Impotence linked to ‘manpower’ herbs

A growing number of herbal supplements purported to address erectile dysfunction issues contain hidden unlicensed pharmaceutical ingredients that could endanger people’s health, experts have warned.
Experts Sunday Monitor talked to make it abundantly clear that not only do promoters of such supplements often make unverified claims as to their benefits but some have illegal ingredients which could potentially cause impotence and increase the risk of users being afflicted by non-communicable diseases.
A patient was recently wheeled into Lifeline International Hospital in Zana, Kampala, with a rather embarrassing ailment—a prolonged erection of the penis. The case was referred to Dr Emma Sserunjogi, and the attending physician soon learnt that his patient had “consumed herbs and he erected for four days.”
The herbs in question were discovered to have been laced with Sildenafil, an active compound in prescription drugs used to treat male sexual function problems and commonly identified as “Viagra.”
“Drug overdose comes with varying drug-induced effects and there is specific dosage of drugs that one has to take at a particular time,” Dr Sserunjogi says, 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.”
Globally, Tadalafil and sulfoaildenafil are among the most frequently undeclared ingredients in products for erectile dysfunction. When taken with other medicines containing nitrates, they can lower blood pressure drastically and cause serious health problems.
In Uganda, anecdotal evidence suggests that users of the unlicensed remedies are consuming large quantities of them without knowing the interactions with other supplements or medicines they may be taking. Dr Sserunjogi says there can be severe side effects. There are chances that the victim may never get an erection and, in cases of an aggressive solution, never erect again.
Liver damage
The concoctions have also been known to increase the risk of liver problems as a 28-year-old male (name withheld), who drank herbal extracts for erectile dysfunction recently learnt. After complaining about persistent abdominal pain, he was diagnosed with drug induced liver injury.
Dr Jacob Otile, a medical practitioner and researcher, notes that the liver plays various roles. A telling one is removing toxins from one’s body. These toxins include, among others, the drugs or herbs that we take. These are majorly broken down by the liver into less toxic substances for the body to process and utilise.
This may come at an expense to the drug consumer as some of the components in aphrodisiacs that have gained traction in Uganda end up damaging the liver.
“When someone already has pre-existing diseases of the liver, 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 Sunday Monitor, adding that most herbal remedies on market have no approved doses unlike clinical drugs.
Herbal remedies explained
In fact, Dr Sserunjogi has drawn a nexus between usage of unlicensed herbal remedies and the spike of gastrointestinal issues in Uganda, most of which are liver-related. He says the liberty given to those selling herbal medicine has been mismanaged, hence fuelling a looming crisis of liver-injury related issues.
“The issue is that whatever a human being eats must go to the liver before entering the general blood circulation to the heart, then the heart pumps it to the body,” he explains, adding, “So, in case the herb you consume has excess toxins, the liver will eventually get damaged.”
Dr Sserunjogi says many people are not aware that the so-called modern drugs are extracted from herbs and then standardised through carrying out 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 you absorb it directly, you could be absorbing an overdose of active compounds of a particular medicine, which is dangerous to the body,” he tells Sunday Monitor, stressing the importance of standardisation of the quantity side of things.
Unscrupulous herbalists
Mr Jamir Mukwaya, the president of the Uganda Herbalists Association, opines that there is a crisis created by unscrupulous individuals who manufacture unverified herbs, which they supply on the black market. He adds that just like in the bio-medic world, there are several unapproved remedies that end up on the market and tarnish the general image of herbal medicine. This works to the detriment of approved herbal drugs that are effective, of which—according to Mr Mukwaya—there are many.
Dr Sserunjogi warns of a growing tendency of herbalists mixing bio-medic drugs with herbs. He says this trend is common with drugs prescribed for treatment of erectile dysfunction and this poses high risks of impotence.
Not safe
Dr Otile cautions Ugandans against buying street herbal medicine. He, especially zooms in on those that claim to treat more than 10 diseases in one bottle.
“Many of the people selling the herbal medicines cannot 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 treats specifically, as well as side effects, and that is very worrying,” he says.
Dr Otile says these street-peddled drugs pose many risks. These include, but are not limited to: under or overdosing; dangerous/adverse effects; damage to vital organs such as the liver and kidney injury, sometimes leading to kidney failure. Unknown safety, especially in pregnant women, means they might end up causing harm to the baby; increase risk of anti-microbial or antibiotics resistance; very bad drug interactions, especially when given concurrently with clinical drugs (since we do know the components in the herbs) and worsening of pre-existing conditions in patients, especially those with pre-existing liver diseases.
What NDA says
Mr Abiaz Rwamwiri, the National Drug Authority (NDA) spokesperson, says in no uncertain terms that the medical regulatory body condemns the sale of uncertified herbal remedies. He adds that NDA has always discouraged patients from using herbs that are not sold in licensed drug shops and pharmacies.
“We are aware of illegal remedies on the market and we are working towards eliminating the trend. We always tell Ugandans not to consume drugs that are not legally allowed,” he says.
Mr Rwamwiri also reveals that NDA is supporting research that is related to the improvement of herbal medicine to save the lives of Ugandans who consume unverified 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 discloses, adding, “We test for toxicity of specific drugs and approve them in case they pass a test.”
He further reveals that it is illegal to advertise some drugs such as those related to erectile dysfunction and reproduction. Hawking and selling of herbal remedies on streets is also outlawed.
The research
According to the National Centre for Biotechnology Information Community, consumption of herbal plants in developing countries is a common practice. However, scarcity of information on their physicochemical composition is a major public health concern.
In Uganda, Vernonia amygdalina (locally known as mululuza) is of interest in rural communities due to its therapeutic action on both bacterial and protozoal parasites. 
However, no studies have been conducted to assess the heavy metal concentrations in traditional plants used in alternative medicine.