Pharmacovigilance on sexual enhancing herbal supplements

Development and psychometric properties of an instrument to measure perception of aphrodisiac use among undergraduates in a southwestern Nigerian university

A tool to measure perception of aphrodisiac use by undergraduates students of University of Ibadan, Oyo State, Nigeria was developed and validated. The study was hinged on several theories that could explain potential to use aphrodisiac among the youths. An exploratory mixed methods design was used to develop a scale to measure perception of aphrodisiac use by undergraduate students of University of Ibadan. Qualitative data collection was performed among thirty equally represented male and female students and five key informant interview participants while 919 participants completed the quantitative phase (surveys). Integration of matched qualitative themes from FGD/KII to survey domains was achieved through the 'building approach'. Qualitative themes assessing perceptions of aphrodisiac use by university undergraduate students were used to develop original survey items as well as new survey items peculiar to research subjects. Exploratory factor analysis was deployed on polychoric correlation matrix of the items using R-statistical packages. Further model fit analysis was conducted using confirmatory factor analysis on the items suggested by EFA as well as composite reliability and construct validity tests for the constructs. Mean Z-scores of factors were computed against socio-demographics and symptoms of aphrodisiac use among respondents that have ever used it. Most respondents (84.3%) were under 25 years, mostly male (58.4%) and singles (96.3%), with 41.3% earning ≤20,000 naira monthly. The enhanced content validity of the items from mixed method analysis yielded two major domains. Two succession of factor analyses and a structural equation modeling suggested that a first-order model is good fit for experimental data (TLI = 0.931; CFI = 0.948; SRMR = 0.047; RMSEA = 0.083). The four-factor solution to the model included: prolonged sexual performance, use without erectile dysfunction or medical advice, treatment of erectile dysfunction and recreational purposes with an internal and composite reliability that ranged from 0.62-0.92 and 0.63-0.92. The validation with socio-demographics and consequences of aphrodisiac use indicated that: Male respondents, those older than 20years, the married, those from poorly educated parent and sufferers of all related consequences had statistically significant differences with poor perception of aphrodisiac use' domains. This validated instrument is good for assessment of perception of aphrodisiac use among students in tertiary institution albeit with caution. A version of the scale that is broadened with highly refined items and tested for high internal validity is suggested.

Consumption of aphrodisiac drugs without prescription among men in Saudi Arabia: cross-sectional study

Background: The prevalence and patterns of aphrodisiac drug consumption without prescription among men in Saudi Arabia remain underexplored, with limited empirical evidence available. Given the potential health implications and societal considerations, a comprehensive investigation is warranted. Aim: Assess the Prevalence, pattern of use and the associated factors of Aphrodisiac drugs consumption without prescription among men at Najran City, Saudi Arabia. Methods: Employing a cross-sectional descriptive study, 500 participants were included through convenience sampling. The utilized questionnaires covered a range of data, including socio-demographic information, patterns of aphrodisiac use, knowledge about aphrodisiacs, lifestyle details, a sexual health inventory for men, and a perceived stress level scale. Results: The study reveals a significant prevalence of unsanctioned aphrodisiac drug use (31%) among men in Najran City, Saudi Arabia, with a majority (79.3%) consuming these substances four times monthly. Associated disparities in knowledge, lifestyle, stress, and sexual function underscore the urgent need for policy interventions and tailored health education initiatives for this demographic. Conclusion: Approximately one-third of the sampled population engaged in the unsanctioned use of aphrodisiac drugs, with the majority utilizing them four times monthly. Tablets emerged as the most prevalent form of consumption. Commonly cited motives and justifications included peer influence and the perceived safety of aphrodisiacs. Influential factors encompassed levels of knowledge, lifestyle, stress levels, erectile function, age, education, and the number of wives. Recommendations: Urgent policy interventions are warranted to regulate the acquisition and distribution of aphrodisiacs. Tailored health education initiatives should be implemented for married and prospective married men.

The use of Traditional Medicines for Sexual Enhancement in Northern Nigeria

BACKGROUND

There is a paucity of information on the use of traditional medicine TM to improve sexual performance. This study aims to assess the prevalence and self-reported adverse effects associated with the use of TM as a sexual enhancer in northern Nigeria.

