Ben Stiller, left, and Robert De Niro costar in "Little Fockers." (Glen Wilson, Universal…)
Gaylord "Greg" Focker (Ben Stiller), a nurse in charge of a medical surgical unit at a hospital, is looking for extra income. He is approached by sexy pharmaceutical drug representative Andi Garcia (Jessica Alba), who offers him a gig as a spokesman for a new erectile dysfunction drug. She tells him the drug, Sustengo, is safe to use in heart patients because it includes a beta blocker that slows heart rate while the essential ingredient increases penile blood flow. Charmed by Andi, Greg agrees and is soon giving lectures. Meanwhile, Greg's father-in-law, Jack Byrnes (Robert De Niro), who has recently developed heart disease, is following Greg to make sure he isn't having an affair with Andi. When Jack discovers Sustengo, he tries it and develops an erection that lasts for more than four hours. At that point, Greg finds him and has to inject his penis with Adrenalin to counteract the drug. Finally, Andi becomes so frustrated by her failed efforts to seduce Greg that she takes Sustengo herself and tries to jump on top of him.
The medical questions
Would adding a beta blocker make an erectile dysfunction drug safe for patients with heart disease? Can ED drugs cause four-hour erections, and would those be reversed by injecting Adrenalin? Are drugs for ED effective for women?
Drugs in the Viagra class — including the fictitious Sustengo — are known as phosphodiesterase type 5 inhibitors. They work by relaxing blood vessels and increasing blood flow to the sponge-like corpus cavernosum of the penis, which fills with blood during an erection. The drugs are safe for patients with heart disease unless they are taking nitroglycerin or other nitrates, which relax the heart's blood vessels by a different mechanism in order to relieve chest pain caused by angina, says Dr. Andrew McCullough, director of andrology at the Albany Medical College in New York. In that case, the two drugs in combination could reduce a patient's blood pressure to dangerously low levels, leading to a heart attack, stroke or fainting.
Adding a beta blocker wouldn't make a PDE5 inhibitor safer for heart patients and could actually work to depress blood pressure, further increasing the risk of fainting, McCullough says. In fact, beta blockers can sometimes precipitate impotence by preventing the penis from getting all the blood it needs to create and sustain an erection.
Priapism — a painful erection that lasts for more than four hours — is extremely unlikely as a result of PDE5 inhibitors like Viagra. "I have treated hundreds of cases of erectile dysfunction with these drugs and have never seen a single case of priapism as a result," says Dr. David Samadi, vice chairman of urology at Mt. Sinai Medical Center in New York. There were also no episodes of priapism in several placebo-controlled studies that tested Viagra, Levitra or Cialis at therapeutic doses.
Priapism, if it does occur, is a urological emergency, Samadi says. Injected phenylephrine, a vaso-constrictor, is a very effective treatment, probably because it constricts the blood vessels and allows blood to flow back out of the penis. Adrenalin (epinephrine) would work by the same mechanism, though it is a more dangerous treatment because it also stimulates the heart.
Finally, Viagra, Levitra and Cialis can increase sexual arousal in women by increasing blood flow to the clitoris. But in women, sexual dysfunction problems are often due to lack of sexual desire, which these drugs don't affect, McCullough says. There is an exception: Studies have shown that PDE5 inhibitors do work in women who have an arousal disorder as a side effect of taking selective serotonin reuptake inhibitors to treat depression. But neither depression nor low libido appears to be a problem for Andi Garcia.
Siegel is an associate professor of medicine and medical director of Doctor Radio at New York University Langone Medical Center.