sildenafil-citrate and Hypoglycemia

The aim of the present study was to determine the effect of sildenafil on dopamine, 5-hydroxyindol acetic acid (5-HIAA) and selected biomarkers of oxidative stress in the brain of hypoglycemic rats. The animals were treated intraperitoneally as follows: group 1 (control), saline solution; group 2, insulin (10 U per rat or 50 U kg-1); group 3, insulin + single dose of sildenafil (50 U kg-1 + 50 mg kg-1); group 4, insulin + three doses of sildenafil every 24 hours (50 U kg-1 + 50 mg kg-1). In groups 2, 3 and 4, insulin was administered every 24 hours for 10 days. Blood glucose was measured after the last treatment. On the last day of the treatment, the animals´ brains were extracted to measure the levels of oxidative stress markers [H2O2, Ca2+,Mg2+-ATPase, glutathione and lipid peroxidation (TBARS)], dopamine and 5-HIAA in the cortex, striatum and cerebellum/medulla oblongata by validated methods. The results suggest that administration of insulin in combination with sildenafil induces hypoglycemia and hypotension, enhances oxidative damage and provokes changes in the brain metabolism of biogenic amines. Administration of insulin and sildenafil promotes biometabolic responses in glucose control, namely, it induces hypoglycemia and hypotension. It also enhances oxidative damage and provokes changes in the brain metabolism of biogenic amines.

Topics: Animals; Biogenic Amines; Blood Glucose; Brain; Dopamine; Hydroxyindoleacetic Acid; Hypoglycemia; Insulin; Lipid Peroxidation; Male; Oxidative Stress; Rats; Rats, Wistar; Sildenafil Citrate

Sexual enhancement medication presents a large market for counterfeit versions. We report here a case of hypoglycemia caused by an illicit sexual enhancement medication containing an extremely large amount of the sulfonylurea drug glibenclamide together with a moderate amount sildenafil citrate.

Topics: Adult; Blood Glucose; Drug Combinations; Erectile Dysfunction; Glyburide; Humans; Hypoglycemia; Hypoglycemic Agents; Male; Phosphodiesterase 5 Inhibitors; Sildenafil Citrate

Cross-border importation of traditional and prescription medications is common, and many of these drugs are not approved by the Australian Therapeutic Goods Administration. Furthermore, counterfeit versions of prescription medications are also available (eg, weight-loss medications, anabolic steroids, and medications to enhance sexual performance). We describe a 54-year-old man with the first Australian case of severe hypoglycaemia induced by imported, laboratory-confirmed counterfeit Cialis. This serves to remind medical practitioners that counterfeit medication may be the cause of severe hypoglycaemia (or other unexplained illness).

Topics: Drug Contamination; Erectile Dysfunction; Glyburide; Humans; Hypoglycemia; Hypoglycemic Agents; Male; Middle Aged; Piperazines; Purines; Self Medication; Sildenafil Citrate; Sulfones; Vasodilator Agents

To describe the magnetic resonance (MR) imaging findings associated with severe hypoglycemia after consumption of an illegal sexual enhancement product (Power 1 Walnut) adulterated with glibenclamide, an oral hypoglycemic agent used to treat diabetes mellitus.. Institutional review board approval was obtained for this retrospective study. Records in eight male patients with severe hypoglycemia of unknown cause, without prior treatment for diabetes, and with positive blood toxicology results for glibenclamide were reviewed. MR imaging included diffusion-weighted imaging and, in some patients, MR angiography, dynamic contrast material-enhanced perfusion MR imaging, and MR spectroscopy.. In seven patients, there were hyperintense abnormalities on diffusion-weighted and T2-weighted images in the hippocampus and cerebral cortex, sparing the subcortical white matter and cerebellum. Three patients had abnormalities of the splenium of the corpus callosum, and one had widespread involvement, including the caudate nucleus, basal ganglia, and internal capsule bilaterally. In three patients, unilateral cortical involvement, which did not conform to the typical cerebral arterial territories, was noted. In one patient, perfusion MR imaging showed slightly increased relative cerebral blood volume, and MR spectroscopy revealed no evidence of abnormal lactate in the affected cerebral cortex.. Diffusion-weighted MR imaging findings in patients with severe hypoglycemia showed typical lesions in the hippocampus and cerebral cortex, but the caudate nucleus and basal ganglia were involved in only the most severely affected patient. The splenium of the corpus callosum and internal capsule were also abnormal in three patients, and unilateral cortical lesions could be distinguished from acute ischemic stroke by the pattern of involvement and MR angiographic, perfusion, and spectroscopic findings.

Topics: Adult; Aged; Blood Volume; Brain; Cerebrovascular Disorders; Coma; Consciousness Disorders; Diffusion Magnetic Resonance Imaging; Dominance, Cerebral; Drug Contamination; Glasgow Coma Scale; Glyburide; Humans; Hypoglycemia; Hypoglycemic Agents; Illicit Drugs; Image Processing, Computer-Assisted; Lactic Acid; Magnetic Resonance Angiography; Magnetic Resonance Spectroscopy; Male; Middle Aged; Phytotherapy; Piperazines; Purines; Retrospective Studies; Seizures; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Adult; Aged; Aged, 80 and over; Carbolines; Chromatography, High Pressure Liquid; Disease Outbreaks; Drug Contamination; Erectile Dysfunction; Glyburide; Humans; Hypoglycemia; Hypoglycemic Agents; Illicit Drugs; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Plant Extracts; Purines; Sildenafil Citrate; Singapore; Sulfones; Tadalafil; Young Adult

To describe a cluster of Hong Kong subjects with hypoglycaemia, after they had taken various non-prescription sildenafil products containing glibenclamide.. Retrospective study.. A tertiary referral centre for clinical toxicology analysis in Hong Kong.. All men referred to the laboratory for investigation of suspected drug-induced hypoglycaemia from December 2007 to September 2008.. The characteristics of these patients, including their clinical presentations, outcomes, drug history, urine toxicology analysis results, and in some instances, analysis results of unused products.. A total of 144 male patients were referred for suspected drug-induced hypoglycaemia. Sildenafil and glibenclamide, or their metabolites, were detected in the urine specimens of 68 (47%) patients, none of whom had been prescribed either drug by a registered medical practitioner. Among these subjects, 24 (35%) denied any use of sexual enhancement products despite repeated questioning. Eight patients had repeated exposure resulting in re-admission. The sources of these sexual enhancement products included pharmacies in Mainland China, friends, local pharmacies, peddlers, or were unknown. Three patients died, one remains in a vegetative state and one suffered cognitive impairment; the remaining 63 recovered fully. Twenty-five unused sexual enhancement products of seven different kinds were recovered for analysis. The median (range) of sildenafil and glibenclamide per unit dose was 64 (0.05-198) mg and 70 (0-158) mg, respectively.. These illegal products pose a severe and continued threat to society and therefore deserve widespread vigilance, so that such products can be eradicated at their source.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Disease Outbreaks; Drug Combinations; Glyburide; Hong Kong; Humans; Hypoglycemia; Hypoglycemic Agents; Male; Middle Aged; Piperazines; Purines; Retrospective Studies; Sexual Behavior; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Administration, Oral; Disease Outbreaks; Drug Combinations; Drug Contamination; Erectile Dysfunction; Glyburide; Humans; Hypoglycemia; Hypoglycemic Agents; Legislation, Drug; Male; Piperazines; Purines; Risk Assessment; Sildenafil Citrate; Sulfones; Vasodilator Agents