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Illegal drugs linked to coma, death in Singapore
cialis tabletA rash of cases of dangerously low blood sugar (hypoglycaemia) among people in Singapore has been attributed to counterfeit versions of Eli Lilly’s erectile dysfunction drug Cialis (tadalafil) and various over-the-counter (OTC) herbal remedies.

In the first five months of 2008 hospitals in Singapore were confronted with 150 cases of people who were not diabetic but presented with dangerously low blood sugar levels. All but one of the cases involved men, aged between 19 and 97. Seven went into coma as a result of the prolonged hypoglycaemia, and four of those affected have died.

Investigating this bizarre outbreak, a team of doctors led by Ling Kao of Singapore’s National University Hospital found that 85 per cent of the men had the diabetes drug glyburide in their blood or urine, which would account for the low blood sugar.

30 per cent of the men admitted taking illegal products to boost sexual function. A subsequent analysis revealed that four of the products – counterfeit Cialis and three supplement-type products (Power 1 Walnut, Santi Bovine Penis Erecting Capsule and Zhong Hua Niu Bian) – contained glyburide in amounts ranging from 13mg to 100mg per tablet.

To put that exposure in context, a typical starting dose for glyburide in a diabetic patient would be 2.5mg or 5mg daily, with a small proportion of very treatment-resistant patients perhaps hiking their dose to a level of around 20mg/day.

“We speculate that simultaneous contamination of several brands of drugs is consistent with a common manufacturing source,” say the researchers, who have published their study in the New England Journal of Medicine (February 12).

“The drug packaging contained names of fictitious overseas factories, so it is not known whether there was deliberate or accidental contamination,” they write.

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