METHODS

The study was a cross-sectional design among adults aged 18 years and above, who are residing in northern Nigeria. A mixed-mode approach was utilized using face-to-face interviews and an online survey. For the online survey, a link to the questionnaire was shared on the social media platforms of the targeted participants.

RESULTS

A total of 794 eligible participants completed the survey over the six weeks. Of this number, 508 reported ever using TM for sexual enhancement, with a prevalence of 64% (95% CI: 60.5, 67.3). About 30 (3.8%) reported daily use, 49 (4.9%) weekly, 65 (8.2%) monthly and 473 (59.6%) as when needed. Islamic medicine was the most frequently implicated TM. Most respondents obtained it TM practitioners 213 (26.8%). Participants 164 (20.7%) reported experiencing side effects, mostly headaches 59 (35.9%), and 31 (3.9%) were severe (required hospitalization). Predictors of TM use for sexual enhancement were found to be gender, marital status, number of wives, ethnicity, educational level, and lifestyle.

CONCLUSION

The use of TM for sexual enhancement is common among the adult population in northern Nigeria. One out of five of the users reported an adverse event. Therefore, there is a need for improved awareness of the safe use of the TM in the community, especially among females, those with multiple wives, a low education level, and poor lifestyles.

Screening and Determination of Synthetic PDE-5 Inhibitors in Adulterated Sexual Enhancement Supplements

This paper reports an important investigation and quantification of adulteration of sexual enhancement supplements with prescription medicines available in United Arab Emirates (UAE): tadalafil, sildenafil and vardenafil. A total of 158 sexual enhancement supplements were collected and analyzed in the current study. The samples were screened using REVERSE-phase liquid chromatography tandem high-resolution mass spectrometry/mass spectrometry (RP-HPLC-MS/MS). Of all sexual enhancements, 12.7% (95% CI: 7.4-18) contained undeclared sildenafil, 3.8% (95% CI: 0.78-6.81) contained undeclared tadalafil and 1.9% (95% CI: 0.25-4.05) contained undeclared vardenafil. Of all sexual enhancement supplements, 13.9% (95% CI: 8.5-19.4) contained significant concentrations of sildenafil, tadalafil or vardenafil. While the study found relatively low levels of undeclared pharmaceutical ingredients in the sexual enhancement dietary supplements available on the UAE market, it is likely that patients with ED tend to consume multiple such supplements daily, thereby exposing themselves to highly elevated cumulative levels.

Survey on Sildenafil, Tadalafil, and Vardenafil Concentrations in Food Supplements for Erectile Dysfunction

The aim of the study was to analyze the presence of undeclared sildenafil, tadalafil, and vardenafil in food supplements (FSs) for erectile dysfunction. The presence of sildenafil, tadalafil, and vardenafil was determined using the generated ultraviolet (UV)-spectra and mass-spectrometry (MS)-spectra as well as chromatograms produced by the photodiode array (PDA)-detector and ion trap MS-detector. The results were processed by Xcalibur ver. 2.0.7. Fourteen of the 20 analyzed FSs contained undeclared ingredients. Sildenafil was present in 12 of them. Many violations and discrepancies between the label information and the real composition of the FS were identified. 70% of the samples contained undeclared ingredients of an erectile dysfunction medicinal product. The quantities varied within broad limits from 2 mg per tablet to 116.55 mg per tablet. Sildenafil was present in amounts exceeding 16.55 mg that is the maximum recommended dose, thus creating risk of overdose. Besides that, food supplements adulterated with sildenafil analogues are a health risk for consumer's health as there is no evidence of modified sildenafil toxicity. All analyzed FSs were claimed to be 100% natural, not provoking side effects. No information for any FS contained indications of age limits or risk for interaction with other FSs or medical products.

