The Man Who Went to the Emergency Room Because of a Gas Station Pill: A Real Story.

The Story

A man, the case report does not give his age, but describes him as an adult male with no documented history of cardiovascular disease, purchased a sexual enhancement supplement from a gas station. The product was marketed as an all natural herbal supplement for male performance enhancement. The label listed botanical ingredients. There was no mention of any pharmaceutical compound.

He took the product as directed.

Shortly afterward he developed a prolonged, painful erection that would not resolve. This condition, known medically as priapism, is a urological emergency. Priapism is not a normal or desired effect of sexual arousal. It is a medical crisis in which blood becomes trapped in the erectile tissue of the penis and cannot drain. Without timely treatment, the sustained pressure causes irreversible damage to the tissue, damage that can result in permanent erectile dysfunction.

He went to the emergency room. The emergency physicians confirmed the diagnosis of priapism and attempted conservative management. When conservative treatment failed to resolve the condition, surgical intervention was required, a procedure to drain the trapped blood from the erectile tissue manually.

When the product he had taken was analyzed, it was found to contain a substantial quantity of sildenafil, the active ingredient in Viagra, that was not listed anywhere on the label.

The sildenafil content was not a trace amount. It was a pharmacologically significant dose. The man had taken prescription strength sildenafil without knowing he was taking it, without a physician evaluation, and without any of the clinical context that sildenafil prescribing requires.

Why Priapism Is a Medical Emergency

Priapism caused by pharmacological agents, including sildenafil at excessive doses or in susceptible individuals, is a well documented adverse event. The mechanism is straightforward: sildenafil works by inhibiting an enzyme called PDE5, which allows blood vessels in erectile tissue to remain dilated. When the drug is present at high concentrations in a susceptible individual, the vasodilation can become sustained beyond what normal physiological mechanisms can reverse.

The clinical consequences of untreated priapism develop on a documented timeline. After four hours of sustained priapism, ischemic damage to erectile tissue begins. After six hours the damage accelerates. After twenty four hours permanent fibrosis, scarring, begins to develop in the tissue. The long term result of untreated priapism is permanent erectile dysfunction, the exact opposite of the outcome the man was hoping to achieve when he made his purchase.

Time is the critical variable. A man who experiences priapism and waits at home hoping it will resolve on its own, out of embarrassment, out of hope, out of not knowing what he actually took, is allowing preventable permanent damage to occur.

This Is Not an Isolated Case

The case described above is not the only documented case of gas station supplement induced priapism. It is representative of a category of adverse events that emergency physicians see regularly enough that it has generated specific clinical literature.

Poison control centers across the United States receive calls related to gas station sexual enhancement products on a regular basis. The FDA’s MedWatch adverse event reporting system contains numerous reports of serious cardiovascular events, emergency room visits, and deaths associated with sexual enhancement supplement products found to contain undisclosed pharmaceutical ingredients.

The cases that make it into documented medical literature represent a fraction of the actual adverse events. Emergency room physicians do not always identify the specific supplement involved. Patients do not always disclose that they took a gas station supplement. Poison control is not always called. The cases that are reported and analyzed are the visible portion of a much larger problem.

The Other Emergency Room Scenarios From Gas Station Pills

Priapism is the most visually dramatic adverse event associated with gas station sexual enhancement products. It is not the only one.

Cardiovascular collapse from sildenafil nitrate interaction. Men taking nitroglycerin patches, isosorbide mononitrate, or other nitrate medications for heart conditions who unknowingly take a gas station product containing sildenafil can experience a sudden, severe drop in blood pressure, potentially to levels that cause loss of consciousness, cardiac arrhythmia, or worse. This interaction is the reason sildenafil carries an absolute contraindication with nitrates. It is also the interaction most likely to affect the older men with cardiovascular disease who are the most frequent purchasers of gas station performance products.

Seizures from undisclosed stimulants or ginkgo. Gas station products found to contain high doses of ginkgo biloba or undisclosed stimulant compounds have been associated with seizure events, particularly in individuals with seizure disorders or those taking medications that lower the seizure threshold.

Severe hypoglycemia from undisclosed diabetes medications. In August 2019 a gas station supplement product called V8, sold at multiple Mississippi area gas stations, was found by Virginia health authorities to contain a medication used to treat diabetes. Multiple cases of severe hypoglycemia, dangerously low blood sugar, were reported in people who purchased and used the product without any knowledge that it contained a prescription diabetes drug.

Opioid like overdose from tianeptine. As described in our earlier posts, gas station tianeptine products have caused respiratory depression, coma, and death, particularly in combination with other CNS depressants.

Acute liver injury from undisclosed herbal compounds. Certain herbal compounds found in gas station supplement products, including usnic acid, found in some weight loss supplements, have caused acute liver failure requiring hospitalization and in some cases liver transplantation.

What to Do If You Have Taken a Gas Station Supplement and Something Feels Wrong

If you have taken a gas station supplement product and are experiencing any of the following, seek emergency care immediately:

• Chest pain, pressure, or tightness
• Difficulty breathing or shortness of breath
• Severe drop in blood pressure, lightheadedness, fainting, or near fainting
• Prolonged erection lasting more than two hours
• Seizure or convulsion
• Loss of consciousness or inability to be wakened
• Severely rapid or irregular heartbeat
• Severe confusion or altered mental status

Do not wait. Do not search online. Do not try to sleep it off. Call 911 or go to the nearest emergency room immediately.

Call Poison Control, 1 800 222 1222, if you have taken a gas station product and are concerned about what it may contain but do not have an immediate emergency. Poison Control can help identify the product, assess the risk, and advise on the appropriate next step.

The Information That Should Have Been at the Counter

Here is the honest tragedy at the center of every one of these stories.

The man who went to the emergency room did not set out to take a prescription drug. He set out to buy a herbal supplement from a gas station. He read the label. The label said herbal ingredients. It did not say sildenafil. It did not say ”this product may cause a medical emergency requiring surgical intervention.” It said the things that supplement labels are permitted to say under a law that has not been updated in thirty years.

He made a reasonable purchase decision based on the information available to him. The information available to him was incomplete in a way that nearly caused permanent harm.

The information that should have been available to him, that these products frequently contain undisclosed pharmaceutical compounds, that sildenafil at high doses causes priapism in susceptible individuals, that there is a documented FDA tainted supplements database showing hundreds of products in this category with undisclosed ingredients, was not on the label.

It is in this post. It is available at the Fairview Pharmacy counter. And it is the kind of information that a pharmacist gives away for free because the alternative is people getting hurt.

What a Different Decision Would Have Looked Like

A man who walked into Fairview Pharmacy instead of stopping at a gas station counter would have had a five minute conversation with a pharmacist. That conversation would have covered:

The absence of clinical evidence for herbal sexual performance supplements. The documented FDA findings of undisclosed sildenafil in gas station products. The availability of FDA approved generic sildenafil at low cost through a legitimate prescription pathway. The importance of a physician evaluation for erectile dysfunction as a potential early sign of cardiovascular disease. And if the man was on any heart medications, the specific interaction warnings that would have been immediately relevant to his safety.

Five minutes. No emergency room. No surgical procedure. No permanent damage.

That is what a pharmacist is for.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.