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The ED Drug Wars

Published: May 10, 2011

Viagra is going generic in 2012, and a market-fest is warming up.

Pills to treat erectile dysfunction have become a 5 billion dollar industry. Not bad considering Viagra, Cialis and Levitra are only three medications currently available. Given that there is plenty of money in effective treatments for one of the ancient scourges of male-kind, it should surprise no one that the war between competing drugs is about to heat up.

Pfizer, the maker of the first and so far best selling drug – Viagra, must face the fact that it is going off patent in 2012. Since generics promise to be cheaper once that happens, the company is looking for a competitive edge in marketing. So it is that a chewable form called Viagra Jet is being marketed in Mexico. If it proves a success it will be marketed in other countries.

Meanwhile Bayer, the maker of Levitra, is adding some bells and whistles to its product with a dissolvable form of the drug – Levitra ODT which stands for “orodispersible”. Actually this drug was approved last June under the name Staxyn. Not having to take a swallow of water to ingest the product hardly seems like a major leap forward, however that is what the marketing will apparently focus on.

The third drug of the trio may be in the catbird seat as it were, given that Cialis has a couple of advantages. It has a longer half-life than the other two meaning it can be used as a 36 hour “weekender” pill since its happy effects carry over into a second day. A low dose version of the pill is being touted as something that can be taken once-a-day with no worry about having to locate and ingest one before the fun begins. This is a good way to turn a negative into a positive – its longer lasting effect was balanced off by its slower onset of action, a disadvantage countered by the daily dosing strategy. It is expected that Cialis will be the top seller of the trio by years end.

In the meantime Pfizer is planning to use legal firepower to fend off generic competitors until it has milked its patents. Oddly, while the medication goes off patent in 2012 Viagra has also been patented as an ED drug until 2019. Just what that means is unclear. According to a New York Times article by Duff Wilson Viagra has employed “security operations” to fight the counterfeiting of the “little blue pill” which reportedly is THE most counterfeited product in the world. I certainly can’t recommend that anyone buy these drugs on the internet.

These three pills do mark a major breakthrough in the treatment of erectile dysfunction. Before 1998 there were no reliable pills to treat ED. Yohimbine – a drug that still on the market – worked for some people, but had terrible side effects described to me as “like drinking a pot of coffee”. It still turns up in the sort of dubious pills sold in liquor stores, often labeled as a mix of “herbal” products. These herbal pills are unreliable at best, dangerous at worst. Don’t be tempted.

Unfortunately for patients, the big three – Cialis, Viagra, and Levitra – do not solve everyone’s problems. Some medications – particularly nitrates – can have strong interactions with these ED drugs, creating a whole class of people who can’t benefit from their use. More surprisingly, almost 40% of patients who are able to use “the little blue pill” (along with Cialis and Levitra) find it to be wholly ineffective. For 60% of people who do respond to these drugs, the side effects can often become too bothersome for them to handle. We don’t think of the sinuses as being erectile tissue, but they sure do get stuffed-up when congested from swollen blood vessels. This gives a treatment aimed below the waist the side-effect of imitating a serious sinus allergy attack – a surefire way of cooling ones interest in getting frisky. Luckily for patients who do not have the option of this trio of ED meds, other treatment modalities are available. Discussion of these medications are, unfortunately, a topic for another day.