title: Outbreak of hypoglycaemia: sexual enhancement products containing oral hypoglycaemic agent.
abstract: OBJECTIVE
  To describe a cluster of Hong Kong subjects with hypoglycaemia, after they had taken various non-prescription sildenafil products containing glibenclamide.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A tertiary referral centre for clinical toxicology analysis in Hong Kong.
  
  
  METHODS
  All men referred to the laboratory for investigation of suspected drug-induced hypoglycaemia from December 2007 to September 2008.
  
  
  METHODS
  The characteristics of these patients, including their clinical presentations, outcomes, drug history, urine toxicology analysis results, and in some instances, analysis results of unused products.
  
  
  RESULTS
  A total of 144 male patients were referred for suspected drug-induced hypoglycaemia. Sildenafil and glibenclamide, or their metabolites, were detected in the urine specimens of 68 (47%) patients, none of whom had been prescribed either drug by a registered medical practitioner. Among these subjects, 24 (35%) denied any use of sexual enhancement products despite repeated questioning. Eight patients had repeated exposure resulting in re-admission. The sources of these sexual enhancement products included pharmacies in Mainland China, friends, local pharmacies, peddlers, or were unknown. Three patients died, one remains in a vegetative state and one suffered cognitive impairment; the remaining 63 recovered fully. Twenty-five unused sexual enhancement products of seven different kinds were recovered for analysis. The median (range) of sildenafil and glibenclamide per unit dose was 64 (0.05-198) mg and 70 (0-158) mg, respectively.
  
  
  CONCLUSIONS
  These illegal products pose a severe and continued threat to society and therefore deserve widespread vigilance, so that such products can be eradicated at their source.
authors.affiliation: Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Laichikok, Hong Kong.
authors.forename: W T
authors.initials: WT
authors.lastname: Poon
authors.forename: Y H
authors.initials: YH
authors.lastname: Lam
authors.forename: Hencher H C
authors.initials: HH
authors.lastname: Lee
authors.forename: C K
authors.initials: CK
authors.lastname: Ching
authors.forename: W T
authors.initials: WT
authors.lastname: Chan
authors.forename: S S
authors.initials: SS
authors.lastname: Chan
authors.forename: C K
authors.initials: CK
authors.lastname: Lai
authors.forename: M L
authors.initials: ML
authors.lastname: Tse
authors.forename: Albert Y W
authors.initials: AY
authors.lastname: Chan
authors.forename: Tony W L
authors.initials: TW
authors.lastname: Mak
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004338:Drug Combinations; D005905:Glyburide / Q000008:administration & dosage / Q000009:adverse effects*; D006723:Hong Kong; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects*; D011687:Purines / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012725:Sexual Behavior; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D004338:Drug Combinations; D007004:Hypoglycemic Agents; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D005905:Glyburide