Health Canada is advising consumers not to use Liviro3, a natural health product marketed for sexual enhancement, due to concerns about possible side-effects. The product is not authorized for sale in Canada and has not been found in the Canadian marketplace, but is for sale on the Internet, and may have been brought into the country by travellers.

The US Food and Drug Administration (FDA) found Liviro3 to contain tadalafil, a prescription drug that should only be taken under the guidance of a health professional. Ebek Inc., the manufacturer of Liviro3, has recalled the product and has also advised that there is counterfeit Liviro3 on the market. Consumers are therefore advised not to use any product named Liviro3.

There are potential cardiac risks associated with the use of tadalafil in patients with pre-existing cardiovascular diseases, including hypertension, and in patients with a history of myocardial infarction (heart attack), stroke or life-threatening arrhythmia. Use of tadalafil may also be associated with side-effects including headaches, flushing, nasal congestion, vomiting, diarrhea, flu syndrome, blood in the urine, prolonged erection, and abnormal vision including temporary vision loss. Tadalafil is also not recommended for patients who are taking any type of nitrate drug therapy due to the risk of developing potentially life-threatening hypotension.

To minimize the risks associated with purchasing health products online, consumers are advised to only buy prescription drugs with a prescription from a doctor who has examined them in person, using a licensed pharmacy where they have an established relationship.

While legitimate Canadian Internet pharmacies are an option to consider, there are serious health risks associated with buying drugs online. Consumers can help protect themselves if they choose to purchase health products via the Internet. They should not do business with a Web site that:

•  refuses to give a street address, telephone number, and a way of contacting a pharmacist,
•  offers prescription drugs without a prescription,
•  offers to issue a prescription based on answers to an on-line questionnaire,
•  claims to have a "miracle cure" for any serious condition; or
•  sells products that are not authorized for sale by Health Canada.

Drugs and natural health products that are authorized for sale in Canada will have either an eight-digit Drug Identification Number (DIN), a Natural Product Number (NPN) or a Homeopathic Medicine Number (DIN-HM) on the label. These numbers indicate that the products have been assessed by Health Canada for safety, effectiveness and quality.

Patients should be aware of the name of the drugs they are taking and be familiar with their usual colour, size, shape and any imprints or markings on the drug. If a patient is concerned, they should consult a different health professional than the one who supplied them the drug, such as a doctor or pharmacist.