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Viagra: How a Little Blue Pill Changed the World

Medically reviewed by Leigh Ann Anderson, PharmD Last updated on Feb 24, 2020.

Viagra Makes History

Viagra (sildenafil) is one of the most widely-known prescription drug names on the U.S. market.

Often dubbed "the little blue pill", Viagra (sildenafil) was the first phosphodiesterase 5 (PDE5) inhibitor approved to treat erectile dysfunction (ED). ED is a common sexual problem for men and its frequency increases with age.

It is estimated roughly 30 million men in the U.S. and over 100 million men worldwide suffer from ED. A large U.S. survey determined about 50 percent of men 40 to 70 years of age experience some degree of ED.

The Unexpected Discovery of Viagra

The discovery that sildenafil could lead to an erection was an unplanned event.

The sildenafil compound was originally developed by Pfizer for the treatment of hypertension (high blood pressure) and angina pectoris (chest pain due to heart disease). During the heart clinical trials, researchers discovered that the drug was more effective at inducing erections than treating angina.

Pfizer realized ED was an unmet medical need and a major opportunity for financial gain. In 1998, the FDA approved Viagra, the first oral treatment for erectile dysfunction, under a priority review.

Quick Success: The FDA-Approval of Viagra

At the time of its approval, Viagra had the fastest initial sales growth following its launch of any prescription product, reaching 2008 sales of close to $2 billion.

Pfizer promoted Viagra and ED awareness via direct-to-consumer (DTC) advertising, which prompted men to seek medical advice and a prescription from their doctors.

For many men, the stigma and embarrassment of talking to their doctor about ED has declined since the introduction of Viagra and other PDE5 inhibitors.

The Impact of Erectile Dysfunction (ED)

Erectile dysfunction (ED), or the inability to achieve and maintain an erect penis for sexual function, can lead to performance anxiety, a negative impact on self-esteem and personal relationships, and even clinical depression.

In a survey published in BMJ, 62 percent of men reported a decline in self esteem, 29 percent reported a negative effect on a relationship, and 21 percent reported that their relationship had ceased due to ED.

For many men, the inability to perform adequately during sex directly affects their feelings of masculinity.

What Causes ED?

Risk factors for ED include underlying health issues such as:

  • diabetes
  • high blood pressure
  • obesity
  • high cholesterol
  • chronic alcohol or drug abuse
  • certain medications
  • injuries.

Any condition that may restrict blood flow to veins over time, like smoking and normal aging, can lead to ED.

Medical conditions such as Parkinson's disease or Peyronie's disease (scar tissue build-up in the penis) may also cause ED.

Mental health issues can take their toll, too -- depression or stress can result in loss of libido. Erection failures may occur repeatedly in men who experience performance anxiety due to ED.

Which Medications Cause ED?

Many medications have impotence or sexual dysfunction listed as a side effect. A medication review should be performed by a health care provider to determine if any prescription drug treatment may be contributing to symptoms.

Medications that may lead to erectile dysfunction include:

If you regularly experience sexual function or ED problems, contact your doctor for evaluation and treatment.

Just the Basic Facts: How Viagra Works

Viagra works in response to sexual stimulation to increase the blood flow to the penis leading to an erection. Viagra does not result in an erection without sexual stimulation.

When a man is aroused, muscles in the penis relax to allow greater blood flow. Viagra helps to elevate the levels of a substance known as cyclic guanosine monophosphate (or cGMP) that causes the tissues to relax, leads to an inflow of blood, and causes an erection with sexual stimulation.

Viagra and other PDE5 inhibitors like Cialis, Levitra, Stendra and Staxyn treat erectile dysfunction (ED), but do not directly increase a man's sexual desire.

However, knowing that one can perform better in bed may indirectly boost libido. Several of these agents are now available generically, too, which can help in the wallet.

What's the Safest Way to Take Viagra?

Viagra (sildenafil) is taken by mouth usually as a 25 or 50 milligram (mg) tablet one hour before sexual activity. However, Viagra may be taken within a range of one-half hour to four hours before sex.

The dose may be adjusted based on doctor recommendations, but it should not exceed 100 mg per dose and should not be taken more than once per day. Staying with the lowest dose possible may help to lessen side effects. A physician will prescribe your specific dose.

Have your pharmacist check for drug interactions, too. Men who use nitrates (such as nitroglycerin or isosorbide) should never use Viagra or other PDE5 inhibitors (Cialis, Levitra, Stenda, or Staxyn) due to severe, possibly fatal hypotension (low blood pressure).

Does Viagra Have Side Effects?

In general, the most common side effects with PDE5 inhibitors like Viagra are mild and short-lived. Side effects may include:

  • Headache
  • Flushing
  • Heartburn
  • Vision problems (blurry vision, light sensitivity)
  • A blue-green tinge to your vision (usually a temporary side effect)
  • Nausea
  • Dizziness

Report a sudden hearing or vision loss to your healthcare provider immediately. An erection lasting more then 4 hours (priapism) is a rare event, but if it occurs get emergency treatment right away.

Be sure to review Viagra drug interactions and precautions with your healthcare provider prior to use. Your dose of Viagra may need to be adjusted based on other drugs you may be taking.

Other Options for Erectile Dysfunction

The simplicity of taking an oral tablet for erectile dysfunction has revolutionized ED treatment.

However, PDE5 inhibitors may not work in about 30 percent of men. It is important for men to know that there are other options available for ED. These solutions were used prior to Viagra, and are still available today:

  • Penile self-injection (Caverject)
  • Transurethral suppositories (MUSE)
  • Vacuum-assisted erection devices
  • Surgical penile prostheses

These options may be useful for some; however, for many men they can be complicated, painful, and more expensive. Be sure to talk to your doctor about all options.

