holy crap, that’s insane. You don’t just accidentally add sildenafil or tadalafil to your supplements. Unless the FDA is misidentifying compounds present in the herbs in these supplements, which seems unlikely but I’m no pharmacology expert.

Yeah, I don't think "accidentally" is something that happened here. What's the best way to make your "all-natural Viagra" actually work? Make it with real Viagra.

I’d be surprised if the buyers were expecting any different.

With the amount of mislabelled product out there in circulation (and presumably a general lack of harm), does it still make sense to require a prescription?

I'm personally pretty torn on that. On the one hand I agree with you, especially from a harm-reduction perspective (e.g. people who are on blood pressure medication ordering "natural" Viagra because Viagra's contra-indicated with the medication they're on, not realizing that they're getting something that could cause a very bad situation). On the other hand, requiring a prescription does mean that a physician can ask that question ("are you on blood pressure medication?") and counsel the patient to look at different options instead.

I mean, even though 50% of these are intentional overdoses... the other 50% probably didn't know they were doing something that was going to destroy their liver: https://www.ncbi.nlm.nih.gov/books/NBK441917/

It’s pretty much just an interaction with “nitrates” which are typically taken by people with pretty serious cardiac issues, and usually educated re: the side effects if taken with viagra or similar compounds (cuz you never know if someone has Viagra in their drawer from another pharmacy or years ago or “natural” Viagra from another source).

The interaction with other blood pressure meds appears additive rather than synergistic and Viagra alone only minimally reduced blood pressure. The cough and cold aisle or a cafe presents more dangers.

https://pubmed.ncbi.nlm.nih.gov/10078539/

At least over the counter Viagra would be properly labelled about these things.

Adding restricted ingredients to generally available supplements is a known tactic that supplement producers utilize extensively. In the past, this has been a well-known "secret" that bodybuilders basically relied on: buying tainted pre- and post-workout supplements that contain illegal steroids and such.

It's a better regulated industry now, but with the explosion in supplement popularity over the last decade I doubt there is an easy way to test and punish all manufacturers. If you look at the list of supplements included in that warning letter, they have classic nonsensical names that Chinese companies are known for (WeFun, Genergy, etc). None are on www.amazon.com anymore, but hundreds of other supplements show up with absolutely no way of telling whether any of them are clean (e.g. "Endurance 2Nite").

Are you saying there could be Viagra in my Endurance 2Nite?

Although they are most associated with ED, those supplements are also performance enhancers. For decades, unscrupulous supplement companies have put illicit or prescription drugs in their products. Many of those drugs (not the supplements) do, in fact, work. The rumor was the gameplan was to start with that until you get enough market hype and then remove them, but I've also heard some of the illicit drugs are cheap enough that they could still continue tainting them and make a profit. So even if they work, people deserve to know what they're putting in their bodies.