FDA lab-confirmed 2026-03-14
Blue Bull Extreme
Undeclared ingredient record: Sildenafil.
- Action
- Voluntary Nationwide Recall + Public Notification (Hidden Drug Ingredient)
- UPC / Lot
- 707443349917
Medical Evidence Database
Safety &
Medical Evidence
Comprehensive medical protocols, adverse event reports, and harm reduction guidance compiled from FDA enforcement records and peer-reviewed clinical literature.
Editorial review by HoneyPackFinder Editorial · Last reviewed · FDA honey data current as of
Emergency Hotline
1-800-222-1222
Poison Control - 24/7
Source-backed alerts
Latest Honey-Pack Safety Updates
FDA honey-products source current as of
FDA lab-confirmed 2026-03-14
Boner Bears Honey
Undeclared ingredient record: Sildenafil, Tadalafil.
- Action
- Voluntary Nationwide Recall + Public Notification (Hidden Drug Ingredient)
- UPC / Lot
- 788362191603 · Lot BBH0128
FDA lab-confirmed 2026-03-14
Red Bull Extreme
Undeclared ingredient record: Sildenafil.
- Action
- Voluntary Nationwide Recall + Public Notification (Hidden Drug Ingredient)
- UPC / Lot
- 9554100205595 · Lot ORB524
First 10 minutes
Symptoms First, Product Second
- • Call 911 for chest pain, trouble breathing, seizure, collapse, or loss of consciousness.
- • Call Poison Control at 1-800-222-1222 if you are unsure what to do.
- • Keep the wrapper, UPC, lot number, seller, and time consumed for clinicians.
Medication classes
Interaction Risk Pages
Reporting
Report Side Effects
HoneyPackFinder does not collect adverse-event medical details in v1. Use FDA MedWatch for medical product reports and Poison Control for immediate exposure guidance.
Reporting guide →Emergency Protocols
⚠ CALL 911 IMMEDIATELY IF:
Chest pain or pressure
Difficulty breathing
Severe dizziness or fainting
Erection lasting more than 4 hours
Irregular heartbeat
Sudden vision loss
Sudden hearing loss
Seizures
Signs of stroke (facial drooping, arm weakness, speech difficulty)
National Poison Control
1-800-222-1222
24/7 - Free, confidential expert medical advice
When to Call:
- • Accidental overdose (multiple packets)
- • Severe symptoms
- • Child or pet ingestion
- • Uncertain about product contents
- • Experiencing unusual or prolonged symptoms
If You've Already Consumed a Honey Pack
Immediate Steps:
- → Do NOT take any nitrate medications (nitroglycerin, etc.)
- → Inform any healthcare providers that you consumed a product that may contain sildenafil or tadalafil
- → Monitor for symptoms (chest pain, severe dizziness, prolonged erection, difficulty breathing)
- → Have someone stay with you for monitoring
- → Know the location of nearest emergency room
What to Tell Medical Professionals:
- • Exact product name if known
- • When consumed (time and date)
- • Amount consumed
- • All current medications
- • Any pre-existing medical conditions
- • Symptoms experienced
Duration of Effects:
Sildenafil effects last 4-6 hours. Tadalafil effects last up to 36 hours. Monitor for side effects during this period.
