Royal honey products are marketed as natural supplements for sexual performance, but laboratory testing by regulatory authorities has repeatedly revealed a dangerous truth: many contain undeclared sildenafil, the active ingredient in Viagra. These unlicensed products pose serious health risks, including life-threatening cardiovascular events and drug interactions. The MHRA has issued warnings about royal honey and similar supplements, which circulate online and in shops without quality control or safety oversight. Consumers cannot determine from packaging whether these products contain hidden prescription medicines. This article examines the evidence, explains the dangers, and outlines safe, regulated alternatives for erectile dysfunction available through the NHS.

What Is Royal Honey and What Does It Contain?

Royal honey products are marketed as natural dietary supplements, often promoted for enhancing sexual performance, energy, and vitality. These products typically claim to contain honey enriched with royal jelly, bee pollen, and various herbal extracts. Manufacturers frequently advertise royal honey as a "natural" alternative to prescription medications for erectile dysfunction, appealing to consumers seeking over-the-counter solutions.

However, laboratory testing by regulatory authorities has repeatedly revealed that many royal honey products contain undeclared pharmaceutical ingredients, most notably phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil (the active ingredient in Viagra) or tadalafil (the active ingredient in Cialis). These substances are prescription-only medicines in the UK and should never be present in food supplements. The presence of these medicines is not listed on product labels, meaning consumers are unknowingly taking potent medications without medical supervision.

The composition of royal honey products varies significantly between brands and batches, with no standardisation or quality control. International regulatory authorities, including the US Food and Drug Administration (FDA) and Singapore's Health Sciences Authority (HSA), have identified numerous royal honey brands containing therapeutic or even supra-therapeutic doses of sildenafil and other PDE5 inhibitors. Some products contain multiple undeclared active pharmaceutical ingredients. This adulteration is intentional, designed to produce noticeable effects that consumers attribute to the "natural" ingredients, thereby driving repeat purchases.

The MHRA (Medicines and Healthcare products Regulatory Agency) has issued warnings about unlicensed sexual enhancement products, including those marketed as "herbal Viagra" or natural supplements, which may contain hidden medicines. These products circulate online, in convenience stores, and through social media platforms. Consumers cannot determine from packaging or appearance whether a royal honey product contains dangerous undeclared ingredients, making these products a significant public health concern in the UK.

Why Undeclared Sildenafil in Supplements Is Dangerous

Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor that works by relaxing blood vessels and increasing blood flow to the penis, facilitating erections in response to sexual stimulation. Whilst effective when prescribed appropriately, sildenafil carries significant risks that require medical assessment before use. Taking sildenafil without medical supervision—particularly when unaware of its presence—can lead to serious adverse effects and dangerous drug interactions.

Key dangers of undeclared sildenafil include:

• Cardiovascular risks: Sildenafil can cause dangerous drops in blood pressure, particularly in individuals with cardiovascular disease or those taking nitrate medications (commonly prescribed for angina). The combination of sildenafil with nitrates or guanylate cyclase stimulators such as riociguat can result in life-threatening hypotension, heart attack, or stroke. Sildenafil is contraindicated in patients with hypotension (blood pressure below 90/50 mmHg), recent myocardial infarction or stroke (within the past six months), and in those for whom sexual activity is inadvisable due to cardiovascular status.

• Unpredictable dosing: Royal honey products contain variable and often excessive amounts of sildenafil. Without knowing the dose, users cannot control their exposure, increasing the risk of overdose and severe side effects including priapism (prolonged, painful erections lasting more than four hours, which require emergency treatment).

• Drug interactions: Sildenafil interacts with numerous medications. Potent inhibitors of the liver enzyme CYP3A4—including certain antibiotics (erythromycin, clarithromycin), antifungals (ketoconazole, itraconazole), and HIV protease inhibitors—can significantly increase sildenafil levels in the blood, raising the risk of adverse effects. Grapefruit juice also inhibits CYP3A4 and should be avoided. Patients taking alpha-blockers (such as doxazosin) for prostate or blood pressure problems may experience symptomatic hypotension; sildenafil should only be started once the patient is stable on alpha-blocker therapy, and lower starting doses with careful timing are recommended.

• Contraindications ignored: Sildenafil is contraindicated in individuals with severe hepatic impairment, hereditary degenerative retinal disorders (such as retinitis pigmentosa), and those taking nitrates or riociguat. Without medical screening, vulnerable individuals may unknowingly expose themselves to serious harm.

Common adverse effects of sildenafil include headache, facial flushing, indigestion, nasal congestion, and visual disturbances. More serious effects include sudden vision or hearing loss, chest pain, and irregular heartbeat. Anyone experiencing chest pain during sexual activity, an erection lasting more than four hours, or sudden loss of vision or hearing after consuming royal honey should call 999 or attend A&E immediately and inform healthcare professionals about the product consumed. Suspected side effects from any medicine, including undeclared ingredients in supplements, should be reported via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

MHRA Warnings and Regulatory Action on Royal Honey Products

The MHRA has issued public warnings regarding unlicensed sexual enhancement products, including those marketed as "herbal Viagra" or natural supplements such as royal honey, classifying them as unlicensed medicines that pose serious risks to health. These warnings highlight that such products may contain undeclared pharmaceutical ingredients, including sildenafil and related PDE5 inhibitors, and advise consumers not to purchase or consume them. The regulatory action reflects the severity of the public health threat posed by these adulterated supplements.

