Viagra and potency drugs – risks, counterfeits, priapism

Content author: Jakub Krącz, MD, urologist · Editorial work: Editorial team of Wyspa Medycyna Przyjaznej · Medical review: Jakub Krącz, M.D. · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is for educational purposes and does not contain information about the dosage or method of using medications. It does not replace a medical consultation. An erection lasting longer than four hours, especially if it is painful, is an emergency requiring immediate reporting to the emergency room. Chest pain, shortness of breath, fainting, sudden deterioration of vision or sudden hearing loss after taking the drug also require urgent medical attention.

The most important information at a glance

• PDE5 inhibitors do not cause an erection on their own - they enhance the natural mechanism and require sexual stimulation.
• They are not an aphrodisiac and do not increase sexual drive.
• Combination with nitrates used in coronary heart disease is strictly contraindicated and may lead to a sharp drop in blood pressure.
• Nitrates also include "poppers" - substances used recreationally. This combination can be deadly dangerous.
• Preparations purchased outside the legal market regularly contain doses many times higher than declared or completely different substances.
• Excessive dosage does not mean "better performance" - it means a higher risk of low blood pressure, visual disturbances and priapism.
• Priapism is a prolonged, painful erection without arousal that lasts more than four hours. This is an emergency.
• In priapism, blood becomes trapped in the corpus cavernosum, hypoxia occurs and tissue damage occurs.
• The longer priapism lasts, the greater the risk of permanent fibrosis of the corpora cavernosa and irreversible erectile dysfunction.
• Erectile dysfunction may be a symptom of diseases requiring treatment - therefore, taking medications without diagnosis delays the diagnosis.

Find out more about the specialist

Jakub Krącz, MD, PhD, is a urologist at Wyspa Medycyny Przyjaznej in Gdańsk. He deals with the diagnosis and treatment of diseases of the urogenital system and men's sexual health problems. Some patients report erectile dysfunction, which is the result of a previous, untreated, prolonged erection - this is one of the most unnecessary complications we encounter in this field.

Meet Jakub Krącz, M.D.

Erection longer than four hours - go to the emergency room immediately

This is the most important information in the entire article. If the erection lasts for more than four hours, is painful and does not go away despite the lack of arousal - do not wait until the morning, do not count on it "going away" and do not try home remedies. Report to the emergency department.

The following also require immediate help:

• chest pain, shortness of breath or heart palpitations after taking the drug,
• fainting, severe dizziness, pallor and cold sweats,
• sudden deterioration or loss of vision in one eye,
• sudden hearing loss or tinnitus,
• severe, increasing pain in the penis,
• taking the drug after taking any substance from the nitrate group, including "poppers".

In the case of a prolonged erection, time counts. Changes in the corpus cavernosum tissue begin after just a few hours, and the longer the hypoxia lasts, the lower the chance for full recovery of function. Shame is the worst advisor here - emergency department staff know this problem and treat it as an emergency, not an embarrassing situation.

How do potency drugs work?

All popular drugs of this type belong to one group: phosphodiesterase type 5 inhibitors, abbreviated PDE5. Their mechanism is sometimes misunderstood, and this misunderstanding leads to dangerous behavior.

An erection occurs when, under the influence of a sexual stimulus, nitric oxide is released, which triggers a cascade leading to the relaxation of the smooth muscle of the penile vessels. The PDE5 enzyme is a natural "brake" to this process - it breaks down the molecule responsible for maintaining diastole. The drug blocks this enzyme, so the effect lasts longer and is stronger.

Two things come out of this that are worth remembering. Firstly, the drug does not cause an erection on its own — strengthens the mechanism that must be activated by a sexual stimulus. Secondly, it is not an aphrodisiac and does not increase libido. A man whose problem is lack of desire will not get the expected effect from it, because the drug affects a completely different element of the puzzle.

Individual substances from this group differ in their duration of action and details of their safety profile. This is why the selection of the preparation is up to the doctor - it depends on comorbidities, medications taken and the patient's situation, and not on what sounds better in the advertisement.

When these medications should not be used

There is one absolute contraindication that everyone must know about: nitrates. These are drugs used in coronary artery disease, including nitroglycerin administered sublingually for coronary pain. Both they and PDE5 inhibitors lower blood pressure. Their combination may cause a sudden, deep drop in pressure, which is life-threatening.

