Is Kamagra dangerous? What is really in those pills

Kamagra is dangerous for two separate reasons. First, the medicine is not registered in Europe, so nobody checks how much sildenafil a tablet actually contains. Second, anyone buying it online skips the medical check, and that check is exactly what catches the risks.

Kamagra contains sildenafil in principle, the same active substance as Viagra. It is produced in India for markets where it is approved, and reaches the Netherlands via the internet.

This article is not about where to buy it. It is about what you are risking if you already use it.

How many men use ED pills without a prescription?

Far more than most people assume. Based on wastewater research by the Dutch public health institute RIVM, broadcaster NOS reported in 2017 that around 150,000 men in the Netherlands use ED pills while roughly 45,000 had a prescription. That works out at roughly 70 percent outside regular care.

Wastewater research is a clever method, because it measures what people actually take rather than what they report.

That ratio says something uncomfortable. The use itself has become normal, the guidance around it has not.

Why is being unregistered such a problem?

A registered medicine goes through checks on composition, dosage and production. Kamagra lacks that oversight in Europe, so the amount of active substance per tablet can differ from what the packaging claims. Too little means it does not work, too much means more side effects.

Analyses of falsified ED medicines bought online show that packaging and tablets can closely resemble the original while the contents differ. Researchers needed laboratory techniques to tell them apart.

That is the heart of the problem. You cannot tell by looking whether a tablet is what it claims.

What is the difference between Viagra and Kamagra?

The active substance is sildenafil in both cases, so in theory they do the same thing. The difference is certainty: with Viagra or generic sildenafil from the pharmacy you know what you are taking, with Kamagra you do not. On top of that, the pharmacy route includes a medical assessment.

Kamagra is also sold as an oral jelly, in fruit-flavoured sachets. That format suggests something more harmless than a prescription tablet.

That is precisely the wrong suggestion. The active substance and the risks are the same.

More on the side effects of sildenafil itself is in Viagra side effects.

Which risk is the biggest?

Not the dosage, but the skipped check. The most dangerous interaction of sildenafil is with nitrates, such as nitroglycerin for heart complaints and poppers. Together they can drop blood pressure far enough to become life threatening.

A doctor asks about that as standard before prescribing anything. A web shop does not.

Take a man of 58 with early narrowing in his coronary arteries that he knows nothing about. He orders Kamagra, uses poppers one evening as well, and his blood pressure drops far. At the GP that combination would have surfaced with a single question.

There is a second reason that check matters, and I think it is the part men underestimate most. In research, erection problems regularly appear as an early signal of vascular damage, sometimes years before heart complaints show up.

Anyone who papers over the complaint with a pill from a sachet misses that signal. We wrote about it in blood values and cardiovascular disease and in impotence: what it means.

What if you already use it?

Be honest with your GP, even if you would rather not say where it came from. Doctors are far less impressed by this than people expect, and the information does change their assessment.

Tell them which medicine, which strength according to the packaging, how often, and whether you take other medication. That last part matters most.

We described how that conversation goes in discussing erection problems with your GP. If you get an erection that will not go away, that is an emergency: see priapism.

The legal route is less hassle than you think

What strikes me most: men rarely choose the illegal route over price. It is almost always embarrassment, or the assumption that the GP route is complicated. In practice it is a short consultation about your heart, your blood pressure and your medication, and generic sildenafil has become cheap.

The available options are set out in ED medications compared. If low desire plays a role too, read low libido in men.

If a medicine falls short of expectations, the question is rarely which pill is stronger. More often it is testosterone, blood sugar or blood vessels. A testosterone test shows part of that picture.

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.

References

• RIVM wastewater research into the use of ED medication, reported via NOS, 13 May 2017.
• Hikage T, et al. Falsified tadalafil tablets distributed in Japan via the internet. Forensic Sci Int, 2020. PMID: 31931435
• Detection method of falsified medicines using low-cost Raman scattering spectrometry. Biol Pharm Bull, 2021. PMID: 33952825
• Corona G, et al. Erectile dysfunction and cardiovascular risk: a review of current findings. Expert Rev Cardiovasc Ther, 2020. PMID: 32192361