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Viagra News and Research Information
For the latest information on Viagra including articles and other Viagra news simply click on the title of interest listed below:
Watson, Russell; Moreau, Ron; Nagorski, Andrew; Dennis, Mark; Reno, Jamie; Mehta, Avani The Globe Is Gaga for Viagra. Newsweek v131, n25 (June 22, 1998):44.
Around the world, approved or not, the little blue pin is a social phenomenon: the hottest new drug in history. Is this a good thing? By now, Viagra is a global phenomenon. the blue, diamond-shaped pill made by Pfizer Inc. is the hottest new drug in history almost everywhere in the world, including many countries where it's not yet legal for sale (map). Not since "sputnik" has a new word entered so many languages so quickly. In Mexico, humorists say Viagra means "the old lady is grateful," from the words vieja and agradecida. In Italy, enterprising marketers have come up with nonmedicinal "pizza Viagra" (topped with hot chili peppers), "gelati Viagra" (a blue ice cream that tastes like vanilla) and "formaggio Viagra" (a disappointingly soft cheese). The news media are full of glowing, if unscientific, endorsements.
Brazilian columnist Paulo Sant'Ana, a 58-year-old grandfather, took the pill on two occasions and described the results as "incessant, pleasurable" and so long-lasting that he stopped making love only when his partner begged for a rest. "Viagra won't let you down," he says. Former Italian soccer player Stefano Tacconi, 41, said the pill produced a duration of "twice as long as usual." But he said he wouldn't use the drug again because it takes the "poetry" out of sex.
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Computer users click onto Web sites like www.on-linepharmacyuk.com where Viagra is "this month's special." In just a few minutes they can safely buy Viagra online at significantly reduced prices. Desperate, horny or merely curious, millions of men around the world are redrawing the romantic road map, hoping to find a pharmaceutical fountain of youth. The German tabloid Bild predicts that Viagra "can set off a sexual revolution, just like the anti-baby pill did 30 years ago.' The implicit promise of Viagra--one not endorsed by its manufacturer--is good sex for all old or young gay or straight, male or female. "Henceforth the world will move for everyone," novelist Howard Jacobson writes in Britain's Evening Standard. Maybe not. There are relatively few risks to buying Viagra, especially without a prescription and a medical exam. Pfizer says the drug is safe when used by the clinically impotent patients for whom it was intended. The blue pill is not an aphrodisiac. It increases the flow of blood to the genitals, causing or sustaining a male erection. But that's not a guarantee of great sex. "The magic bullet is no substitute for romance," says Dr. Leung Ying-kit, a sexologist who hosts a radio talk show in Hong Kong. "A poor lover plus Viagra does not make a good lover, but merely a poor lover with a long erection."
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To give its customers a shot at the real thing, a travel agency in Japan offers Viagra Tours to Guam or Hawaii, where the drug can be purchased legally. A three-night trip to Hawaii costs $1,379, including a doctor's exam and two bottles of Viagra. So far, 25 Japanese men, mostly in their 50s, have taken the trip. Traffic is brisker across North American borders. Canadian men. who still can't buy the drug at home, are slipping across their southern frontier to shop for Viagra. "You could call it Vermont's No. 1 export," a urologist in Colchester told a reporter. Although the sale of Viagra has been approved in Mexico, druggists in cities like Tijuana still cut corners. When a NEWSWEEK reporter visited more than two dozen pharmacies there last week, only five of them demanded the prescription required by law. "You need a prescription, but we don't make you show it to us," said one druggist. Pills made by Pfizer in Mexico were sold for $11.50 each; stronger pills made in the United States were available in some places, illegally, for $18 apiece. Pharmacists say Viagra is more popular with foreign visitors than with Mexicans. "There is a pride factor among Mexican gentlemen who come to me for Viagra," says Dr. Eduardo Partida, a Tijuana physician. "They don't want to admit, many of them, that they have any sexual problems. Many of them tell me they are coming in for a friend or a relative." Viagra may not solve all of their sexual problems; lovemaking is more complicated than just achieving an erection. But on this Big Blue Planet, that's not a message that is likely to sink in with millions of eager Viagra men.
