Move over Viagra

// November 15th, 2010 // No Comments » // Impotence

Ever since sildenafil (Viagra, Pfizer) hit the market in 1998 as the first oral medication for erectile dysfunction (ED), people have been wondering, “What’s next?”

New data presented at a recent meeting of the European Association of Urology demonstrated strong results for two potential new treatments. Bayer AG presented promising data for its investigational phosphodiesterase (PDES) inhibitor, vardenafil, now in phase III studies. In an analysis of 580 patients, vardenafil improved erections in up to 80% of men, as well as increasing the ability to complete sexual intercourse with ejaculation.

In a separate study, vardenafil was found to be highly selective at targeting the PDE5 enzyme. PDE5 selectivity is of potential clinical importance because phosphodiesterases are widely distributed throughout the body, with PDE3, for example, playing an important role in cardiac contractility.

Lilly/ICOS unveiled compelling results for its next-generation PDE5 inhibitor, IC351 (Cialis). In a placebo-controlled phase III study in men with difficult-to-treat diabetes-related ED, up to 64% of men reported improved erections, compared with 25% for placebo.

In preclinical investigations, Cialis demonstrated an even higher affinity for the PDE enzyme than sildenafil did. Researchers saw no significant changes in clinical laboratory values, ECGs, or blood pressure in the phase III trial.

Fake viagra

// October 31st, 2010 // 1 Comment » // Impotence

Email Systems, a company that measures spam emails on the INTERNET, reports that in the first three months of 2005 two in five spam emails were offering drugs for sale. As the volume of spam is now almost 90 per cent of all email sent, that means one out of every three emails sent is offering you cut-price drugs over the net.

fake viagra

In September 2003, Dr Nic Wilson, a researcher at the University of London, announced to the British Pharmaceutical Conference in Manchester that she had been testing samples of internet-bought it accurately measures the ingredients in each tablet. The result was that half of the pills were lakes. ‘The user runs the risk of poor quality and possible toxicity, not to mention the fact that there is a high probability that the tablets have no clinical effect,’ she told her audience, who probably looked around the room to see who was blushing – Brits being the largest consumers of Viagra in Europe.
It’s comparatively easy to set up a Viagra factory, and some crooks have gone into the business in a big way: an example is 44-year-old Londoner Allen Valentine, convicted in November 2004 at Harrow Crown Court and sentenced to five and a half years in prison for supplying class C drugs. In effect, he was sentenced as if he had been supplying large amounts of cannabis.
His factory in Wembley was more than just a cement mixer: it could create 500,000 tablets a day. On the side, he was also making steroids and anti-stress medication, and a great deal of cash: the day before his arrest in April 2004. he had offered cash for a £1.25 million house and bought a new jeep.
Valentine knew how much people wanted Viagra – he was previously a rep for Viagra’s manufacturer, Pfizer.
The little blue pill is a common find for the drugs squads of Europe, the US and Asia. In January, £1 million of fake Viagra was found in an abandoned car outside Glasgow. ‘It is quite common to recover one or two thousand fake Viagra pills. They are usually found along with Class A drugs like cocaine, heroin and ecstasy,’ said Detective Sergeant Ken Simpson of Strathclyde Drugs Squad.
This is no cottage industry: Richard Widup recalls a case from his time at the FDA: ‘It was over the Christmas holidays 2002, in Southern California…  There were 700,000 counterfeit Viagra.

VIAGRA FOR MEN WITH PSYCHOGENIC IMPOTENCE

// October 30th, 2010 // No Comments » // Impotence

The man who has lost confidence in his ability to engage in sexual intercourse because of his preoccupation with his ability to acquire and then sustain an erection and has lapsed into the ritual of “spectatoring” whenever he attempts to make love is an ideal candidate for Viagra. His concerns regarding the durability of his erection can be put to rest if he is willing to wait for the Viagra to take effect. Then, with the caressing and genital stimulation of normal foreplay, his penis will become erect and will remain so until he has completed intercourse and ejaculated. If, however, he is impatient or brings to the bedroom the anxieties of past sexual failures, he will continue to have problems. In that case, coupling a dose of Viagra with the sensate focus exercises described should allow him to regain his lost self-assurance and enjoy sex once again.

WHO WILL PAY FOR FREE VIAGRA?

