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ARC Journal of Forensic Science
Volume 4, Issue 1, 2019, PP 26-31
ISSN 2456-0049
http://dx.doi.org/10.20431/2456-0049.0401003
www.arcjournals.org
ARC Journal of Forensic Science Page | 26
Toxic Effects of Sexual Drug Overdose: Sildenafil (Viagra)
Rohit Kumar Verma1, Mahipal Singh Sankhla2*, Rajeev Kumar3
1Student of B.Sc. (Hons.) Forensic Science, Galgotias University, Greater Noida
2Research Scholar, Division of Forensic Science, Galgotias University, Greater Noida
3Associate professor, Division of Forensic science, Galgotias University, Greater Noida
1. INTRODUCTION
Sildenafil is the sexual drug. Sildenafil is a new
oral drug specially aimed at the cure of erectile
dysfunction [1]. Sildenafil citrate is a discerning
inhibitor of phosphodiesterase 5 (PDE5) and
stayed the initial agent through this way of act
for the cure of man erectile dysfunction [2].
Male erectile dysfunction (ED) is the
determined or recurring incapability to reach, or
to uphold till end of the sexual action, a suitable
erection [3]. Sildenafil (Viagra) conventional
Food and Drug Administration approval in
March 1998 such as the earliest oral agent for
erectile dysfunction [4]. Sildenafil workings
such as a modest inhibitor of an enzyme of the
phosphodiesterase type five class (PDE-5). Here
are eleven forms of phosphodiesterase found
over the body [5, 6]. Sildenafil is a weak
vasodilator, resultant in lesser, transitory
decreases in systolic (10 mmHg) and diastolic (7
mmHg) blood pressure (BP) when directed
orally; no clinically important special effects on
heart rate (HR) have been stated [7]. Sildenafil
is quickly engrossed, by maximum plasma
concentrations happening in one hour after oral
admin then a mean fatal half-life of three to five
hours [5]. Since the approval of sildenafil,
several information of unexpected death amid
patients preserved by this drug have upraised
about worries concerning its care in patients
with coronary artery disease [8].
The furthermost usually stated adverse effects of
sildenafil are headache, gastroesophageal reflux,
dyspepsia, facial flushing, nasal congestion,
pupil sparing, and third nerve palsy [9, 10].
Described cardiovascular side properties in the
usual healthy population are naturally slight and
related with vasodilatation (ie, headache,
flushing, and small decreases in systolic and
diastolic blood pressures). However, although
their incidence is small, serious cardiovascular
events, including significant hypotension, can
occur in certain populations at risk [11]. The
blood pressure dropping effect of sildenafil is
uncertain and therefore improbable to activate a
reflex heart rate response. Certainly, a mild
sympathetic reaction straight to the vasculature
might remain accountable for the upkeep of
blood pressure deprived of activating a impulse
tachycardia [12]. Though, with pharmacological
efforts resultant in larger reduction of blood
pressure as understood by the nitrate contact
study here is a minor impulse reaction in heart
rate in demand toward uphold blood pressure
Abstract: In today’s world main problem adolescence consumption of drugs are increasing day by day.
Sildenafil is the sexual drug. Sildenafil is the drug which to increase sexual power and improves flow of
blood to the phallus (male reproductive part). It’s most commonly found in the form of brand names are
Viagra and Revatio. It can be administrated orally or injected directly into the veins. Sildenafil is an
effective inhibitor of recurring guanosine monophosphate in the corpus cavernosum and consequently rises
the penile reaction to sexual stimulus. Sildenafil also causes some side effect like headache, heartburn,
flushed skin, visual disturbance, and dyspepsia. Sildenafil does not protect with sexually transmitted
diseases like HIV, hepatitis B, AIDS etc. Sildenafil may effect severe organ like cardiovascular system,
reproductive system, pulmonary hypertension, retinal dysfunction etc. Due to overdose of the sildenafil the
person get heart attack, stroke, irregular heartbeats and death may also occur in rare cases. This paper
aims about the detailed study of the sexual drug and the poisonous effects which is caused to the humans.
Keywords: sildenafil, sexual drug, Viagra, dyspepsia.
*Corresponding Author: Mahipal Singh Sankhla, Research Scholar, Division of Forensic Science,
Galgotias University, Greater Noida, India. Email: mahipal4n6@gmail.com
Toxic Effects of Sexual Drug Overdose: Sildenafil (Viagra)
ARC Journal of Forensic Science Page | 27
[13]. The cardiovascular effects of sildenafil are
important subsequently of the recurring
incidence of vital cardiac disease in men with
erectile dysfunction and information
representing severe cardiac actions temporally
related by the usage of this drug [14]. Sildenafil
may be expectable to improve reduction of the
cavernosal smooth muscle, which in go
increases blood flow into the cavernosal spaces,
thus foremost to increased intracavernosal
pressure, a main issue in making an erect penis
[15, 16]. Sildenafil has remained carefully used
in the action of erectile dysfunction of numerous
etiologies through decent acceptance and a low
occurrence of lateral special effects. Though, the
statement that maximum issued information to
age have been industry supported has presented
a possible prejudice. In accumulation,
insufficient studies to era devise inspected the
side-effect outline of sildenafil in a medical
exercise surrounding a widespread variety of
patients. This description delivers a non-
industry maintained review in a campus
condition of the side-effect outline of a general
and widely used medicine [17, 18, 19].