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Maclean Hunter 'A MAN AGAIN': Experts Praise a Pill That Treats Impotence. (the use of the Viagra, an impotence drug) Maclean's v111, n18 (May 4, 1998):58
In December, 1994, Lorne had just turned 40 and life was good. Married, he had two young children, a house near Vancouver and a job he enjoyed. Then disaster struck: as he changed a tire on his car beside a roadway, another automobile hit him. Though Lorne can walk and is about to go back to work, the accident damaged spinal nerves and left him with enduring problems, including numbness in some parts of his body and distressing limits on his sex life due to difficulties having and maintaining erections. "It was depressing," he recalls, "when my wife was in the mood for sex and I just wasn't interested." Doctors suggested remedies involving pumps and injections, but Lorne was not interested in them. Then, he had the opportunity to take part in clinical trials for a new drug called Viagra that is designed to deal with problems like his. In December, 1996, Lorne began popping a sky-blue tablet whenever sex was in the offing. Once again, his life was transformed. "Sex is as good as it used to be-maybe even a little better," he says. "Viagra is just fantastic."
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Thousands of European men appear to agree. Since Viagra was approved for sale in the Europe, demand has soared to the point that physicians are scribbling an estimated 40,000 prescriptions a day. Manufactured by New York City-based Pfizer Inc., Viagra-which has yet to be cleared for general use in Canada-can apparently restore virility in about 80 per cent of men who have problems, with only minor side-effects including headaches and indigestion. "This isn't just another drug, it's the drug-the magic bullet we've been waiting for," says Dr. Sidney Radomski, a urologist at The Toronto Hospital, one of 27 Canadian centres that took part in the clinical testing of Viagra. "It's going to revolutionize the treatment of impotence."
Pfizer developed Viagra after researchers testing a drug for angina found that it triggered erections in men. Now, it seems destined to largely replace existing treatments which-though effective-cause many men to recoil in horror. The most popular method requires a man who expects to have sex to use a needle to inject an erection-causing drug into the side of his penis. Another involves using a vacuum pump to draw blood into the penis to create an erection, then placing rubber bands around the base of the organ to keep it erect. "It was such a performance," says one middle-aged Viagra user, who lives near Washington. Those methods, he adds, "undermined erotic moments by taking the spontaneity out of sex."
Unlike older treatments, which can leave men with erections that last for hours if sex does not occur, Viagra only becomes effective when a man is sexually aroused. The drug works by blocking the operation of an enzyme that normally breaks down a chemical-cyclic GMP-that plays a key role in maintaining erections. Even though Viagra-assisted erections subside after intercourse, some men report that the drug can remain effective for up to 24 hours. "It means that when they have a sexual thought during the day, they feel a physical response," says Dr. Rosemary Basson, a sexual medicine specialist at The Vancouver Hospital, who has prescribed the drug to 20 men as part of a long-term study. "That says, OK, you're a man again. It's tremendously important to them."
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While experts estimate that about three million Canadians, including perhaps half of all men over 65, have potency problems, many doctors say the real number is unknown because so many males are unwilling to discuss the issue, even with their doctors. That may be changing. "Some patients who never told me they had a problem are asking about Viagra," says Toronto physician James Brooks. "Now that they think they won't have to mess around with pumps or needles, they're coming out of the closet."
For all its early promise, experts caution that Viagra's long-term effects are not yet known. Moreover, the drug will not be a panacea for every man who suffers from penile dysfunction-the medical term that covers a wide range of potency problems. But for those who experience physical arousal but still have performance problems, says Heaton, "Viagra is going to be just great"-a judgment that Lorne and other early users of the drug wholeheartedly endorse.
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Greenwald, John Drug Quest: Magic Bullets for Boomers. (success of Viagra and other lifestyle-enhancing drugs) Time v151, n17 (May 4, 1998):54 (2 pages).
