Fake Cialis linked to dangerously low blood sugar

An unusual outbreak of dangerously low blood sugar has been traced to illegal anti-impotence drugs and herbal remedies contaminated with a drug for diabetics, doctors warn.

Between Jan. 1 and May 26, 2008, 150 non-diabetic patients with severe hypoglycemia were admitted to public hospital in Singapore. There were four deaths, and seven patients remained comatose, Dr. Kok Onn Lee of National University Hospital in Singapore report in Thursday's New England Journal of Medicine.

All of the patients except one were men, and they ranged in age from 19 to 97, with an average age of 51.

The drugs included counterfeit Cialis and herbal remedies called Power 1 Walnut and Santi Bovine Penis Erecting Capsule.

The drug packaging listed names of fictitious overseas factories, so it is not known whether the contamination was deliberate or accidental, the doctors said.

"We believe that physicians should be cognizant of this phenomenon when evaluating patients with severe unexplained hypoglycemia, particularly if a clustering of cases is noted," the team wrote.

They also called for better collaboration between national and international drug regulators and enforcement agencies to address clandestine manufacturing processes, the cross-border movement of drugs, and the sale of adulterated medications online.