Online prescribing of sildenafil (Viagra) on the world wide web - PubMed

Background: In today's digital age, an alarming increase in the number of prescription medications, including sildenafil (commonly known as Viagra), is made available and marketed directly to consumers through various online platforms. However, the overarching concern remains that there exists a significant lack of understanding regarding the operational frameworks and overall quality standards upheld by these so-called "virtual pharmacies." More critically, it raises questions about the ethical and responsible issuance of "online prescriptions," particularly when juxtaposed against traditional pharmacy practices.

Objective: This study aims to investigate the extent to which sildenafil is marketed and sold over the Internet, notwithstanding established medical contraindications and safety protocols that should dictate the issuance of such prescriptions.

Methods: An extensive search was conducted across the World Wide Web to identify companies that claim to provide online prescriptions for sildenafil or offer the drug for sale without any prescription requirements. Under the guise of a patient, we sought to obtain an online prescription for sildenafil, despite the known contraindications. For the purpose of this investigation, the hypothetical patient was characterized as a 69-year-old woman with a comprehensive medical history including obesity (165 cm/78 kg), coronary artery disease, hypertension, and medication management involving captopril, pravachol, atenolol, and erythromycin. This profile has been intentionally designed to highlight potential risks associated with unsupervised access to the medication.

Results: A total of twenty-two distinct online entities were identified; these comprised of three categories: two firms required a valid written prescription from a licensed healthcare provider, nine facilitated the sale of sildenafil without necessitating any prescription whatsoever, and eleven companies purported to issue an "online prescription" after an allegedly qualified physician reviewed the medical questionnaire completed by the consumer. From the latter group, ten companies were tested, eight of which were based in the United States. In total, we placed orders for 66 pills, with an aggregate value of US$ 1,802.84. Notably, three companies, including two European entities, were able to deliver the medication within a timeframe of 6, 10, and 34 days, respectively, despite the clear contraindications outlined in the patient's medical profile. Alarmingly, in 80% of cases, no thorough medical history was documented, inappropriate medical terminology was utilized in 70% of communications, and only in two cases did a physician adequately review the order form and identify themselves in the process.

Conclusions: Despite the fact that a significant proportion of Internet pharmacies declined to fulfill the orders placed, it is imperative that the public remains acutely aware of the potential dangers and ethical implications associated with the online prescribing and dispensing of prescription medications. Due diligence is crucial when navigating the complexities of obtaining medication via the Internet, as many consumers may unknowingly expose themselves to severe health risks.

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