Emergency Department Presentation: Unexplained Cardiovascular Symptoms in Young Adult
Source: JEMS Clinical Guidance for Prehospital Providers
Scenario:
Young patients presenting with unexplained cardiovascular symptoms
Clinical Approach:
- history: Obtain thorough history regarding supplement use, specifically asking about honey packets, energy supplements, and sexual enhancement products
- physical Exam: Repeated vital sign assessments to detect orthostatic hypotension or persistent blood pressure instability
- diagnostics: EKG to assess for cardiac ischemia
- differential Diagnosis: Consider undeclared pharmaceutical ingredient ingestion in young patients with cardiovascular symptoms and recent supplement use
Preventative Guidance:
Prehospital clinicians should maintain high index of suspicion for honey packet use in young adults with unexplained cardiovascular or erectile function complaints
Prolonged Erection (Priapism) Requiring Emergency Care
Source: FDA safety warnings and clinical pharmacology
Presentation:
Erection lasting more than 4 hours
Mechanism:
Excessive or uncontrolled dosing of sildenafil/tadalafil from honey packs
Urgency:
Medical emergency requiring immediate treatment
Consequences:
Permanent erectile tissue damage if not treated within 4-6 hours
Treatment:
Emergency department intervention, possible surgical decompression
Honey Pack Factor:
Unknown dosage and potential consumption of multiple packets increases priapism risk
Documented Adverse Events
Severe Hypotension from Honey Packet Consumption
JEMS - The Hidden Dangers of Honey Packets: A Guide for Prehospital Clinicians
Published: 2024
Clinical Presentation:
Symptoms: Severe hypotension (sudden blood pressure drop), Loss of consciousness, Syncope and dizziness, Physical trauma from falls
Mechanism: Undisclosed sildenafil/tadalafil combined with alcohol or other substances
Population: College students (common user demographic)
Potential Complications:
- • Organ injury from hypotension
- • Physical injuries from falls
- • Arrhythmias
- • Myocardial infarction
- • Cardiac ischemia (detectable via EKG)
Cardiovascular Complications from Royal Honey Consumption
Healthline - Honey Pack Trend: Is It Dangerous?
Published: 2024
Common Effects:
- • Blood pressure crashes
- • Vision changes (blue tint, blurred vision)
- • Headache
- • Flushing
- • Dizziness
Serious Effects:
- • Hospital visits
- • Cardiovascular complications
- • Dangerous drug interactions
MedWatch Adverse Event Reporting for Royal Honey Products
FDA MedWatch Safety Information and Adverse Event Reporting Program
Drug Interaction Cases: Nitrates and Honey Pack PDE-5 Inhibitors
Multiple FDA warnings and clinical literature
At-Risk Populations:
Heart disease patients taking nitroglycerin, Patients on isosorbide mononitrate, Patients on isosorbide dinitrate, Diabetes patients (often prescribed nitrates), High blood pressure patients, High cholesterol patients, Patients with history of heart attack or stroke
Visual and Auditory Adverse Events from Undeclared Sildenafil
FDA Drug Labeling - Sildenafil Safety Information
Common Symptoms
Headache
Vasodilation from PDE-5 inhibition
Severity: Mild to moderate
Flushing
Peripheral vasodilation
Severity:
Dizziness
Blood pressure changes
Severity: Mild to moderate
Nausea
GI effects of PDE-5 inhibitors
Severity: Mild
Visual disturbances
PDE-6 inhibition in retina (cross-reactivity)
Severity:
Serious Symptoms
Chest pain or pressure
→ CALL 911 IMMEDIATELY
Severe blood pressure drop
→ Emergency medical care
Prolonged erection (priapism)
→ Emergency department immediately
Heart palpitations
→ Seek immediate medical care
Fainting
→ Emergency medical care, fall injury assessment
Drug Interactions
Nitrates
Examples: Nitroglycerin (Nitrostat, Nitro-Dur), Isosorbide mononitrate (Imdur, Monoket), Isosorbide dinitrate (Isordil), Amyl nitrite (poppers)
Interaction:
Severe blood pressure drop, cardiovascular collapse, death
