burro EN Primavera 250k Male Sexual Enhancement A PDE5 inhibitor is a vasodilator, meaning that it opens blood vessels. Though the packaging proudly stated that the product is made in the USA, phrases such as “gentleman entry begins” and “rock hard rerctions (sic)” didn’t instill me with confidence that these pills were in any way legit. Being the curious sort and in a somewhat silly mood, I forked out the $10 on the “Rhinozen Black Fire” just to make sure that these pills were snake oil and not, as the cashier suggested, potent. “Yo, that’s good shit man,” the cashier said when he saw me eyeing up the selection of around half a dozen packets of pills. “Horny goat weed”—often a top line ingredient in these pills—just sounded ridiculous. As a result, many so-called “natural” supplements, in fact, contain active ingredients of prescription strength drugs that could be potentially harmful. The man had no known exposure to insulin or other hypoglycemic medications; however, he disclosed recently using V8, an oral male enhancement supplement purchased from a local convenience store in the metropolitan Richmond area. An unlabeled, over-the-counter product sold in Virginia convenience stores as a male enhancement supplement contained sildenafil and glyburide, a potent hypoglycemic agent, leading to life-threatening episodes of hypoglycemia requiring prolonged hospitalization among users. Over-the-counter products sold as dietary supplements might contain undeclared Food and Drug Administration–approved prescription pharmaceuticals that could pose a substantial health risk to consumers who believe them to be harmless. It is important to consult a healthcare professional for proper diagnosis and guidance in choosing the most suitable treatment option. This is because a prolonged erection, known as priapism, can be a serious medical condition that requires prompt evaluation and treatment. If an erection lasts for more than four hours, it is crucial to seek immediate medical attention by visiting the nearest emergency room. Rhino Pills not only claim to enhance the strength and hardness of erections but also promise prolonged periods of heightened sexual performance. Two separate analyses in Europe estimated that 0.6 to 2.5 million men are being exposed to illicit sildenafil compared to approximately 2.5 million users of legal sildenafil (8).Microbial growth analysis of phosphodiesterase-5 inhibitors (PDE-5i) products (29).Rhino male enhancement pills are not recommended by any doctor as they are untested and potentially life-threatening.Strategies to limit counterfeiting should be multi-faceted and target prescribing healthcare professionals, pharmaceutical companies, regulatory authorities, and patients.This process is known as vasodilation, and essentially what happens during it is the smooth muscle tissue surrounding the penile chambers relax, allowing for increased blood flow during erection.Rhino Pills not only claim to enhance the strength and hardness of erections but also promise prolonged periods of heightened sexual performance.Tons of research shows that supplementation with Saw Palmetto can really dramatically boost sex drive, and it has actually been used in the past to help treat impotency.The pervasive use of counterfeit sexual enhancement supplements is increasing worldwide. In 2015, Nam Hyun Lee, a South Korean living in Southern California, got into the lucrative business of making herbal, over-the-counter sex supplements for men. Interestingly, since our initial contact with the FDA Safety Reporting Portal, multiple investigations of Rhino products have demonstrated that sildenafil is a non-labeled ingredient. There are few studies performed and few case reports regarding the roles of various supplements in causing priapism. Companies like Alpha MD specialize in providing medically-approved treatments for issues like erectile dysfunction (ED) and low testosterone. At first glance, it may seem effective as it is believed to contain ingredients that increase blood flow and swelling of the penis. This includes substances that should only be prescribed by prescription due to the risk of side effects and dangerous drug interactions. But questionable brands aren’t the only problem with what are considered sex enhancement pills. There are numerous reports of sildenafil causing acute MI in nitrate-free patients, and despite the low incidence of MI in these patients from PDE5i, these drugs are known to display adverse cardiac events 8,9. A 40-year-old male called the emergency medical services immediately after experiencing an unrelenting headache, nausea, and chest pain, that evolved shortly after consuming rhino and completing intercourse. Lastly, the contaminated market for sexual enhancement pills is proliferating, with recreational use growing in prevalence 2,4. All medical treatment decisions, including whether to prescribe medication, remain solely within the discretion of the treating healthcare provider. This website advertises telehealth medical services. Energy Virtual Medical PA employs the licensed physicians and healthcare practitioners who provide telehealth medical services.