Baby boomers who want to stay young forever--and who desires anything less these days?--are giving the pharmaceutical industry something that very few consumer-products makers have: a growing, demand-driven market. European companies will spend more than $20 billion this year to develop pills and potions for everything from wrinkles and baldness to the prevention of strokes and heart attacks. More boomer selfishness? Maybe not. If science insists on getting more mileage out of the engine and prolonging our lives--thus allowing us to work into our 70s--what's wrong with maintaining the chrome and fenders? "We expect medicine to deliver that," says Susan Coleman, president of NCI Consulting, adviser to drug companies.
The payoff can be awesome: 79 million boomers have begun to turn 50 at the rate of one every eight seconds or so. That's why this $300 billion industry is the most profitable segment of the FORTUNE 500. Pfizer's impotence pill, Viagra, already the hottest new drug launch ever, could reach $2 billion in sales by the year 2000. Delirious investors pushed Pfizer's stock from about $45 a share a year ago to $118.25 last week.
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Although Viagra is a kind of lucky accident--its application to impotence was discovered in 1992 during research on heart medications--chairman William Steere realized the significance of such drugs in the marketplace. Says Steere: "It occurred to me at the time that with the aging baby boomers, quality of life is going to become very important." Indeed, Steere has practically repositioned the company to deliver better living through chemistry. Last year sales hit $12.5 billion, and profits reached $2.2 billion.
Today the industry as a whole is feverishly developing silver bullets for boomers that, like Viagra, seek to rewrite the physical and mental decline genetically programmed into each of us. Among the latest life-style-enhancing remedies:
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LET THEM EAT CAKE Lipitor, a cholesterol fighter developed by Warner-Lambert and marketed with Pfizer, roared out of the chute last year, the only Rx rookie to rack up $1 billion in first-year sales. Lipitor lowers cholesterol--and by extension the risk of heart attacks--by interfering with an enzyme that the liver uses to make cholesterol. Analysts expect sales to top $3 billion by 2000.
GOOD HAIR DAYS with as many as 50% of the European men who are 50 or older scratching their heads over male-pattern baldness, Propecia, made by Merck (1997 sales: $23.6 billion), is the first pill that aims to grow back hair. The company says some 90% of the men who took Propecia in clinical trials sprouted natural-looking hair. For more information concerning buying Propecia online (click here).
LOOK GOOD, FEEL GOOD Bristol-Myers Squibb is testing a remedy designed to fade skin blotches caused by exposure to the sun. The company is awaiting final approval. Johnson & Johnson has clinical proof that a substance called Renova can reduce wrinkles. Renova is based on tretinoin, derived from vitamin A.
SLEEP ALL NIGHT The ability to sleep soundly decreases with age. Sonata, which American Home Product's pharmaceutical unit Wyeth-Ayerst hopes to launch next year, is designed to induce sleep without producing a groggy feeling the next morning. "There is a tremendous issue in sleep disturbance," says consultant Coleman. "So when we get a product that people have utter confidence in, that will be a gold mine for someone."
MEDICAL MIRACLE? Perhaps the most striking of all recent drug news were reports that Evista, Eli Lilly's new osteoporosis medicine, could also be effective in preventing heart disease and breast cancer in older women. Clinical trials of the drug's ability to stave off heart attacks begins in May, with testing of the impact on breast cancer to start later this year. The implications could be huge for Lilly. Carl Seiden, an analyst who follows the drug industry for J.P. Morgan Securities, says sales of Evista as an osteoporosis remedy alone could approach $2 billion by 2002.
COMFORT AND CONFIDENCE Incontinence affects an estimated 17 million Europeans, but only some 20% seek help. Women are the most frequent sufferers because the condition is often linked to menopause. Pharmacia & Upjohn is rolling out a bladder-control drug called Detrol this spring. The pill is the first such medication to win federal approval in more than 20 years.
The drug companies aren't the only ones that will benefit from boomer products. The industry will spend more than $1 billion this year selling its new remedies. The pitches may have the familiar ring of youth-in-a-bottle advertising. Only this time, the stuff will really work.
Apgar, Barbara Use of Sildenafil as Treatment for Erectile Dysfunction. (Tips from Other Journals) Family Physician v58, n2 (August, 1998):499 (2 pages).