A Social-Ecological Study of Perceptions and Determinants of Sexual Enhancement Drug Use among Men and Women in Ghana

The use and sale of sexual enhancement drugs (particularly unapproved aphrodisiacs) have become a public health concern in Ghana and many other sub-Saharan African countries. While most studies have examined this phenomenon from the level of individual perspectives, this study investigates the multi-dimensional and multi-level factors (e.g., individual characteristics and behaviours, interpersonal factors, community norms and practices, institutional and public policy factors) that influence attitudes, perceptions, and use of aphrodisiacs among men and women in Ghana. Using a concurrent mixed-method design, we derived the data from a semi-structured interview and cross-sectional survey conducted across five administrative regions in Ghana. Interpretative phenomenological analysis and logistic regression techniques were used to analyse the qualitative and quantitative (survey) data, respectively. Approximately 12.6% of participants (17.6% among males and 7.2% among females) had used an aphrodisiac in the six months prior to the study. Approximately 23.4% of the participants had more than one partner during the same period. Among men, being religious (B = −0.238, p < 0.05) and having multiple sexual partners (B = 0.481, p < 0.01) were positively associated with the use of aphrodisiacs. For women, being employed (B = −1.539, p < 0.01), engaging in physical activities (exercising) (B = −0.658, p < 0.05), having good health (B = 0.869, p < 0.05), having multiple sexual partners (B = 1.191, p < 0.01), and taking alcohol (B = 1.041, p < 0.01) were associated with use of aphrodisiacs. Although many participants had used aphrodisiacs, women, in particular, held unfavourable views about the drugs due to perceived negative health implications for themselves and their partners. The findings also show that community-level factors (e.g., social norms and expectations), interpersonal factors (e.g., expectations of partners and friends), public policy (e.g., drug-related regulations), and organisational/institutional factors (e.g., health system arrangements about access and use of drugs) were critical to the sale and use of aphrodisiacs among both men and women in Ghana. A multi-level analysis of the use of sexual enhancement drugs among men and women is crucial to formulating social and public health policies that aim to improve public knowledge of these drugs, reduce uncontrolled production, and protect population health and well-being.

[Literature review on pharmacovigilance of medicines derived from traditional pharmacopoeias. Part II: risks assessment and prevention]

After the initial stage of the pharmacovigilance process for medicines from traditional pharmacopoeias - which concerns the identification of the risks associated with their use - the risk assessment should now be approached. The latter makes it possible to detect potential signals early and to take preventive measures. We sought to understand, from a review of the literature, the steps and methods of risk assessment relating to traditional medicines, as well as the prevention strategies applied to them. All of the work carried out on the subject has shown that the steps and methods for assessing and preventing drug risks are the same for both conventional and traditional medicines. Risk assessment includes analysis of the quality of individual notifications, assessment of causality, detection and evaluation of signals. The World Health Organization method is the most widely used for causality assessment internationally, while disproportionality measures are the most applied for signal detection. Regarding prevention, risk communication is the main strategy for the risks associated with traditional medicines. This review suggests the involvement of traditional medicine practitioners both in the notification system and in the communication strategy on the risks associated with their products.

The 4-month effect of Vitex agnus-castus plant on sexual function of women of reproductive age: A clinical trial

BACKGROUND

Sexual dysfunction in women is a common disorder. Yet, there is no consensus on its treatment. Few studies have shown that Vitex agnus-castus improves sexual dysfunction in postmenopausal women; the present study was conducted to evaluate the effect of V. agnus-castus on the female sexual function in the reproductive age.

MATERIALS AND METHODS

This was a double-blinded randomized control clinical trial on the women of reproductive age referred to the gynecology clinic of Al-Zahra Medical Center in Rasht, Iran, from February 2018 to December 2019. The intervention group received Agnugol tablet containing 3.2-4.8 mg dried extract V. agnus-castus (51 participants) and the control group received a placebo tablet (51 participants). All participants received one tablet daily for 16 weeks. The participants were asked to complete the Female Sexual Function Index questionnaire at the beginning of the study and after 4, 8, 12, and 16 weeks. Data were analyzed in SPSS statistics (version 21) using Chi-square test, t-test, Mann-Whitney U-test, analysis of variance, and mixed model to examine the differences between the groups.

RESULTS

The results showed that the difference between the two groups was not significant in each domain, but there was a significant difference in the overall sexual function mean score so that the intervention group had a higher score than the placebo group after 16 weeks (P < 0.05).

CONCLUSION

In the present study, it was observed that the consumption of V. agnus-castus during 16 weeks was more effective than the placebo in improving sexual dysfunction. Further studies with larger sample sizes are needed to be able to decide on the prescription of this drug in the clinics.