To keep up with the latest news and developments, consider joining the Q & A Erection Support Group to get support from people with similar concerns.

What is Low T?

Media advertising has dramatically -- and sometimes sensationally -- increased the awareness of "Low-T" or low blood testosterone (also called androgen deficiency).

  • Men with low blood testosterone levels may suffer from a lower sex drive, erectile dysfunction (ED), brittle bones (osteoporosis), low muscle mass and higher fat accumulation.
  • Typically, a man's testosterone level is considered low if it's below 300 nanograms/deciliter.

Testosterone therapy is available by injection, gel, skin patch, spray or lozenge to raise testosterone levels. However, in addition to heart risks, older men who take testosterone replacements may need to have regular prostate cancer screening tests. Plus, testosterone therapy currently carries a boxed warning of potential heart risks, mandated by the FDA.

A report on the Testosterone Trials noted that testosterone therapy can possibly raise the risk of heart disease and stroke, and may not be safe is men with low-but-normal testosterone levels and no outward symptoms related to low T.

  • These trials were a set of seven year-long clinical trials in 788 men 65 years or older and with hypogonadism conducted at 12 sites across the United States.
  • Overall, the Testosterone Trials showed that the volume of arterial plaque increased more in the testosterone-treated group compared to the untreated "control" group, which could increase the risk over time for heart attack or stroke.
  • The trials showed a positive benefit for bone health, anemia, and sexuality, but experts stated that it's unlikley testosterone will be considered a first-line treatment for those conditions, as other more effective and well-established options are available. No improvement in cognitive function (memory) was seen.

One more important point: adding testosterone to sildenafil (Viagra) treatment has no added benefit in men with erectile dysfunction and low testosterone levels, as noted in one well-designed clinical study.

Viagra: But at What Cost?

Erectile dysfunction drugs have finally become affordable due to generic availability. However, some men still prefer the brand names.

But beware. Much of the advertised Viagra on the Internet is counterfeit, and may even contain dangerous and toxic drugs.

To help combat the counterfeit market, Pfizer now offers online Viagra prescription orders and home delivery through licensed pharmacies. Pfizer also offers significant savings, up to 50% off, for the brand name product.

In December 2017, generic versions of Viagra became commercially available, which has lowered cost considerably. In general, generic Viagra runs about $25 per 10 tablets. Know that these prices can vary based on the pharmacy, your location, and if you use an online pharmacy coupon. So be sure to check for price differences.

Another option is to talk to your doctor about using the generic form of Revatio (sildenafil), approved for pulmonary hypertension. It's the same drug that's in Viagra, just at a slight lower dose. Just like Viagra, you'll need a prescription, but the cost savings are significant, too.

Counterfeit Viagra: A Dangerous Practice

Viagra has become the victim of Internet fraud due to its rapid success and famous name.

According to Pfizer, 80 percent of the top 22 Internet sites that came up in search results for the phrase "buy Viagra" were selling counterfeit pills.

Products sold as "natural" or "herbal" Viagra claim to enhance performance; however, these illegal products have not undergone FDA review or approval. Fraudulent Viagra products contain unknown chemical ingredients that may pose a serious health risk.

Upon testing the counterfeit Viagra, Pfizer found these chemicals in the illegal drugs:

  • blue printer ink
  • amphetamines, also known as “speed”
  • metronidazole, a powerful antibiotic that could cause an allergic reaction, diarrhea, or vomiting
  • too much active ingredient (or not enough), which may cause you harm
  • binding agents, such as drywall, that prevent the tablet from breaking down in your system.

Will Viagra Be Approved For Women?

More than 50 million women experience some type of sexual dysfunction. Studies looking at Viagra in women have theorized that sildenafil could increase genital blood flow and boost arousal. However, most studies have found a limited beneficial effect of Viagra for women. Lack of sex drive in a woman is a complicated process, often magnified by stress, hormonal changes, or lack of intimacy.

However, medications to help boost libido and other sexual problems in women are becoming available.

  • Addyi (flibanserin) was approved in August 2015 to treat low sex drive -- generalized hypoactive sexual desire disorder (HSDD) in pre-menopausal women.
  • Osphena (ospemifene), as well as Intrarosa (prasterone) are available for vaginal dryness and dyspareunia (painful intercourse) that can interfere with sex in menopausal women.
  • In May 2018, Imvexxy (estradiol vaginal insert) was also approved for females who experience painful sexual intercourse.
  • In June 019, Vyleesi (bremelanotide) injection was approved to treat low sexual desire in women who have not gone through menopause and have not had low sexual desire in the past. Vyleesi is the second female libido drug to gain FDA approval after Addyi (flibanserin) in 2015; however, with Vyleesi, there is no warning for combined alcohol use.

Generic Options for Erectile Dysfunction

Other medications used for the treatment of erectile dysfunction, Cialis (generic: tadalafil), as well as Levitra and Staxyn (generic: vardenafil) are now available generically at U.S. pharmacies.

For most men interested in cost savings, switching to the generic forms may be a good option if they use the brand Stendra (avanafil). Generic options for this brand is not yet on the market. Ask your doctor or pharmacist about switching.

If you prefer not to switch to the generic, be sure to check with the manufacturer of the product you use to determine if they have discount programs that might help save you some money.

Finished: Viagra: How a Little Blue Pill Changed the World

Viagra: 11 Interesting Facts That You Can't Help But Be Amazed By

Originally developed to treat heart problems, Viagra remains one of the world’s most iconic pills. This little blue pill revolutionized treatment for erectile dysfunction. But what else has it been…

Sources

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