The Virginia Department of Health said this week that 11 men have fallen ill in recent weeks after purchasing a male sexual enhancement product called V8 from convenience stores and gas stations.

Six of the men live in Southwest Virginia. The Health Department said the first cluster occurred in Richmond in mid-August, when three people required emergency care after experiencing severe hypoglycemia, or very low blood sugar.

Severe hypoglycemia symptoms include sweating, a racing heartbeat, irritability, anxiety, shakiness and altered mental status, the department said. Anyone experiencing those symptoms should seek immediate treatment.

The Health Department said the Virginia Department of Agriculture and Consumer Services issued a news release at that time advising consumers not to purchase or use V8, but since then similar illnesses have been reported across the state.

As of Monday, one case had been reported in the eastern region, four in the central region and six in the southwest region. The Health Department said it has confirmed seven of the cases and four are under investigation. All those sickened have recovered with medical treatment.

The Health Department’s news release said that preliminary laboratory analysis identified several compounds in the pills that could result in severe hypoglycemia, and that the U.S. Food and Drug Administration has reported an emerging trend of over-the-counter products containing hidden active ingredients that are harmful.

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