2. CHEMICAL STRUCTURE OF SILDENAFIL
CITRATE
Sildenafil is chemically 5-[2-ethoxy 5-(4-me thy
lpip e razi ne-1-yl suI fony 1) phenyl) -1-
methyl-3-propyl-6, 7-dihydro1- H-pyrazolol [4-
3-d] pyrimidin-7-one. With molecular formula -
C22H30N6O4S as shown in fig [20].
Fig: Chemical structure of sildenafil citrate [20]
2.1. Sildenafil uses as a Club or Party Drug
In the face of an increasing body of literature
,there are still no clear and reliable definitions or
drug lists amongst educations; others have
renowned this irregularity [21,22] and have
mentioned to the term “club drug” as
“amorphous” [23] Club drugs are frequently
consumed at subversive all-night events known
as “raves” [24]. Some men, therefore, may
consume sildenafil to produce an erection to
permit penetrating anal sex. Consequently,
opposing effects since club drugs used in tour
gathering surroundings might rise from
overdose, medication interface, or leisure drug–
pharmaceutical interfaces. Furthermore, an
inability to acquisition drugs might lead to
changed sexual actions and increase the danger
of HIV transmission [25-28]. Though club drugs
are frequently used unaccompanied to excess,
two additional mechanisms combine, maybe
synergistically, to produce club drug
poisonousness [29].
2.2. Pharmacology of Sildenafil Citrate
In scientific studies, sildenafil has been
evaluated for its effect on the capability of men
was varied in the residual 18% of men [30].
Sildenafil is quickly engrossed afterward oral
administration, with absolute bioavailability of
about 40%. Its pharmacokinetics is dosage
proportional above the suggested dosage range
(25, 50 and 100 gm). It is eradicated mainly by
hepatic metabolism (mainly cytochrome P450
3A4) and is rehabilitated to lively metabolite
with properties alike to parental molecule
sildenafil [20]. The pharmacodynamics close
opinions that have remained examined with
sildenafil imitate the dispersal of PDE5 in
altered tissues, i.e., human corpus cavernosum
(penile tumescence), vascular smooth muscle
(vasodilatation), and platelets (antiplatelet
function) [31]. Plasma absorptions highest in 30
to 120 minutes (median, 60 minutes) of oral
dosage active in the desisted state. Sildenafil is
chiefly absorbed by the cytochrome P450 3A4
(major route) and 2C9 (minor route) hepatic
microsomal isoenzymes, which alteration it to
an active N-dimethyl metabolite that has
continued exposed to individual 50% of the
parent drug’s potency for inhibiting PDE5.
Plasma concentrations of this metabolite are
'40% of individuals understood for sildenafil, so
that the metabolite accounts for '20% of the
pharmacological effects of sildenafil [32].
2.3. Adverse Effect of Sildenafil Citrate on
Human Health
2.3.1. Effect of Hormonal and Reproductive
Disturbance
Brain controls hormonal secretion and it is
sensitive to hormonal response; the neuro
endocrine response system contains
hypothalamus, pituitary, gonads, however also
the amygdala that is related to the
hypothalamic–pituitary axis (HPA) elaborate in
Toxic Effects of Sexual Drug Overdose: Sildenafil (Viagra)
ARC Journal of Forensic Science Page | 28
the regulation, making and secretion of sex
hormones [33]. Severe stimulus of testosterone
secretion with management of human chorionic
gonadotropin (HCG), a complex through
luteinizing hormone-like activities, produces
only a reduced reaction in uremic men [34].
2.3.2. Effect of Retinal Dysfunction
Though the part of sildenafil in erectile
dysfunction exists well understood and has be
clear in feature, optical effect of sildenafil are
still deficient. There are about reports in the
literature on the retinal side-effects of sildenafi1
[35, 36]. Supervision of PDE5 inhibitors has
been connected with visual turbulences such as
blue tinge, increased glare of coloured lights and
blurry vision; but, the precise device of these
disorders takes not remained definitively
clarified [37]. The PDE5 enzyme presented a
extensive appearance on retinal and choroidal
vessels, confirming the straight influence of
PDE5 inhibitors on their enlargement. Lastly,
surprisingly, we establish the occurrence of the
PDE5 enzyme on ganglion (III neuron) and
bipolar cell layers (II neuron). Ganglion and
bipolar cell layers performs as a filter in the
visual signal, giving a first codification of the
neural signal [38-41].