International regulatory authorities, including the US FDA and Singapore's HSA, have identified sildenafil and other PDE5 inhibitors in numerous royal honey brands, including products marketed as Etumax Royal Honey, Vital Honey, Kingdom Honey, Wonderful Honey, and various "VIP Royal Honey" or "Magic Honey" products. The MHRA issues Drug Safety Updates, Drug Alerts, and enforcement notices regarding unlicensed and adulterated medicines. Consumers should check the MHRA website for current safety alerts before purchasing any sexual enhancement supplements.

The MHRA works with UK Border Force, online marketplaces, and trading standards to remove dangerous products from sale. Despite these efforts, royal honey products continue to circulate through:

• Online retailers and social media platforms: Products are frequently sold via websites, Facebook, Instagram, and messaging apps, often shipped from overseas.

• Convenience stores and specialist shops: Some retailers stock these products, either unaware of the risks or deliberately circumventing regulations.

• International suppliers: Products purchased abroad or imported by individuals may bypass UK safety checks.

The MHRA emphasises that no royal honey product is licensed as a medicine in the UK, and any product claiming to treat erectile dysfunction should be regarded with extreme suspicion. Consumers who have purchased royal honey products are advised to stop using them immediately. Healthcare professionals should remain alert to patients presenting with unexplained symptoms potentially related to undeclared sildenafil consumption. The MHRA provides guidance on buying medicines safely online and how to identify legitimate suppliers on its website.

Safe and Legal Alternatives for Erectile Dysfunction in the UK

Men experiencing erectile dysfunction (ED) have access to safe, regulated, and effective treatments through the NHS and private healthcare providers in the UK. The appropriate first step is consultation with a GP, who can assess underlying causes, review medical history, and prescribe suitable treatment. ED may indicate cardiovascular disease, diabetes, or psychological factors requiring specific management.

Initial assessment by a GP typically includes:

• Cardiovascular risk assessment, including blood pressure and body mass index (BMI)

• Blood tests: HbA1c or fasting glucose (to screen for diabetes), lipid profile, and renal function

• Morning total testosterone level if there are features of hypogonadism (low libido, reduced energy, loss of muscle mass)

• Consideration of prolactin measurement if clinically indicated

• Review of current medications and identification of modifiable risk factors

NICE-recommended treatment options include:

• PDE5 inhibitors: Sildenafil, tadalafil, vardenafil, and avanafil are available on prescription following medical assessment. These medications are identical in mechanism to the sildenafil found in royal honey but are provided in controlled doses with appropriate safety monitoring. In the UK, sildenafil 50 mg (Viagra Connect) is also available as a Pharmacy (P) medicine without a prescription, following assessment by a registered pharmacist. All other PDE5 inhibitors and higher doses of sildenafil remain prescription-only. Sildenafil is available as a generic medication and can also be obtained through legitimate online pharmacies registered with the General Pharmaceutical Council (GPhC).

• Lifestyle modifications: NICE guidance emphasises addressing modifiable risk factors including obesity, smoking, excessive alcohol consumption, and physical inactivity. Weight loss, regular exercise, and smoking cessation can significantly improve erectile function.

• Psychological interventions: Cognitive behavioural therapy (CBT) or psychosexual counselling may be appropriate when psychological factors contribute to ED. These interventions can be accessed through GP referral or private practitioners.

• Vacuum erection devices and other treatments: For men unable to use PDE5 inhibitors, alternatives include vacuum pumps, intracavernosal injections, or intraurethral preparations.

When to seek medical advice and referral:

Men should consult their GP if experiencing persistent erectile difficulties, as this may indicate underlying health conditions requiring investigation. Referral to specialist services (urology, endocrinology, or cardiology) may be appropriate if:

• PDE5 inhibitors are ineffective or not tolerated

• There is suspected Peyronie's disease or other penile structural abnormality

• Endocrine disorders (such as hypogonadism) are identified

• Complex or high-risk cardiovascular disease requires specialist input before treatment

• Consideration of intracavernosal therapies or surgical options is needed

Urgent medical attention is needed if:

• ED occurs suddenly alongside chest pain or cardiovascular symptoms

• Priapism (erection lasting more than four hours) develops—this is a medical emergency requiring immediate attendance at A&E or calling 999

• Sudden loss of vision or hearing occurs

Legitimate online pharmacies offer convenient access to ED medications but must be GPhC-registered and require completion of a medical questionnaire reviewed by a UK-registered prescriber. Consumers should verify registration by checking the GPhC online register at www.pharmacyregulation.org and ensure the pharmacy displays a UK address and contact details. Avoid websites offering products without prescription or medical assessment. The NHS website provides comprehensive information on ED treatments and how to access them safely through regulated channels.

Frequently Asked Questions