Adulteration in herbal aphrodisiacs: Toxicological risks, analytical detection, and regulatory gaps in low and middle income countries

Abstract

Herbal aphrodisiacs have gained significant popularity as perceived natural remedies for sexual dysfunction, particularly in Sub-Saharan Africa and other low-resource regions. However, growing evidence indicates that many of these products are adulterated with undeclared sildenafil. This review synthesizes current toxicological findings, detection strategies, and regulatory shortcomings associated with sildenafil adulteration in herbal sexual enhancers. The undisclosed presence of sildenafil poses serious health risks, especially for individuals with cardiovascular conditions or those using nitrate-based medications, due to the potential for hypotension. Chronic exposure has also been linked to hepatotoxicity, nephrotoxicity, and reproductive dysfunction through oxidative stress and hormonal disruption. The review outlines key analytical techniques employed in the detection of undeclared PDE-5 inhibitors such as HPLC, LC-MS/MS, FTIR, and TLC emphasizing their respective strengths, applicability, and limitations. Despite these advancements, access to such technologies remains limited in many low-income countries. Furthermore, regulatory oversight is often weak, fragmented, or poorly enforced, particularly in informal and cross-border markets. By swhowing clinical case reports, pharmacological interactions, and regulatory challenges, this review underscores the urgent need for integrated toxicovigilance systems, accessible analytical platforms, and harmonized policy reforms to better protect public health in emerging economies.