Sexual enhancement supplements – like those reportedly taken by Lamar Odom before he collapsed at a Nevada brothel – are often spiked with powerful and hidden pharmaceuticals, despite labels claiming they only contain herbs and other natural ingredients, experts and regulators have warned for years.

Odom took cocaine and as many as 10 sexual–performance supplement pills leading up to his hospitalization in Las Vegas, according to a 911 call released Wednesday by the Nye County Sheriff’s Department. The product he took was “Reload; 72-hour strong; sexual performance enhancer for men,” two employees of the Love Ranch said on the 911 call.

In 2013, the FDA issued a public warning that consumers should not purchase or use a supplement called Reload because tests found it contains sildenafil, the active ingredient in the prescription erectile dysfunction drug Viagra. The undeclared ingredient may dangerously interact with other drugs, especially nitrates often taken by men with diabetes, high blood pressure or heart disease, the FDA warned.

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