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A sexual marathon in a bottle

November 26, 2003
Carey Hamilton
The Salt Lake Tribune

Men who suffer from impotence no longer have to spend as much time planning their love life around a pill. Instead, they could take a drug that leaves them in the mood and ready to roll for up to a day and a half.

The Food and Drug Administration recently approved the sale of Cialis -- the latest prescription for erectile dysfunction. The drug, made by Eli Lilly & Co., will compete with Viagra, which hit the market in 1998, and Levitra, which was approved in August by the FDA.

In studies, Cialis was found to work quicker and stay longer in the body -- up to 36 hours -- than Viagra. In France, where the drug has been available for some time, Cialis is referred to as "Le weekend" pill.

Levitra is said to start working within 15 minutes, faster than the one hour recommended for Viagra.

"The greatest potential benefit for Cialis is it offers more spontaneity," said Steve Gange, a urologist at Western Urological Clinic in Holladay. "The other two drugs are great, and I'm not going to bash them. But you might have to plan at dinner to take the pill to have intercourse at bedtime."

Up to 30 million men have some trouble repeatedly achieving or sustaining an erection firm enough for sexual intercourse, the National Institutes of Health reports on its Web site.

In 1985, for every 1,000 men in the United States who went to the doctor, 7.7 of those visits were for erectile dysfunction, according to the National Ambulatory Medical Care Survey. By 1999, that rate had nearly tripled to 22.3, largely because of the availability of Viagra and the wider acceptance of talking about impotence.

In most cases, erectile dysfunction is the result of physical injuries or defects, such as damage to nerves, arteries, smooth muscles and fibrous tissues, often as a result of disease, according to the National Institutes of Health. Some of those diseases include diabetes, kidney disease, chronic alcoholism, multiple sclerosis, vascular disease and neurologic disease. Between 35 percent and 50 percent of men with diabetes experience impotence.

Experts believe that psychological factors contribute to 10 percent to 20 percent of the cases.

The market certainly exists for drugs that treat impotency. Last year, Pfizer Inc. posted $1.7 billion in sales for Viagra.

The drugs are now part of pop-culture, fodder for jokes on late-night television and the cause celebre of professional athletes and folks like Bob Dole.

"We're talking about a huge population of people before these pills came out who didn't have much of a choice," Gange said. "Erectile dysfunction is a big hit to somebody. It ranks right up there with depression and diabetes. For a guy who can't perform, there's a lot of confidence that's drained."

Gange issued a caveat: Do not use any of the prescriptions before seeing a doctor.

"Don't just buy the drugs off the Internet," he said. "People need screening by a physician."

The drug is not recommended for patients on some heart medications, such as nitroglycerin tablets or some alpha blockers, because the combination can cause a sharp drop in blood pressure. This can cause fainting or even death in some men.

The most common reported side effects from clinical trials of Cialis were headache, indigestion, back pain, muscle aches and, go figure, flushing -- a sudden excitement or exhilaration.

The Associated Press contributed to this story.

Copyright © 2003, The Salt Lake Tribune