They belong to the same group "poppers" — alkyl nitrites used recreationally. This combination is particularly dangerous because it often affects young men who are not aware that they are taking a substance from the same category as a heart drug.

In addition, there are a number of situations that require an individual medical assessment, including:

• recent heart attack or stroke,
• unstable coronary artery disease and coronary pain with slight exertion,
• severe heart failure and significant arrhythmias,
• very low or poorly controlled blood pressure,
• taking alpha-blocking drugs used in prostate diseases,
• taking riociguat and some other medicines that affect the vessels,
• severe liver and kidney diseases,
• selected retinal diseases, including retinitis pigmentosa,
• previous optic neuropathy,
• conditions that predispose you to priapism, including sickle cell disease and some blood diseases.

This list shows why qualifying is not a formality. A man in his 50s with erectile dysfunction has an increased risk of cardiovascular disease - the very group of conditions that nitrates are used to treat. This is not a theoretical risk.

Preparations from uncertain sources - what's really inside

The market of "potency" preparations sold outside the legal market - via the Internet, advertising portals, shipments from abroad - is huge. They are advertised as "stronger", "original from Asia" or "herbal, so natural". Research on products secured by customs services and pharmaceutical inspections has shown the same picture for years.

The third line is the most insidious. A product sold as a "herbal supplement" may actually be a carrier of a medicinal substance - and a man with coronary artery disease who believes he is taking herbs may take it with nitroglycerin. This is a scenario in which both of the patient's assumptions are false at once.

It is also worth dealing with the logic of "more is better". A higher dose does not give a stronger erection - the effect of the drug has a ceiling. However, it has significantly more side effects: headaches, facial redness, visual disturbances, blood pressure drops and - the most dangerous - priapism.

Priapism - what happens to the penis

Priapism is a prolonged erection that persists despite the lack of sexual arousal and is usually painful. The conventional limit is four hours. This isn't a "successful drug effect" or something to joke about - it's a urological emergency.

The mechanism of the most common form, so-called ischemic priapism, is as follows. During a normal erection, blood flows into the corpus cavernosum and flows out after the stimulation stops. In priapism, the outflow becomes blocked - the blood remains trapped in the corpus cavernosum and ceases to be exchanged.

Trapped blood consumes oxygen quickly. Hypoxia develops in the corpora cavernosa, the pH drops, and carbon dioxide accumulates. Smooth muscle tissue, which is responsible for the ability of the penis to relax and fill with blood, begins to be damaged. This is exactly the same principle as in the case of ischemia of any other organ - with the difference that here you can recognize the problem yourself by looking at your watch.

Symptoms that should prompt immediate action: an erection that persists despite the lack of arousal, increasing pain, hard corpora cavernosa next to the usually soft glans and no reaction to the passage of time.

Why every hour matters

Tissue damage increases with the duration of ischemia - and this is why priapism is treated like an infarction or testicular torsion, rather than something to be discussed at the next visit.

The last line is the crux of the problem. Fibrosis means that elastic tissue capable of filling with blood is replaced by scar tissue. The penis loses the ability to have a proper erection - and this is a structural change on which potency drugs no longer work.

In clinical practice, we see patients whose erectile dysfunction is the result of such an episode from months or years ago. The most common scenario is almost identical: a preparation from an uncertain source, an erection that did not go away, shame, an attempt to wait until the morning - and reporting after several hours. For some of these men, conservative treatment is no longer sufficient and the conversation now concerns prosthetic solutions. This is a complication that could have been avoided with one decision made a few hours earlier.

How is priapism treated?

Management depends on the duration and type of priapism. The first step is to determine what form we are dealing with - this is done by examining and assessing blood taken from the corpora cavernosa, which shows the degree of hypoxia.

In the ischemic form, treatment involves decompression of the corpus cavernosum: removal of residual blood, rinsing and - if necessary - administering a vasoconstrictor drug directly to the corpus cavernosum. The procedure is performed under local anesthesia. In cases of long-lasting or resistant episodes, surgical treatment may be necessary, which involves creating a connection allowing blood outflow.

