March 8, 2002
J. Francois Eid, MD, Weill Medical College of Cornell University and New York Presbyterian Hospital
Viagra has revolutionized the treatment of erectile dysfunction, but there are promising new drugs on the horizon that may work even better. Below, urologist and sexual function expert Dr. Francois Eid, talks about the ups and downs of Viagra, and the drugs we can expect to see on the market soon.
What are the benefits and the drawbacks of Viagra?
Of those who have used it, Viagra improved the erections of about two-thirds of men with erectile dysfunction. But it's not a perfect drug.
The most common side effects are headache, flushing of the face, stuffy nose and heartburn. About three percent of patients develop visual disturbances at 100 mg, the large dose. And some patients complain of a hypersensitivity to light or a bluish tinge to light. The side effects for most men are very mild, transient, and they're very well-tolerated.
Also, Viagra is absolutely contraindicated in patients who take nitrates. Nitrates is a class of medications that men who have coronary heart disease -- angina, blocked arteries to the heart -- need to take in order to help their chest pain.
What about the timing required to take Viagra?
You need to plan sex with Viagra. Sex is an activity that we like not to have to plan for. And with Viagra, you have to plan.
You also can't eat, because anything that you take that delays gastric emptying will decrease the efficacy of Viagra. So you can't eat any fatty food, or if you eat meat, it has to be a very light meal. And then you have to wait about an hour to an hour-and-a-half before you engage in sexual activity.
Can you drink alcohol with Viagra?
Alcohol will diminish a man's already diminished erectile function. So it's a little bit counterproductive.
Are there any other oral medications currently available that men can take for erectile dysfunction?
There are two medications that have actually completed clinical trials, and new drug applications have been filed with the FDA for each of these medications.
Which means that we may be seeing them on the market soon?
Yes. On June 28th of 2001, an application was filed for a drug called "Cialis." And that medication works in a similar fashion to Viagra, but it has some other properties. It is absorbed slightly faster, it can be taken with food -- which is a big plus, because sex can be spontaneous -- and it lasts longer in the bloodstream. The medication may stay in the bloodstream for about 34 hours. So that's one and a half days.
Is that a good thing?
Well, it's a good thing and a bad thing. It's a good thing because let's say you take it on a Friday and you want to have sex Saturday night, you don't need to take the medication again. Or you can have sex spontaneously.
However, let's say you get a side effect from the medication. Then you may experience side effects for longer.
What's the second drug being developed?
Vardenafil, which is also very similar to Viagra. It is active at lower doses, and targets the chemical that takes away erections a little more specifically than Viagra. Remember, the way these medications work is they block the enzyme that takes away an erection. So getting an erection for men taking these drugs still requires sexual stimulation and arousal.
But vardenafil may be a cleaner medication; it isn't associated with the same visual disturbances, for example.
Can these drugs treat all patients with erectile dysfunction? Is this enough of a choice?
We believe that these drugs will treat about two-thirds to 80% of men who suffer from erectile dysfunction. A third of patients who have severe endstage erectile dysfunction, will not respond to these medications, and these patients will require more advanced treatment options such as a penile prosthesis or an internal penile pump.
But these treatments are increasing awareness of the condition?
Every time there's a new treatment in the field of erectile dysfunction, more patients come into the treatment pool. Patients who have tried Viagra once and never wanted to try it again may want to try one of the new drugs. People who are satisfied with Viagra will want to come back and try the new drugs to compare. People who were afraid of Viagra will say, "Gee, you know, now there's a second drug on the market. Maybe it is safe after all. Let me try it."
Do you have any words of advice to a patient out there who has erectile dysfunction who maybe hasn't decided to actually seek treatment yet?
Well, the advice is, number one, get evaluated. Because really, erectile dysfunction is a sign of an underlying disorder, which can be more serious, such as high cholesterol levels, diabetes and so forth.
Number two, you can be successfully treated in 2002. There isn't a man that we cannot treat. Go to a qualified urologist and get checked out.
Penile Pumps: Who Can Benefit?
What to Expect From a Penile Pump Implant
Penile Pump Implants: A Long-Term Solution?
Erectile Dysfunction: Why Does it Happen?
Reclaiming Your Sexual Life: Treatment Strategies for Erectile Dysfunction
Copyright 2002 Healthology, Inc