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For men, choices beyond Viagra

September 01, 2003|Jane E. Allen | Times Staff Writer

The little blue pill that revolutionized impotence treatment now has some competition.

Levitra, approved by the Food and Drug Administration last month, can work in as little as 20 minutes, compared with about 40 for Viagra. And unlike its famous predecessor, the orange tablet can be taken with fatty foods.

"Everybody who tried Viagra and wasn't happy with it is going to try this," said Dr. Stephen M. Auerbach, a Newport Beach urologist who specializes in male sexual dysfunction.

Levitra is the first in a growing array of Viagra alternatives. Another pill, whose effects last 36 hours, could be approved by year's end. A nasal spray, a topical cream and a pill that dissolves under the tongue also are in the pipeline and could be available in two to three years.

For The Record
Los Angeles Times Thursday September 04, 2003 Home Edition Main News Part A Page 2 National Desk 1 inches; 36 words Type of Material: Correction
Impotence drugs -- In a story on impotence treatments in Monday's Health section, the name of an alpha blocker drug that should not be taken with some impotence pills was misspelled. It is Hytrin, not Hydrin.
For The Record
Los Angeles Times Friday September 05, 2003 Home Edition Main News Part A Page 2 National Desk 3 inches; 122 words Type of Material: Correction
Impotence treatments -- An article in Monday's Health section about treatments for impotence said that a new drug, Levitra, could be effective as quickly as 20 minutes after it was taken, compared with about 40 minutes for Viagra. However, that comparison was misleading because the figure for Viagra was an average. The quickest that the drugs have worked, according to manufacturer-sponsored studies, is 16 minutes for Levitra and 14 minutes for Viagra. Urologists say that both drugs generally are effective in 30 to 60 minutes. The article also said that although Viagra could not be taken with fatty foods, there were no similar restrictions for Levitra. Levitra can be taken with meals, but very high-fat meals might affect its effectiveness as well.
For The Record
Los Angeles Times Monday September 08, 2003 Home Edition Health Part F Page 10 Features Desk 4 inches; 147 words Type of Material: Correction
Impotence treatments -- A story in last Monday's Health section about treatments for impotence said that a new drug, Levitra, can be effective as quickly as 20 minutes after it is taken, compared with about 40 minutes for Viagra.
However, that comparison is misleading because the figure for Viagra is an average. The quickest the drugs have worked, according to manufacturer-sponsored studies, is 16 minutes for Levitra and 14 minutes for Viagra. Urologists say that both drugs generally are effective within 30 to 60 minutes.
The story also said that although Viagra cannot be taken with fatty foods, there are no similar restrictions for Levitra. Levitra can be taken with meals, but very high-fat meals might affect its effectiveness as well.
The story also misspelled the name of a hypertension drug that should not be taken with some impotence pills. The correct spelling is Hytrin, not Hydrin.

These new, noninvasive approaches have developed relatively quickly -- over the last few years. Not long ago, men were often too embarrassed to seek treatment for erectile dysfunction and, even when they did, their only options were injections, vacuum pumps and implants.

Viagra changed that. For the first time, men had a treatment that was easy, painless and discreet -- one that only took effect when they were aroused, making sex more spontaneous. The massive marketing campaign brought impotence out of the shadows. Men became more willing to discuss the problem with their doctors and try the pill. And try it they did. Pfizer Inc. sells $1.7 billion worth of Viagra each year worldwide; $1 billion of it in the United States.

"For a guy, our whole self-image is brought up around our erections," said Auerbach. "We may not be the studs we used to be, but in our brain we are."

Impotence has many causes, such as vascular problems from high blood pressure, diabetes and cardiovascular disease; neurological problems stemming from surgery, spinal injuries or diseases; psychological problems such as depression and anxiety; and medication side effects.

Although Viagra can work no matter what the cause, it doesn't help all men. Its effectiveness is about 70% overall and it works best for men with mild to moderate impotence.

Some men for whom it might work don't give the drug a second chance after a disappointing experience. Some are put off by having to take it on an empty stomach.

Levitra and its followers aim to pick up where Viagra left off.

Manufactured by Bayer and marketed by GlaxoSmithKline, Levitra was approved by the FDA on Aug. 19. It belongs to the same class of medication as Viagra (sildenafil), and both work for several hours. A third drug in that same class, Cialis (tadalafil), promises the longest-lasting effects: up to 36 hours, offering the most spontaneity of any treatment. Eli Lilly & Co. and Icos Corp., which already sell Cialis in Europe, are hoping for FDA go-ahead by year's end.

All three pills improve blood flow to the penis by blocking an enzyme called phosphodiesterase 5 or PDE5. But the speed at which they take effect and how long the effects last varies. With any of them, Auerbach said, "some people react very quickly, some react in an hour."

Although the impotence pills could work for the vast majority of men with erection problems, they're not for everyone. Levitra, Viagra and Cialis shouldn't be used by men who take nitrate-containing heart medications, such as nitroglycerin, or alpha blockers for high blood pressure and enlarged prostates, such as Hydrin, Cardura or Flomax, because the combinations can make blood pressure plunge and cause fainting. (Auerbach said patients on alpha blockers might be able to use Viagra if they wait four hours between medications.)

Of the 30 million American men estimated to have at least occasional problems getting and sustaining an erection, only about 10% seek treatment. But the publicity that Viagra and Levitra have garnered -- and that expected for the future options -- may encourage more men to acknowledge the problem and be treated, rather than give up on the possibility of reviving their sex life.

Just as former Senate Majority Leader Bob Dole (R-Kansas) and baseball player Rafael Palmeiro spoke out about erectile dysfunction and in the process helped make Pfizer's diamond-shaped Viagra pill nearly as well-known as aspirin and heartburn drugs, the makers of Levitra hope that former NFL coach Mike Ditka can appeal to regular guys and further destigmatize the problem.

Viagra also has shifted impotence treatment from urologists to family practitioners and internists, who probably will be the biggest prescribers of the newer therapies, said Dr. Jacob Rajfer, a UCLA urologist whose research into the biochemistry of erections led to the development of Viagra. Levitra's side effects, like those of Viagra, include headaches and flushing. It also may cause nasal congestion, while Viagra can cause indigestion and visual disturbances such as blurriness, sensitivity to light or blue-tinged vision.

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