Viagra is the first oral drug approved, for treatment of erectile dysfunction. Although other drugs have been on the market for some time, they have met with mixed success because of the need for injection or insertion into the urethra. Viagra enhances the physiologic response that causes penile erection after sexual arousal. It inhibits the enzyme conversion that produces the contraction of the smooth muscle of the corpus cavernosum, allowing engorgement to be maintained. Medical Letter consultants reviewed the data on this drug. Viagra significantly enhances erections, Viagra could be the most popular medication of the decade.
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Plasma concentrations of Viagra reach a peak in about one hour. A fatty meal delays the peak by about one hour and decreases the peak concentration without affecting total absorption. The drug is actively metabolized in the liver and is excreted largely as metabolites in the stool. Both the parent drug and the active metabolite have a half-life of about four hours. In men older than 65 years and in men with hepatic or severe renal insufficiency, clearance is slower.
Only one published study of Viagra using objective measurements has been conducted. Plethysmographic measurements were obtained in 12 men with erectile dysfunction in a randomized, controlled crossover study. The mean duration of erections was about one minute with placebo, four minutes with 10 mg of Viagra, about eight minutes with 25 mg and eight to 11 minutes with 50 mg of active drug. The men were instructed to record erectile activity after taking 25 mg of Viagra or placebo once daily for seven days. The number of erections within two hours after taking Viagra was about five times greater with the active drug than with placebo (sugar pill).
Other unpublished studies evaluated men with erectile dysfunction who took 25, 50 or 100 mg of Viagra or placebo at home for up to six months. The drug did not affect the frequency of attempted intercourse. However, in four fixed-dose trials, improvement in erections was reported by 63 percent of the 214 men taking 25 mg of Viagra, 74 percent of the 391 men taking 50 mg and 82 percent of the 380 men taking 100 mg of the drug. Twenty-four percent of the 463 men taking placebo experienced improvement in erectile functioning. The effect was detectable as soon as 30 minutes after taking the drug and lasted up to four hours. Some men also reported increased erectile functioning the next day. Forty-three percent of men with radical prostatectomy reported improvement in erections after taking Viagra compared with 15 percent after taking placebo.
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Viagra lowers blood pressure slightly in normal patients and substantially in patients who are undergoing nitrate therapy for angina. The most common side effects are headache, flushing and dyspepsia. Transient abnormal vision, usually a color tinge or increased sensitivity to light, is uncommon and is usually dose-related. No incidence of priapism has been reported. Viagra should be used cautiously in patients taking cimetidine, erythromycin, rifampin and ketoconazole.
Viagra is available in 25-, 50- and 100mg tablets. The manufacturer recommends an initial dosage of 50 mg (which can be increased to 100 mg if necessary) taken one hour before intercourse. Patients older than 65 years of age, those with hepatic or renal dysfunction and those who are taking a CYP3A4 inhibitor should start with a 25-mg dosage. Viagra should not be taken more than once a day.
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Medical Letter consultants conclude that Viagra appears to be an effective oral drug for treatment of erectile dysfunction, although not all patients respond, and long-term safety has not been established. The hypotensive effects may be troublesome in some patients; persons using nitrates for treatment of angina should not take Viagra.
Medical Letter consultants. Viagra: an oral drug for impotence. Med Lett Drugs Ther May 8, 1998;40 (1026):51-2.
Henderson Charles Viagra Used Recreationally on British Club Scene. Impotence & Male Health Weekly Plus (March 8, 1999).
Viagra is being used by young people in British nightclubs in potentially lethal combination with cocaine, Ecstasy, and other illegal drugs, researchers said.
"The recreational use of Viagra by apparently healthy women and men is now occurring in Britain," Judith Aldridge and Fiona Measham, senior researchers at the University of Manchester, said in a letter posted on The British Medical Journal Internet site.
Aldridge and Measham interviewed young adults at nightclubs in northern England within weeks of the launch of the drug in Britain in 1998. Customers and staff said the triangular blue pills made by the U.S. pharmaceutical company Pfizer were readily available for 12 pounds (US$18) for a 50 mg tablet. Most of the men and women who admitted taking Viagra used it simultaneously with other drugs and alcohol.