// October 29th, 2010 // No Comments » // Impotence

Free Viagra

Free Viagra

As soon as it became apparent that Viagra was effective and allowed sexually impaired men to enjoy sexual intercourse once again, there was an overwhelming lust for this new medication. Demand for Viagra skyrocketed, and within six months after it had been released and made available in drugstores, Viagra sales exceeded $5 hundred million. First-year projections were expected to top $1 billion, making Viagra the most successful drug ever launched in the history of medicine.

Shortly after Viagra was released, almost all managed-care organizations panicked and, perceiving Viagra as a threat to their bottom line, circled the wagons. Surely, they reasoned, a medication this effective will be sought after by every male and some females. If we, as insurers, allow reimbursement for this medication by anyone who wants it, we will surely suffer. So HMOs decided that they would either not pay for any, or severely restrict, the numbers of Viagra pills their subscribers could receive.Their tactics were simple.

Here is what happened with free Viagra

Before HMOs had any true sense of what the demand for Viagra would be, HMO executives in this country and the National Health Service in Great Britain projected what it would cost them to cover the cost of providing Viagra. When they calculated anticipated demand and multiplied this number by the wholesale per-pill cost, they choked.

Proclaiming everything from imminent fiscal doom to a need to raise premiums to keep up with demand, they blitzed the media. Dr. David Eddy, a prominent health-care economist, talked about making choices, and the choice he made, on behalf of Kaiser Foundation Health Plan, was not to provide this “sex pill” for any of Kaiser’s millions of male subscribers. Impotence was, he reasoned, not life-threatening, and therefore he felt under no obligation to provide this medication. Curiously, impotence was the only non-life-threatening health condition treated this way. Other “quality of life” non-life-threatening conditions like acne, for example, were still deemed important enough to be covered in Kaiser’s “comprehensive” care. Many health plans followed Kaiser’s lead, and at first neither Aetna US Health Care nor any of the Prudential health insurance plans were willing to cover the cost of a single Viagra tablet.

Different insurers proved to be less miserly and grudgingly agreed to cover the cost of Viagra, but only in limited quantity. Tufts Health Plan, a popular Massachusetts insurer, will pay for four Viagra tablets per month, figuring that no man in his right mind would want to have sexual intercourse more than once a week. Each health plan scrambled to cope, and within months after Viagra was available, all had settled on ways to “deal with the Viagra problem.” Strategies were hastily devised as each HMO crafted an individual policy on its willingness to pay for Free Viagra.

No other medication, including even the most expensive prescription products for lowering high cholesterol levels and any of the other erectile dysfunction treatments, has been so severely restricted. The limitations imposed on Viagra did not, at first, also apply to other approved impotence treatments like Caverject and MUSE. Many insurers even willingly covered the cost of vacuum devices if prescribed by a physician. Why then were HMOs so restrictive when it came to Viagra?

Free Viagra Cost.

Reasons may have differed for each insurer, but in the final analysis, it was not concern for their subscribers’ welfare but rather preoccupation with HMO profitability that compelled HMOs to either avoid paying for or severely restrict Viagra’s availability to their subscribers. Further, they found that they could trivialize the value of this medication by demonizing Viagra as a “sex drug” that would benefit only some sexually obsessed men. Finally, they maintained that Viagra’s cost would be a financial burden that would force HMOs to charge more for their annual health-care premiums. Threatening to raise the amount they would have to charge their subscribers, the HMOs were confident they could avoid a customer backlash.

All of this was played out in newspapers and on television news programs. Media watchdogs raised no objection and were perfectly willing to accept the HMOs’ explanation that drawing the line with Viagra was just another one of their clever cost-control maneuvers designed to squelch ever-escalating health-care expenses.

Then, when no one objected to their singling out male sexual problems as frivolous concerns, they learned that they could also limit their payments for all erectile dysfunction treatments. In Massachusetts, for example, Blue Cross will cover the cost of Viagra, MUSE, Caverject, or vacuum erection devices only if the patient’s private physician discloses intimate details of each man’s sexual inadequacies. Prying into patients’ lives to this degree is unique to the treatment of erectile dysfunction. In essence, HMOs had made the unilateral decision to single out one medical problem for derision and by so doing ignored the plight and rights of 30 million American men.

