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    Mayo Clinic Q and A: Treating erectile dysfunction safely

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DEAR MAYO CLINIC: Are the advertised herbal supplements for erectile dysfunction, or ED, just as effective as the actual drug? Are they safer because they’re natural? Can there be side effects from these supplements?

ANSWER: Be cautious about using any herbal supplement. Those products aren’t held to the same standards as prescriptions or over-the-counter medications approved by the U.S. Food and Drug Administration, or FDA. As a result, there’s no way to know which are effective or safe. Some dangerous side effects have been linked to herbal supplements that claim to be natural forms of the prescription drugs that treat ED.

Herbal products that claim to treat ED often are marketed as “herbal Viagra.” Viagra is one of the brand names for the medication sildenafil. Sildenafil belongs to a group of medicines called phosphodiesterase 5, or PDE5, inhibitors. These medicines block an enzyme known as phosphodiesterase type-5 from working too quickly in the body and breaking down an erection.

Before taking sildenafil or other medications to treat ED, it’s important to be evaluated by a health care provider to ensure an oral medication is an appropriate ED treatment for you. In some cases, ED can be a sign of another medical condition, or it might be a side effect from a medication. In those situations, treating the underlying condition or switching to a different medication may be all you need to relieve ED.

Also, ED pills don’t work for everyone. For example, some men who have had prostate surgery or those who have diabetes may not benefit from these drugs. In rare cases, ED medications can be dangerous. Because of the potential for serious side effects, usually they are not recommended for men who take nitrate drugs, such as nitroglycerin, isosorbide mononitrate and isosorbide dinitrate.

If you use a product that’s touted as an herbal ED treatment, you won’t have an opportunity to review your medical history with a health care provider, and weigh the risks and benefits of treatment. You also won’t know exactly what’s in the pill you’re taking.

The FDA regulates prescription and over-the-counter medications in the U.S., ensuring they meet strict safety standards before they can be sold to the public. The FDA does not, however, have a role in approving the safety or effectiveness of herbal supplements. Instead, if there are concerns about an herbal product, the FDA must prove it’s unsafe before it comes off the market — the opposite of the process that FDA-approved medications undergo.

Certain herbal supplements marketed to treat ED appear to contain substances similar to prescription ED medications. But there have been serious side effects linked to some of these products, including triggering dangerously low blood pressure in some men. Other herbal supplements have been pulled from the market because they contained additional prescription medications not identified on the packaging and unknown amounts of other unidentified ingredients.

Although herbal alternatives may be less expensive and more convenient to purchase than prescription ED medications, there is no guarantee these products are safe or effective. At this time, there are no FDA-approved ED medications available without a prescription. If you are concerned about erectile dysfunction, make an appointment to see your health care provider to have your condition evaluated and decide on a treatment plan that’s right for you. Dr. Landon Trost, Urology, Mayo Clinic, Rochester, Minnesota