Emma Hitt, PhD

May 24, 2012

May 24, 2012 (Atlanta, Georgia) — Sildenafil (Viagra, Pfizer) purchased online was found to be counterfeit in more than three quarters of cases, according to a study that analyzed the content and origin of medication ordered over the Internet.

Irwin Goldstein, MD, from Alvarado Hospital, in San Diego, California, and colleagues from Pfizer presented their findings in a moderated poster session here at the American Urological Association 2012 Annual Scientific Meeting.

"I was very surprised by these findings," Dr. Goldstein told Medscape Medical News during the session. As physicians, "we give patients approved drugs using a prescription, and we tend not to think that this issue exists," he explained.

Dr. Goldstein and colleagues analyzed the chemical content, origin, and cost of sildenafil purchased from 22 unique Web sites claiming to sell the drug. Web sites were identified using Google or Bing search engines, and multiple purchases were made from each Web site.

"Of the 22 Web sites assessed, 100% did not ask for a prescription, as is required by law," the researchers note.

Of the 22 sample tablets analyzed, 77% were counterfeit. The counterfeit pills were found to contain 30% to 50% of the active pharmaceutical ingredient concentration found in the sildenafil formulation approved by the US Food and Drug Administration. Of the pills that were not counterfeit, 17 (15%) were authentic and 5 (4%) were generic.

The cost per pill ranged from $3.28 to $33.00. Products were shipped most often from Hong Kong (11 Web sites), the United States (6 Web sites), and the United Kingdom (2 Web sites), but also came from Canada, China, and India.

"This issue is relevant to both clinicians and consumers," Dr. Goldstein said. "People are relatively careful about what they put into their mouths when it comes to grocery stores and restaurants," he said. "But when it comes to these drugs, people may be embarrassed; there may also be financial motivations."

According to Dr. Goldstein, there are 50 known counterfeit Pfizer products circulating. "The counterfeit drug industry is a $100 billion industry; perpetrators are not being sought by government enforcement agencies because it is not opium or cocaine."

"People have died from taking these counterfeits," Dr. Goldstein said. "Beyond the fact that they don't have the real drug in it, they can be very dangerous."

One way to identify authentic products online, study author Vera Stecher, PhD, clinical director at Pfizer, said after the presentation is to go to the National Board of Pharmacy Web site and look for pharmacies with VIPPS approval.

According to Graham Jackson, MD, from London Bridge Hospital in the United Kingdom, who researches counterfeit medications, the content of the tablets can vary wildly and can contain potentially dangerous chemicals.

This study adds to the concerns we have that men, by avoiding healthcare professionals, do not have associated conditions assessed," he told Medscape Medical News. "All clinicians should emphasize that prescription-only meds are just that; if offered without a script or by an Internet doctor, they are not legal and are potentially dangerous."

The study was supported by Pfizer. Dr. Goldstein reports receiving research support from Pfizer. Dr. Stecher is employed by Pfizer. Dr. Jackson has disclosed no relevant financial relationships.

American Urological Association (AUA) 2012 Annual Scientific Meeting: Abstract 1486. Presented May 22, 2012.

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