2.3.3. Effect on Pulmonary Hypertension in
Human Health
Pulmonary hypertension (PH) of unidentified
etiology or related with connective tissue
syndrome is a lethal disease with few medical
treatments [42]. Patients with liver diseases are
at hazard of emerging pulmonary vascular
complications [43]. Sildenafil has also been
reported to increase arterial Po2 [44] and
recover bodily performance in numerous
circumstances of severe pulmonary hypertension,
but no education has explored the consequence
of a numerous daytime action by sildenafil on
these variables in usual focusses bare to
elevation circumstances [45, 46, 47].
Approximately medical doctor have initiated by
sildenafil as another to, and in mixture with, in
the initial organisation of PAH, but its residence
is inaccurate [48]. Headache existence a
probable adversative outcome of sildenafil,
though, its likely upsurge in preserved issues
might have risk a likely helpful outcome on
general AMS score since of a improved blood
oxygenation. The suggestion of sildenafil in the
action of HAPE has not stayed addressed in the
current study since nobody of the issues
agonised after this severe disorder. The valued
effect on Ppa powerfully advises, though, that
this drug could be extremely effective in this
disorder, deprived of adverse systemic effect,
opposing to the typically proposed calcium
blockers [49, 50]. A few uncontrolled clinical
studies have suggested that combinations of
aerosolised iloprost and sildenafil, as fine as
aerosolised iloprost and are harmless and
effective in selected patients with liberal disease
in spite of prostanoid cure [51,52]. Preclinical
studies have revealed that sildenafil selectively
decreases pulmonary artery pressure with slight
effect on systemic BP. Randomised, double
blind, crossover design studies support these
findings; sildenafil improved 6-min walking
distance and reduced mean pulmonary arterial
systolic pressure in patients with primary
pulmonary hypertension [53, 54].
2.3.4. Effect on Cardiovascular System
Males through cardiovascular illness are further
possible to have erectile dysfunction than the
overall male inhabitants since together
circumstances share a number of hazard
influences [55]. Different cAMP-specific PDE-3
inhibitors (milrinone, vesnarinone, and
enoximone) that rise long-standing death in
patients with heart failure [19, 20], sildenafil
stays extremely selective (4000-fold) for human
PDE-5 over human PDE-3 and has not been
found to elevate cAMP [56]. Anecdotal
information of cardiovascular deaths associated
with sildenafil use produced substantial worry in
the medicinal public in months of the drug’s
endorsement in late March 1998. Meanwhile
formerly, the FDA has complete obtainable
information on deaths in patients receiving
sildenafil among the period of its endorsement
and mid-November 1998 [57].Besides, PDE5 is
not present in cardiac myocytes, and sildenafil
has been exposed to take no straight inotropic
special effects on dog trabeculae muscle (Pfizer,
unpublished data). Though, sildenafil has not
been examined widely in heart failure patients
[58].
3. DISCUSSION
Sildenafil is a sexual dysfunction and a
psychotropic drug which is used in the form of
antidepressants. This was a major essential
growing problem that provides us to keep the
use of sildenafil in differential for any patient
who present with symptoms described about.
Human health is directly affected by
Neurological dysfunction. Some study also
shown that the sildenafil uses in the sexual
assault cases by giving the drug forcefully to the
teenagers so, that they go in the unconscious
Toxic Effects of Sexual Drug Overdose: Sildenafil (Viagra)
ARC Journal of Forensic Science Page | 29
state. This study shows that sildenafil, directed
in particular oral dosages, is in effect in
improving erectile activity in patients with male
erectile dysfunction for which there is no
recognised biological cause. Due to the
overdose of the sildenafil drug, the person occur
various disease like strokes, heart failure and
death may be also occur. The absence of
scientific study in human awareness about the
hazard of sildenafil and adolescence will
unceasingly use and mainly by those who have
already experienced the effect of sildenafil.
4. CONCLUSION
Sildenafil is an operational oral drug for erectile
dysfunction. The toxicologist have detected the
minor and major effects on various parts of the
human body. Analytical techniques which is use
to detect the concentration of the drug from the
body are HPLC, spectrophotometer, GC-MS,
LC-MS etc. Additional connected study decided
out in the upcoming with sample confined in
different conditions, will allow a quantitative
report of the drug in these samples to be defined
at the national level. The occurrence of contrary
proceedings owed to sildenafil may be greater
than primarily described.
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Citation: Rohit Kumar Verma, Mahipal Singh Sankhla, Rajeev Kumar. Toxic Effects of Sexual Drug
Overdose: Sildenafil (Viagra). ARC Journal of Forensic Science. 2019 4(1): 26-31. http://dx.doi.org/10.
20431/ 2456-0049.0401003
Copyright: © 2019 Authors. This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
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