Mechanism:
Synergistic increase in cGMP causing profound vasodilation
At-Risk Populations:
Angina patients, Heart failure patients, Post-MI patients, Coronary artery disease patients
Alpha-blockers
Examples: Doxazosin (Cardura), Tamsulosin (Flomax), Terazosin (Hytrin), Alfuzosin (Uroxatral)
Interaction:
Additive blood pressure lowering, orthostatic hypotension, dizziness, fainting
Mechanism:
Both cause vasodilation through different mechanisms
At-Risk Populations:
BPH patients, Hypertension patients, Elderly men
Antihypertensive Medications
Examples: ACE inhibitors, ARBs, Calcium channel blockers, Beta blockers, Diuretics
Interaction:
Enhanced blood pressure lowering effects
Mechanism:
Additive vasodilation
CYP3A4 Inhibitors
Examples: Ritonavir (HIV medication), Saquinavir (HIV medication), Ketoconazole (antifungal), Itraconazole (antifungal), Erythromycin (antibiotic), Clarithromycin (antibiotic), Grapefruit juice
Interaction:
Increased sildenafil/tadalafil blood levels, enhanced side effects, prolonged duration
Mechanism:
Inhibition of hepatic metabolism (CYP3A4)
Honey Pack Specific Risk:
Unknown dosage in honey packs means users cannot adjust for drug interactions
Other PDE-5 Inhibitors
Examples: Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), Stendra (avanafil)
Interaction:
Additive effects, excessive hypotension, priapism risk
Honey Pack Specific Risk:
Users may unknowingly combine prescription ED medication with honey pack, doubling dosage
Alcohol
Interaction:
Enhanced hypotensive effects, increased risk of severe blood pressure drop
Mechanism:
Both cause vasodilation
At-Risk Populations
Cardiovascular Disease Patients
EXTREMELY HIGH- • Coronary artery disease
- • History of heart attack
- • History of stroke
- • Heart failure
- • Arrhythmias
Life-threatening cardiovascular events
Diabetes Patients
HIGHHypertension Patients
HIGHMen Over 65
HIGH- • Higher prevalence of cardiovascular disease
- • More likely on nitrates
- • More likely on multiple medications
- • Decreased drug clearance
- • Higher sensitivity to side effects
HIV Patients on Protease Inhibitors
HIGHCollege Students / Young Adults
MODERATE to HIGHUndeclared Pharmaceutical Drugs
Sildenafil
Brand Name: Viagra
Prescription PDE-5 Inhibitor
Approved Use:
FDA-approved treatment for erectile dysfunction
Legal Status:
Prescription only - illegal in supplements without labeling
Found In:
Royal Honey VIPKingdom HoneyEtumax Royal HoneySecret Miracle HoneyBlack Mamba 2 PremiumBunny Love Honey
Health Risks:
- • Dangerous interactions with nitrate medications
- • Severe blood pressure drops
- • Cardiovascular events
- • Unpredictable dosing in supplements
- • Heart attack risk in at-risk populations
Tadalafil
Brand Name: Cialis
Prescription PDE-5 Inhibitor
Approved Use:
FDA-approved treatment for erectile dysfunction
Legal Status:
Prescription only - illegal in supplements without labeling
Found In:
Royal Honey VIPEtumax Royal HoneyVital HoneyX Rated HoneyBlack Mamba Premium 18000Black Horse Vital HoneyBunny Love Honey
Health Risks:
- • Dangerous interactions with nitrate medications
- • Prolonged erections (priapism)
- • Cardiovascular events
- • Unknown dosing in supplements
- • Life-threatening blood pressure drops
Phenolphthalein
Brand Name: None (withdrawn from market)
Chemical laxative
Approved Use:
Formerly used as laxative, now banned
Legal Status:
Banned from all products in the US
Found In:
Black Mamba Hyperrush
Health Risks:
- • Carcinogenic (cancer-causing)
- • Not approved for any use in United States
- • Long-term cancer risk with exposure
Warning: The Same Drugs Are Sold Openly Online
The prescription drugs found hidden in honey packs — particularly tadalafil and sildenafil — are openly sold by grey-market online pharmacies. Vendors like ModafinilXL, ModaWhale, and others sell tadalafil alongside nootropics like modafinil to consumers worldwide, often without prescriptions.