The effectiveness of these methods is directly dependent on time. If reported early, the chances of full recovery are high. After several hours, not only the technical difficulties increase, but also the risk that even successful decompression will not prevent subsequent fibrosis.

What not to do while waiting for help: do not try to "discharge" the erection with intercourse or masturbation, do not apply ice directly to the skin, do not take further medications, do not drink alcohol and do not wait until the morning. However, it is worth taking the packaging of the preparation you have taken with you - even if it comes from an unreliable source. This information really makes treatment easier, and no one will judge the patient.

Other risks of uncontrolled use

Priapism is the most dramatic complication, but not the only one.

• Drops in blood pressure - especially in combination with antihypertensive drugs, alpha-blockers and alcohol; they threaten to faint and fall.
• Cardiac complications — in men with undiagnosed coronary artery disease, the strain associated with sexual activity itself can be a burden.
• Vision disorders - from transient changes in color perception to rare but serious optic nerve complications.
• Sudden hearing loss - a rare complication requiring urgent consultation.
• Psychological dependence on the drug - a man who started using the drug "just in case", over time is unable to have sexual intercourse without it, despite the efficient mechanism.
• Delay in diagnosis - the most serious long-term consequence.

It is worth expanding on the last point. Erectile dysfunction may be an early signal of atherosclerosis, diabetes, hypertension, lipid disorders, testosterone deficiency or sleep apnea. Penile arteries are narrower than coronary arteries, so they lose their function earlier - erection problems may precede cardiac symptoms by several years. A man who "gets by" with pills from the Internet for two years does not so much treat the symptom as effectively hides the warning signal.

What does the doctor's qualification look like?

This is a shorter and less embarrassing visit than most men assume. It is not about assessing the patient, but about checking whether the treatment will be safe for him and whether it is the right solution at all.

• interview regarding the nature of the problem: lack of erection, lack of desire or fear of failure,
• review of all medications taken, with particular emphasis on nitrates and urological drugs,
• assessment of comorbidities: heart, diabetes, hypertension, eye diseases,
• measurement of blood pressure and basic examination,
• blood tests appropriate to the picture: glucose or HbA1c, lipid profile, testosterone measured in the morning if necessary,
• cardiovascular risk assessment,
• discussion of whether pharmacological treatment is appropriate in a given case and what alternatives are,
• explanation of symptoms for which help should be sought immediately.

The last point is the most important in practice. A patient who knows that a prolonged erection is an emergency and that he needs to go to the emergency room is protected against a complication that could otherwise cost him sexual function.

The most common myths

• "A larger dose works stronger." No. The effect has its ceiling, and only the risk of complications, including priapism, increases.
• "It's just a pill, anyone can take it." No. There are absolute contraindications, including nitrates used in coronary artery disease.
• "The herbal preparation is safe." Not always. Many such products contain undeclared medicinal substances.
• "Poppers are not a medicine, so they can be combined." No. These are nitrites - the combination with PDE5 inhibitors can be fatal.
• "The medicine will increase my libido." No. It is not an aphrodisiac and does not work without sexual stimulation.
• "A long erection is a good effect." No. Over four hours is an emergency and may result in permanent damage.
• "Priapism will go away on its own by the morning." No. Waiting is the main mechanism leading to permanent erectile dysfunction.
• "If the pill works, I don't have to go to the doctor." No. Erectile dysfunction may be a symptom of diseases that require treatment.

Before you buy anything online - check whether it is safe in your case

The consultation allows you to assess contraindications, review the medications you are taking and determine the cause of the problem. This is a shorter conversation than treating complications that may be irreversible.

Andrology at the Friendly Medicine Island in Gdańsk

At the Friendly Medicine Island, Jakub Krącz, M.D., consults men with erectile dysfunction, including patients who have previously used the preparations on their own. The visit includes an interview, examination, review of medications taken and comorbidities, and an assessment of whether drug treatment is safe and appropriate.

We also consult patients with the consequences of a prolonged erection. The treatment then depends on the time that has passed and the condition of the corpus cavernosum tissue. The current scope of tests, doctor availability and prices must be confirmed during registration. For an erection that lasts longer than four hours, the appropriate place to go is the emergency room, not a scheduled visit.

Find out more about Dr. Jakub Krącz Urology consultation Urology

What to ask the doctor?

