Tadalafil overdose following ingestion of aphrodisiac honey sold on the internet

A 26-year-old man consults in emergency unit for headache, back pain and persistent dyspnea several hours after ingesting a honey sold on the internet under the name "Kingdom Royal Honey VIP". This product of unknown origin is sold for its aphrodisiac proper-ties and described with a total natural composition. At the request of the Paris poison control center, a toxicological analysis of a product sample is carried out few days later. Targeted and non-targeted screenings by high resolution mass spectrometry are carried out on the "Kingdom Royal Honey VIP" product. Tadalafil, a molecule used in the treatment of erectile dysfunction, has been identified and estimated at 0.4% in the honey. These results do not confirm the inter -net descriptions of the product. Recently, tadalafil and several other related substances have been identified in aphrodisiac honeys sold on the internet, sometimes leading to serious clinical consequences. This case shows once again the danger of this type of products, which are often adulterated and may contain active substances without mentioning it. Toxicological analysis of the ingested product makes it possible to verify the adequacy between the composition entered and the actual composition, and to explain the patient clinical symptoms even few days after the intoxication.