This is critical context: when you consume a honey pack containing hidden tadalafil, you are unknowingly taking the same pharmaceutical sold on unregulated online markets — but without knowing the dose, purity, or potential interactions with other medications you may be taking.
Key Risks of Hidden Pharmaceuticals in Honey Packs
- • Unknown dosage — lab tests show tadalafil levels in honey packs vary wildly, sometimes exceeding prescription strength
- • No medical screening — tadalafil is contraindicated with nitrates (heart medications) and can cause dangerous blood pressure drops
- • No quality control — unlike even grey-market pharmacies, honey pack manufacturers face zero oversight
- • Combination danger — honey packs often contain multiple hidden drugs simultaneously
FDA-Approved Safer Alternatives
Why Choose FDA-Approved Medications?
- • Known, controlled dosage - no surprises
- • Medical screening to identify contraindications
- • Ongoing monitoring by healthcare provider
- • Quality control and manufacturing standards
- • Clear instructions and side effect information
- • No risk of counterfeit or contaminated products
Prescription Options
Sildenafil (Viagra)
Prescription PDE-5 Inhibitor
Dosages
25mg, 50mg, 100mg
Duration
4-6 hours
Onset
30-60 minutes
Most studied ED medication. Generic versions available. Requires prescription and medical screening.
Tadalafil (Cialis)
Prescription PDE-5 Inhibitor
Dosages
2.5mg, 5mg, 10mg, 20mg
Duration
Up to 36 hours
Onset
30-60 minutes
Longer duration than sildenafil. Daily low-dose option available. Generic versions available.
Vardenafil (Levitra, Staxyn)
Prescription PDE-5 Inhibitor
Dosages
5mg, 10mg, 20mg
Duration
4-5 hours
Onset
30-60 minutes
Similar to sildenafil. May work when sildenafil doesn't. Requires prescription.
Avanafil (Stendra)
Prescription PDE-5 Inhibitor
Dosages
50mg, 100mg, 200mg
Duration
4-6 hours
Onset
15-30 minutes
Fastest onset. Fewer side effects reported. Requires prescription.
How to Access Safely
Primary Care Physician
Schedule appointment to discuss erectile dysfunction. Doctor will screen for underlying conditions and medication interactions.
Pros:
- + Comprehensive health screening
- + Ongoing medical supervision
- + Insurance may cover
Cons:
- - Requires in-person visit
- - May feel uncomfortable
Telehealth Services
Online consultation with licensed physicians. Prescription sent to pharmacy if appropriate.
Pros:
- + Convenient
- + Privacy
- + Fast
Cons:
- - May not be covered by insurance
- - Limited physical examination
Examples:
Hims, Roman, BlueChew, Lemonaid Health
Urologist
Specialist in male reproductive health and urinary issues.
Pros:
- + Expert evaluation
- + Can diagnose underlying conditions
- + Comprehensive treatment options
Cons:
- - May require referral
- - Longer wait times
Non-Pharmacological Approaches
Lifestyle Modifications
- • Regular aerobic exercise (30 min, 5 days/week)
- • Healthy diet and weight management
- • Stress reduction techniques
- • Adequate sleep (7-9 hours/night)
- • Smoking cessation
- • Moderate alcohol consumption
- • Blood sugar control (diabetes management)
- • Blood pressure control
Counseling/Therapy
- • Sex therapy
- • Couples counseling
- • Cognitive behavioral therapy for performance anxiety
- • Treatment for depression or anxiety
Medical Devices
- • Vacuum erection devices (FDA-approved)
- • Penile injections (under medical supervision)
- • Penile implants (surgical option)
Report Adverse Events to FDA MedWatch
Your reports help the FDA identify safety signals and take regulatory action to protect public health.
Online
FDA MedWatch →Phone
1-800-FDA-1088
Fax
1-800-FDA-0178
Who Can Report
Consumers, Patients, Healthcare professionals, Caregivers