"Of particular concern is the combination use of Viagra with amyl nitrite ('poppers'), both of which dilate blood vessels, and can result in a dangerous drop in blood pressure potentially causing heart attack or stroke," the researchers said.
All of the people who admitted using Viagra reported positive effects: enhanced sexual desire and lovemaking, and feelings of warmth. They got the drug from friends, partners, dealers, sex shops, or via the Internet.
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Ironically, the drug is not as freely available for many impotent men who need it. Fearful that demand could bankrupt the country's government-funded National Health Service (NHS), Health Secretary Frank Dobson issued proposals suggesting Viagra should only be prescribed in the NHS system for men whose impotence is caused by a physical condition.
The move infuriated doctors who said the policy was unacceptable and unethical. The British Medical Association advised doctors to defy the government and prescribe the drug to patients who would benefit from it.
Earlier in 1999, a British urologist warned that misuse of Viagra as an aphrodisiac to improve sexual performance could cause prolonged erections that could lead to permanent impotence.
Comarow, Avery Viagra Tale: how one man sought an impotence cure - and found one. U.S. News & World Report v124, n17 (May 4, 1998):64 (3 pages).How one man sought an impotence cure--and found one.
This is a report from Viagra's front lines. It is from a married man in his early 50s--a friend of this writer who has tried out Pfizer's new impotence drug. Call him X; he does not want his name used. And call him grateful; Viagra worked for him. Is it a wonder drug? The 75,000 prescriptions written for Viagra in the first two weeks after it came to market in late March suggest that many hope it could be--and the potential market numbers as many as 30 million European men, a significant share in their 40s or even younger.
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Mechanically, an erection must accomplish two goals. Blood must flow vigorously into three parts of the penis stuffed with erectile tissue that absorbs the blood like a sponge. And the muscles in the penis and the valves in the veins leading away must keep the blood from leaking out. When a patient complains about impotence, a physician first looks for a history of diabetes or cardiovascular problems, because the circulation disorders that often accompany these conditions can interfere with an erection.
Candor difficulties. X, who has been married about 30 years, began experiencing erectile dysfunction--now the preferred medical term for impotence--about four years ago. He could achieve an erection but could sustain it less and less often. Seeking medical advice didn't help. During a physical exam, the internist posed his usual inquiry about personal problems. "I said something like, 'Well, I've been having some sexual difficulties,' " says X. "He looked at me and made a note but didn't ask anything else, and I just dropped it. I got the impression that he really didn't want to discuss it, and I was self-conscious enough as it was." This conversation echoed an assertion by the National Institutes of Health, in a 1992 report on impotence, that "embarrassment of patients and the reluctance of both patients and health care providers to discuss sexual matters candidly contribute to under diagnosis."
The physician and patient had similar non conversations over the next couple of years. Meanwhile, X's ability to perform slipped from occasional to rare and, then, inexorably, never. X's relationship with his wife slowly chilled. "I felt as if we were work colleagues," says X. "We'd go places, we'd get done what we had to do around the house, but there was this huge, dark subject we wouldn't discuss."
Last February, X mustered the nerve to push his doctor. That won a referral to a urologist. Once the specialist learned of X's history of heart disease, he didn't bother with a physical examination. Nor did he think X needed specialized tests. "I am 99 percent certain that you've got a circulation problem," he informed X.
The doctor said X could try mechanical contrivances like a vacuum cuff or pump. Or he could have bendable rods surgically implanted. Or, using a small, fine needle, he could inject alprostadil, a drug that mimics a natural substance produced during sexual arousal, into the penis, to encourage blood flow. X did not care for any of these options.
Priapism warnings. His reaction was slightly less negative to the urologist's final proposal: a tiny alprostadil suppository placed about an inch into the opening of the penis with the aid of a special insertion device. Made by Vivus and called the MUSE system, it produces an erection 60 to 70 percent of the time, and X thought it seemed somewhat less onerous than the other methods.
Yet many men who try MUSE abandon it because of insertion discomfort; nearly one third did so in one large study. The urologist also warned of a small but real danger of priapism--a painful, ongoing erection that threatens permanent damage and must be treated at an emergency room. Too, the timing discourages spontaneity. The drug works five to 10 minutes after it is administered, during which time sitting, standing, or walking around is recommended to stimulate blood flow. And languid dallying is out; the effect wears off after 30 to 60 minutes.
