Experts have warned that a growing number of herbal supplements claiming to treat erectile dysfunction contain unlicensed pharmaceutical ingredients that could endanger people’s health.
Sunday Monitor spoke with experts who made it abundantly clear that not only do promoters of such supplements frequently make unverified claims about their benefits, but some contain illegal ingredients that could potentially cause harm and increase the risk of users contracting noncommunicable diseases.
A patient was recently wheeled into Lifeline International Hospital in Zana, Kampala, with an embarrassing condition: a prolonged penile erection. The case was referred to Dr Emma Sserunjogi, who quickly discovered that his patient had “consumed herbs and erected for four days.”
Sildenafil, an active compound in prescription drugs used to treat male sexual function problems and commonly referred to as “Viagra,” was discovered in the herbs in question.
“Drug overdose has varying drug-induced effects, and there is a specific dosage of drugs that one must take at a specific time,” Dr Sserunjogi explains, adding, “Creators of herbal remedies follow the guidelines that their ancestors told them, and some of them go further to mix herbs with supplements and conventional medicine, which is dangerous.”
Tadalafil and sulfoaildenafil are two of the most commonly undeclared ingredients in erectile dysfunction products worldwide. When combined with other nitrate-containing medications, they can significantly lower blood pressure and cause serious health problems.
Anecdotal evidence suggests that users of unlicensed remedies in Uganda are consuming large amounts of them without knowing how they interact with other supplements or medicines they may be taking. According to Dr. Sserunjogi, there may be serious side effects. There is a chance that the victim will never have an erection again if an aggressive solution is used.
Damage to the liver
As a 28-year-old male (name withheld) who drank herbal extracts for erectile dysfunction recently discovered, the concoctions are also known to increase the risk of liver problems. He was diagnosed with drug-induced liver injury after complaining of persistent abdominal pain.
Dr. Jacob Otile, a medical practitioner and researcher, observes that the liver serves several functions. Removing toxins from one’s body is a telling sign. Toxins include, for example, the drugs or herbs we use. The liver breaks these down into less toxic substances that the body can process and use.
This may come at the expense of the drug user, as some of the components in Ugandan aphrodisiacs end up damaging the liver.
“When someone already has pre-existing liver diseases, or if genetically they lack some liver enzymes that should handle these drugs, the liver ends up being injured in the process,” Dr. Otile tells the Sunday Monitor, adding that, unlike clinical drugs, most herbal remedies on the market have no approved doses.
Herbal remedies are defined.
In fact, Dr. Sserunjogi has linked the use of unlicensed herbal remedies to an increase in gastrointestinal issues in Uganda, the majority of which are liver-related. He claims that the freedom granted to those selling herbal medicine has been mismanaged, resulting in a looming crisis of liver-injury-related issues.
“The issue is that whatever a human being eats must first pass through the liver before entering the general blood circulation to the heart, where it is then pumped to the body,” he explains, adding, “So, if the herb you consume contains excess toxins, the liver will eventually be damaged.”
Many people are unaware, according to Dr. Sserunjogi, that so-called modern drugs are extracted from herbs and then standardised through the use of samples, tests, and trials, which is not done with a person who prescribes the herb directly.
“If you pick a plant from which a specific medicine is extracted and absorb it directly, you may be absorbing an overdose of active compounds of a specific medicine, which is dangerous to the body,” he tells the Sunday Monitor, emphasising the importance of quantity standardisation.
According to Mr Jamir Mukwaya, president of the Uganda Herbalists Association, there is a crisis caused by unscrupulous individuals who manufacture unverified herbs and sell them on the black market. He goes on to say that, just like in the bio-medical world, there are several unapproved remedies that end up on the market and taint the overall image of herbal medicine. This works against approved herbal drugs that are effective, of which there are many, according to Mr Mukwaya.
Dr. Sserunjogi warns of an increasing trend among herbalists to combine bio-medic drugs with herbs. He claims that this is common with drugs used to treat erectile dysfunction, and that it poses a high risk of impotence.
It is not safe.
Dr. Otile warns Ugandans against purchasing herbal medicine on the street. He focuses in particular on those who claim to treat more than ten diseases in a single bottle.
“Many of the people selling herbal medicines are unable to explain how the drug works; how the body handles it from when it enters your body to when it is eliminated; what diseases the drug specifically treats, as well as side effects,” he says.
According to Dr. Otile, these drugs are dangerous. These include, but are not limited to, underdosing or overdosing; dangerous/adverse effects; and damage to vital organs such as the liver and kidney injury, which can lead to kidney failure. Unknown safety, particularly in pregnant women, means they could end up harming the baby; increasing the risk of anti-microbial or antibiotic resistance; very bad drug interactions, particularly when given concurrently with clinical drugs (because we do know the components in the herbs); and worsening of pre-existing conditions in patients, particularly those with pre-existing liver diseases.
What the NDA says
The National Drug Authority (NDA) spokesperson, Mr Abiaz Rwamwiri, states unequivocally that the medical regulatory body condemns the sale of uncertified herbal remedies. He goes on to say that the NDA has always advised patients against using herbs that are not sold in licenced drug stores and pharmacies.
“We are aware of illegal remedies on the market and are working to reverse this trend.” “We always advise Ugandans not to consume drugs that are not legal,” he says.
Mr Rwamwiri also reveals that the NDA is funding research to improve herbal medicine in order to save the lives of Ugandans who use unproven remedies.
“The authority has approved more than 200 local herbal medicine types, and the list is published on our website and accessible to the public,” he says, adding, “We test specific drugs for toxicity and approve them if they pass a test.”
He goes on to say that advertising certain drugs, such as those for erectile dysfunction and reproduction, is illegal. It is also illegal to sell herbal remedies on the streets.
Consumption of herbal plants is common in developing countries, according to the National Centre for Biotechnology Information Community. However, a major public health concern is the lack of information on their physicochemical composition.
Vernonia amygdalina (locally known as mululuza) is gaining popularity in Ugandan rural communities due to its antibacterial and antiprotozoal parasitic activity.
However, no studies on heavy metal concentrations in traditional plants used in alternative medicine have been conducted.