Core-shell particles and monolithic columns; tools for simultaneous LC analysis of avanafil, sildenafil, apomorphine, trazodone, yohimbine, tramadol and dapoxetine in pharmaceutical dosage forms, counterfeit products and human plasma

By 2025, it's estimated that 322 million males worldwide will suffer from sexual disorders. This can give an estimation for the size of the pharmaceutical and counterfeit products industry for the next few years. Meanwhile, green analytical chemistry forced itself to decrease the massive environmental pollution and hence new analytical methodologies are needed to replace the old ones that consume large amounts of hazardous solvents. In this research, two new methods were validated for determination of seven recognized drugs used in treatment of male impotence, premature ejaculation as well as enhancing sexual libido by HPLC on RP-C18 core-shell particulate and monolithic columns. The study was extended to compare the capabilities of those stationary phases to accommodate greener chromatography concepts without loss of efficiency. Both morphologies shortened the analysis time relative to the previously reported conventional HPLC methods by different approaches. Core-shell particles had higher efficiency in terms of theoretical plates' number and enhanced resolution power which enabled lower detection limits. However, the monolithic column had lower column backpressure which enabled the use of ethanol as a greener alternative solvent at even higher flow rates. The methods were finally applied successfully for the determination of drugs under study in pharmaceutical dosage forms, counterfeit products and in human plasma.

Differences among health care students' attitudes, knowledge and use of dietary supplements: a cross-sectional study

OBJECTIVES

The objectives of this study were to evaluate the difference among pharmacy, dental and medical students' attitudes, knowledge and use of dietary supplements. Furthermore, factors likely to influence their personal use and willingness to recommend supplement to patient were investigated.

DESIGN

A cross-sectional survey study.

SETTING

The study was carried out at a single university.

MAIN OUTCOME MEASURES

Survey gathered socio-demographic data and questioned students' attitudes, knowledge and use of dietary supplements.

RESULTS

A total of 506 students were included in the study. Pharmacy students showed more positive attitudes about dietary supplements, and achieved higher knowledge scores when compared to dental or medical students (p < 0.001). Medical students were more likely to use evidence based sources of information about dietary supplements. There was no difference in supplements use across study programs (p = 0.177). As many as 59.7% of students that participated in the study reported using dietary supplements. Data analysis showed that the previous personal use supplements was a significant independent predictor whether students would recommend supplements to their patients (OR 27.03, 95% CI 14.08-50, p < 0.001).

CONCLUSIONS

Students' education did not influence their personal use of dietary supplements. However, their personal experience seems to influence their willingness to recommend supplements to patients. Pharmacy students showed greater knowledge about supplements than their dental or medical colleagues. In future practice, health care students could benefit from collaboration with pharmacists when they provide care to patients seeking advice about the use of dietary supplements.

Barriers to the success of an electronic pharmacovigilance reporting system in Kenya: an evaluation three years post implementation

Objective

Electronic pharmacovigilance reporting systems are being implemented in many developing countries in an effort to improve reporting rates. This study sought to establish the factors that acted as barriers to the success of an electronic pharmacovigilance reporting system in Kenya 3 years after its implementation.

Materials and Methods

Factors that could act as barriers to using electronic reporting systems were identified in a review of literature and then used to develop a survey questionnaire that was administered to pharmacists working in government hospitals in 6 counties in Kenya.

Results

The survey was completed by 103 out of the 115 targeted pharmacists (89.5%) and included free-text comments. The key factors identified as barriers were: unavailable, unreliable, or expensive Internet access; challenges associated with a hybrid system of paper and electronic reporting tools; and system usability issues. Coordination challenges at the national pharmacovigilance center and changes in the structure of health management in the country also had an impact on the success of the electronic reporting system.

Discussion

Different personal, organizational, infrastructural, and reporting system factors affect the success of electronic reporting systems in different ways, depending on the context. Context-specific formative evaluations are useful in establishing the performance of electronic reporting systems to identify problems and ensure that they achieve the desired objectives.

Conclusion

While several factors hindered the optimal use of the electronic pharmacovigilance reporting system in Kenya, all were considered modifiable. Effort should be directed toward tackling the identified issues in order to facilitate use and improve pharmacovigilance reporting rates.