Doctors were appalled, patients bewildered, and they collectively contrived new strategies for providing Viagra to men with erectile dysfunction. Some men discovered that the pharmacies in large chain stores like WalMart and K-Mart were, for a while, selling Viagra for about $8.00 per pill rather than the $10.00-per-pill price that prevailed at large chain pharmacies. (The wholesale price to all was about $7.50 per pill.) Those who made this discovery passed the word on to their doctors, who, in turn, encouraged their patients to shop at the less expensive Viagra vendor. Some of my patients who were pleased with the results they achieved with Viagra did not want to limit their sexual activity to the once-a-week schedule ordained by their HMO, which would pay for only four Viagra tablets each month. So they requested two prescriptions, one for the four tablets that would be covered by their insurance and a second one for another four to six, which they would take to another pharmacy, paying cash for the additional pills. This gave these men and their partners the freedom to have sexual intercourse more often than was sanctioned by their HMO.

For a while, some insurers like Harvard Pilgrim Health Care (HPHC) were paying for a few Viagra tablets no matter what the dose. “Aha!” thought doctors prescribing Viagra. Now we can outwit the stingy HMOs. We know that most men can have erections and sexual intercourse after they take a 50-mg Viagra tablet. If we write a prescription for four 100-mg Viagra tablets and give the patient a pill splitter, we can effectively provide him with eight 50-mg doses, twice as much Viagra as the HMO is willing to pay for. For example, Harvard Pilgrim Health Care, one of the big insurers in the New England area, set out precisely those guidelines, indicating that it would cover the cost of four Viagra tablets per month. Doctors started writing prescriptions for “Viagra 100 mg, 4 tablets.” It did not take the HMOs long to discover the doctors’ subterfuge. Within a few months, HPHC had rewritten its guidelines to stipulate that it would only cover the cost of two Viagra pills each month.

The politics of Viagra is always in flux. For example, California-based Kaiser Foundation Health Plan, which had dug in its heels refusing to pay for any Viagra, was rebuked by the State of California and ordered to provide for this medication for its subscribers. Kaiser does not plan to appeal this decision, an unusually submissive response considering its strident opposition to providing this drug benefit in the past.

Viagra directions: TIPS ON USING VIAGRA FOR MAXIMUM BENEFIT AND MINIMAL RISK

// October 29th, 2010 // No Comments » // Impotence

Viagra directions

viagra directions

A Viagra tablet is not like an aspirin. If you have a headache and take two aspirin you will start to feel better within about twenty to thirty minutes. Viagra takes a little longer to work. A man planning to have sex should take his Viagra tablet about one hour earlier. Then enough Viagra will be in his system to work effectively. However, it would be unwise for a man to swallow a blue Viagra tablet at 8 P.M., then stare at the clock and have the sense that he must rush into the bedroom at precisely 9 P.M. before the effect of the Viagra wears off. We know now that the effect of this medication is first apparent within an hour, but Viagra continues to be effective for several more hours. Twenty-four hours later, it is almost completely washed out of a man’s system. The effectiveness of Viagra, with its rapid onset of action and prompt clearance from the body, has made this medication very useful for the treatment of men with erectile dysfunction.

WHAT DRUGS CAN AND CANNOT BE USED SAFELY WITH VIAGRA?

// October 29th, 2010 // No Comments » // Impotence

Some drugs classified as vasodilators, commonly used to treat symptoms of heart disease such as the chest pain of angina pectoris, tend to lower blood pressure. Medications like nitroglycerin and isosorbide are classified as nitrates. Because these medications, as well as some others known as alpha blockers like prazosin (Hytrin), lower blood pressure the same way that Viagra lowers blood pressure, the combined use of the two types of medications is discouraged. If blood pressure drops too much, as it may when the nitrates and Viagra are taken together, there is insufficient blood flow to the brain and in that case, a man will black out and faint. It is possible that other unfavorable drug interactions will be discovered in the future, but for the moment, it is the combined use of Viagra and nitrates that is most worrisome. This may create a hardship for millions of men with heart disease who have relied on nitrates to ward off or control the cardiac pain of angina pectoris.

PRESCRIPTIONS WITHOUT PROPER DIAGNOSIS

Men eager to get their hands on and doctors willing to prescribe Viagra may do so without pursuing the standard diagnostic evaluation accorded to all men with erectile dysfunction.

What has emerged is a worrisome phenomenon of prescribing without diagnosing. This has resulted in a sequence of events in which a man suffering from impotence or erectile dysfunction builds up the courage to discuss this with his doctor. The harried doctor hears the term “erectile dysfunction” and without either exam or diagnostic evaluation scribbles a prescription for Viagra and hustles the man out of his office. This all-too-common practice has allowed men with serious conditions such as pituitary tumors to go undiagnosed. This is an unfortunate consequence for men with prolactinsecreting pituitary tumors, where delay in diagnosis allows further pituitary tumor growth and poor prognosis.