• Is drug treatment safe in my case?
• Are any of the medications I take contraindicated?
• Am I taking any nitrate medicine?
• Should I assess my cardiovascular risk before starting treatment?
• What tests are justified in my situation?
• What side effects should I worry about?
• What exactly should I do if my erection persists?
• Does alcohol affect the safety of treatment?
• Is drug treatment the only option in my case?
• Could the problem have a cause that can be treated without medication?
• What to do if the medicine doesn't work?
• When should I go for a check-up?

FAQ - drugs for potency and priapism

How do drugs for potency work?

They block the PDE5 enzyme, which acts as a brake in the natural erection mechanism. Thanks to this, the erection is stronger and lasts longer. However, the drug does not work without sexual stimulation.

Is it an aphrodisiac?

No. Drugs from this group do not increase sexual drive. If the problem is lack of desire and not lack of erection, different diagnostics and treatment are needed.

What cannot they be combined with?

Absolutely with nitrates used in coronary heart disease, including nitroglycerin. Poppers belong to the same group. The combination may cause a sudden, life-threatening pressure drop.

Does a higher dose work better?

No. The effect of the drug has its ceiling. Increasing the dose does not improve the effect, but clearly increases the risk of side effects, including priapism and pressure drops.

Why are preparations from the Internet dangerous?

Because their composition is unknown. Tests of secured products show doses many times higher than declared, lack of active substance, undeclared drugs in "herbal" preparations and contamination.

What is priapism?

It is a prolonged erection that persists despite the lack of arousal, usually painful, lasting over four hours. Blood becomes trapped in the corpus cavernosum and ceases to be exchanged, leading to tissue hypoxia.

What to do with a prolonged erection?

Go to the emergency department immediately. Do not wait until the morning, do not try to relieve the erection, do not take further medications. It is worth taking the packaging of the preparation you have taken.

Can priapism damage the penis permanently?

Yes. With long-lasting ischemia, fibrosis of the corpus cavernosum occurs - the elastic tissue is replaced by scar tissue. The result may be permanent erectile dysfunction, for which medications no longer work.

How is priapism treated?

By decompression of the corpora cavernosa: removal of residual blood, irrigation and, if necessary, administration of a vasoconstrictor. In long-term episodes, surgical treatment may be necessary. The effectiveness depends on the time of reporting.

Are young men also at risk?

Yes, and especially so. The use of preparations from uncertain sources without indications, often in combination with alcohol or recreational substances, mainly affects younger men - and this is the group most often affected by complications.

Can taking the drug without a doctor cause any harm?

Yes. In addition to the direct risk, it delays the diagnosis of diseases of which erectile dysfunction is sometimes the first symptom: diabetes, hypertension, lipid disorders or sleep apnea.

Who consults on such problems at WMP?

On the WMP website, Jakub Krącz, M.D., is described as a urologist dealing with the diagnosis and treatment of diseases of the urogenital system, including men's sexual health problems.

Sources

• Wyspa Medycyny Przyjaznej, Jakub Krącz, M.D.: https://www.wyspamedycynyPrzyjaznej.pl/pl/jakub-klacz-urolog-gdansk
• Island of Friendly Medicine, urological consultation: https://www.wyspamedycynyPrzyjaznej.pl/pl/konsultacja-urologiczna
• European Association of Urology, Sexual and Reproductive Health Guidelines: https://uroweb.org/guidelines/sexual-and-reproductive-health
• NHS, Erection problems (erectile dysfunction): https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
• NHS, Sildenafil (Viagra): https://www.nhs.uk/medicines/sildenafil-viagra/
• NHS, Priapism (painful erections): https://www.nhs.uk/conditions/priapism-painful-erections/
• NHS, Buying medicines online: https://www.nhs.uk/nhs-services/prescriptions/buying-medicines-online/
• NICE Clinical Knowledge Summaries, Erectile dysfunction: https://cks.nice.org.uk/topics/erectile-dysfunction/
• World Health Organization, Substandard and falsified medical products: https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products
• Main Pharmaceutical Inspectorate, warnings and messages: https://www.gov.pl/web/gif
• British Association of Urological Surgeons, information for patients: https://www.baus.org.uk/patients