"There's a pill coming out in six months, maybe less," the urologist told X. "Take the MUSE brochure. Look it over. See what you think. Maybe the thing to do is to wait for the pill. It's called Viagra."
The visit did warm up the atmosphere at home. Armed with the MUSE brochure, X was inspired to reveal to his wife that he had been seeking help. "She was touched," he says. "She thought I had stopped caring at all." While put off by the fussy MUSE procedure, she was willing to go along. But X was due for a follow-up talk with his internist. The couple put off the MUSE decision until then.
The internist, his interest now piqued, disagreed with the urologist. X's circulation was fine, he said. As X lay on the examining table, the internist pressed X's fingers to the femoral arteries in his groin. "A strong pulse, right?" The blood vessels to the penis branch off the femoral arteries, and good femoral circulation argues against poor blood flow to the penis.
The internist ordered up a testosterone blood test, and the results made him smile with satisfaction; the number was extremely low. A depressed level of the male sex hormone, pumped out by the testes under the control of the pituitary gland in the brain, does not automatically produce erectile dysfunction--men with low testosterone can have normal sexual function--but it might explain X's problem.
X met with an endocrinologist in early April, and left, for the first time, with hope. The hormone specialist took a detailed history, including a list of all of the medications X was taking. He examined X thoroughly, including a rectal check of the prostate gland. He was nonjudgmental, empathetic, and eager to answer X's questions.
Moreover, he was flexible. X's testosterone, he said, could be boosted either by injecting the hormone once every week or two or with a testosterone skin patch. But the shots would require frequent visits, or X or his wife would have to learn to give them.
X was aware that Viagra had come on the market the week before. Would it make sense to try the new drug before turning to supplementary testosterone? Sure, replied the endocrinologist, writing a prescription for 10 pills and asking X to report back. The most excruciating moment of his four-year ordeal, says X, was when he approached the pharmacy counter to pick up his prescription. The clerks at the pharmacy have a habit of repeating the name of the medication aloud to prevent mistakes. This time it didn't happen. X was grateful.
The night X and his wife put Viagra to the test taught them that the drug is not an aphrodisiac. It aids an erection but does not cause one. As is true in the absence of Viagra, stress or nerves play havoc with sexual response, the couple found. A more relaxed attitude allowed Viagra to do its work. The phone call to the endocrinologist would be effusive.
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Viagra facts. News Health writer Mary Brophy Marcus looked into these common questions about Viagra:
How does Viagra work?
It enhances the effect of nitric oxide. This chemical is released into the penis during sexual arousal and relaxes the organ's smooth muscle tissue so that blood flows in, producing an erection.
Will Viagra help me?
The success rate is about 70 percent. Problem candidates usually have conditions like poorly managed diabetes, blocked arteries, or long-standing high blood pressure.
How quickly does Viagra take effect?
It can take as long as an hour, but some men see results in 20 minutes. Most doctors start their patients on 50 milligrams of Viagra but may later alter the dose up to 100 milligrams or down to 25 milligrams. It may take four or five experiences using Viagra before you learn the dosage and timing that are best.
How long does the effect last?
Four to six hours, or until orgasm.
How often can I take it?
The approved dosage is no more than one pill a day. "I know some of my patients, couples who are high-powered Washington types, who when they finally get away for a weekend together and want to have some fun are probably going to take one in the morning and one at night. That most likely will not cause a problem," says a Washington urologist. It might increase the possibility of side effects, which occur in up to 10 percent of men.
Is Viagra good for women, too?
Jennifer Berman, a urologist at the University of Maryland Medical Center in Baltimore, believes there may be as many "impotent women" as men--women who do not enjoy sex because of poor lubrication and other physiological factors--and thinks Viagra could help. This summer Berman will help conduct a study in Boston. Preliminary results should be out within a year. Currently, Viagra is not recommended for women.
Can Viagra improve sex for men who aren't impotent?
Yes. Viagra does help to enhance erections to youthful levels.
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