The man with erectile dysfunction deserves something more than a prescription. Asking about standard medical history, conducting a physical exam, reviewing possible risk factors, and taking hormone measurements as outlined elsewhere in this book are essential procedures. Once the physician is confident there are no other sexual impediments such as depression, cigarette smoking, diabetes mellitus, low testosterone, or high prolactin levels and no cardiac history, then a prescription for Viagra is in order.

TAKING THE WORRY OUT OF SEX

// October 29th, 2010 // No Comments » // Impotence

There is a natural tendency to fret whenever new medications make it easier for men and women to have trouble-free sexual intercourse. Certainly when birth control pills became available, women who had previously shied away from intimate relations could feel more comfortable and less frightened about becoming pregnant. The birth control pills were introduced just before the 1960s sexual revolution and no doubt played a role in contributing to the sexual freedom and perhaps the promiscuity of that era. Women who took their birth control pills daily could and did engage in sexual intercourse more often than they had before the availability of this medication. However, other powerful forces were afoot shaping this turbulent decade, and the birth control pill is probably best viewed as a “facilitator” rather than an instigator of a more relaxed attitude toward sexual behavior. Not all medical advances that made it easier to have sex have had a comparable impact on sexual mores.

When penile prosthesis surgery was introduced a decade earlier, some worried that when impotent men were suddenly equipped with a device that allowed them to have an “on-demand” erection, their sexual behavior would change. They would no longer confine their sexual activities to the privacy of their bedroom but would be inclined to stray and seek out new and varied sexual partners. Some may have, but all of the currently available data indicate that the majority of impotent men who had penile prosthesis surgery were pleased to be able to have sexual intercourse again with their spouses alone.

WHY WAIT ONE HOUR AFTER TAKING VIAGRA BEFORE HAVING SEX?

// October 29th, 2010 // No Comments » // Impotence

Once the Viagra tablet is swallowed, the medication passes through the stomach and into the bloodstream. It takes about forty minutes to one hour before sufficient Viagra has built up in the body to be effective, but a man’s penis does not automatically become erect and stiffen at this time. Viagra works only in a setting of sexual stimulation such as the standard embraces and genital stimulation and caressing that is a normal component of healthy lovemaking. In this way, Viagra more closely mimics the normal pattern of sexual interaction between couples than does penile injection therapy, penile prosthesis, or MUSE.

PHILANDERING AFTER VIAGRA: FANTASY, FEARS, AND REALITY

The potentially dangerous interaction of Viagra with medications commonly used to treat heart conditions was anticipated, whereas the sudden empowerment of once impotent men with a new sense of sexual security was seen as a benefit, not as a threat. No one envisioned that anyone could interpret the availability of this new medication otherwise. Somebody did. What happened?

DOES VIAGRA WORK FOR EVERY IMPOTENT MAN?

// October 29th, 2010 // No Comments » // Impotence

While Viagra improves sexual function for men whose impotence is caused by a wide variety of physical and emotional problems, it does not work as well for every man every time. Much has been made of the fact that following his prostate cancer surgery, former senator Bob Dole participated in one of the early Viagra trials. He was so pleased with the result that he went on the Larry King Live show touting the benefits of this new medication for men with erectile dysfunction. Not all men who have had prostate cancer surgery do as well as former senator Dole. After prostate cancer surgery, less than 50 percent of Viagra-treated men are able to have sexual intercourse. This is especially true in men who have had the more aggressive prostate cancer surgery called radical retropubic prostatectomy (RRP), which cuts into neurovascular bundles vital for normal erectile function. Other coexistent medical problems such as diabetes mellitus and spinal-cord injury may also limit Viagra’s efficacy.

HOW WILL SILDENAFIL (VIAGRA) BE USED?

// October 27th, 2010 // No Comments » // Impotence

Once men with preexisting heart problems and those using nitrate medications are excluded, there remain millions of impotent men for whom Viagra treatment is both useful and appropriate. Those men should know how to use Viagra to achieve maximum benefit.

Men who have side effects such as light-headedness, dizziness, or headache at any dose are encouraged to “step down” and try a lower dose to minimize or eliminate these adverse effects. Some men who are able to tolerate the 50-mg dose but feel they have not had a fully satisfactory dose may do better on the higher 100-mg dose of sildenafil.