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A patient who took too many doses of an erectile dysfunction drug permanently damaged his eyes, reported the doctors this week. Almost two years later, his vision – everything looks red – is still not back to normal.
The 31-year-old man bought a bottle of IronMag liquid sildenafil citrate, which was marked for research purposes, online and over the counter, doctors reported in Retinal Case and Brief Reports. Sildenafil citrate is used in many prescription medications for the treatment of erectile dysfunction, including Viagra. The bottle included a dropper to administer the recommended dose of 50 milligrams orally.
The man admitted that he did not always use the dropper and, when the bottle was almost empty, he added water, twirled it and drank the rest, the report said. His vision almost immediately turned red, but he only asked for help two days later.
The normal dosage of prescription drugs for the treatment of erectile dysfunction, offered only in tablet form, ranges from 25 to 100 milligrams, depending on the patient. The doctors estimated that he was taking four to five times the recommended dose at a time.
"People have a philosophy that if a little is good, much better," said Dr. Richard Rosen, ophthalmologist in New York and author of the report, told NBC News. "Obviously, this is not the case."
The overdose has poisoned his retina and destroyed some of his cones and stems, which helps people see clearly and detect colors. Rosen, director of retinal services at the Mount Sinai Infirmary for the Eyes and Ears of New York, was able to use sophisticated imaging equipment to detect damage to stems and cones.
"He has a permanent injury," said Rosen. Two years later, "I understand that his symptoms are slightly better but are not resolved." IronMag did not respond to an email requesting a comment on Friday.
Sudden vision loss is a symptom of Viagra and other drugs containing sildenafil citrate. While other patients under sildenafil citrate reported seeing colors, most often blue, these symptoms usually disappear within 24 hours.
The drug affects eyesight because it can sometimes interact with an eye protein, PDE6, which facilitates photoreception. Sildenafil citrate works by inhibiting the enzyme PDE5, which prevents the smooth muscles of the penis from standing up. But when it is taken in large doses, it can cause a cross reaction with PDE6, causing blue or red vision, said Dr. Raj Maturi, clinical spokesperson for the American Academy of Ophthalmology, who did not participate in the case study.
But doctors can not explain the patient's persistent red vision. Maturi pointed out that the doctors who looked after him did not know what else was in the medication that he had taken.
"We have no idea what there really was," Maturi said. "A contaminant could be at the root of the problem."
Experts advise patients to take sildenafil citrate only on prescription and at the recommended dose, in order to avoid a similar reaction.
"People have taken very high doses, five to ten times more, and have vision problems," said Maturi. "The life of this poor guy has been permanently changed."
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