Viagra: A Second Honeymoon?

▪ 1999

       The approval in March 1998 of Viagra (sildenafil), the first oral drug for male impotence, brought new hope to the millions who suffered from this condition and revitalized the joke repertoire of late-night-TV talk-show hosts. The number of Viagra jokes was outpaced only by the number of prescriptions written: more than six million during the drug's first seven months on the market. Toward year's end, however, the enthusiasm was tempered by a cautionary note, as the U.S. Food and Drug Administration (FDA) warned of potentially serious side effects in some patients.

      Viagra offered a novel way to treat male impotence, or erectile dysfunction, as it is known medically, a condition that affected an estimated 30 million men in the U.S. alone. Taken in pill form about an hour before sexual activity, Viagra improves blood flow to the penis and thereby allows a man to respond naturally to sexual stimulation. In clinical trials the drug was shown to restore sexual function in 7 out of 10 men. Previous treatments had involved surgical implants, suppositories, pumplike devices, and injection of drugs directly into the penis.

      Doctors were immediately swamped with requests for the new drug, which cost $8-$10 a pill. The overwhelming demand created some unanticipated ethical, legal, and economic dilemmas. Although a full medical examination is recommended prior to taking Viagra, a controversial new industry sprang up, offering consumers prescriptions via the Internet. The high cost led some insurers, both private and public, to refuse to cover the drug, whereas others, including some state Medicaid programs, placed some limits on coverage.

      Medical reports later in the year led the FDA to issue new warnings in November and prompted Pfizer, Inc., Viagra's manufacturer, to add them to its drug labeling for physicians. Although emphasizing that the drug was safe and effective for most users, the agency said that caution should be used in prescribing Viagra for some patients, including those who had recently suffered a heart attack or stroke and those with life-threatening arrhythmias, a history of heart failure or unstable angina, very low or very high blood pressure, or certain eye disorders. This warning was in addition to the original caution against Viagra use by people taking the drug nitroglycerin. The FDA also warned of the rare occurrence among some Viagra users of painful, prolonged erections requiring medical attention. As of mid-November the agency had received reports of 130 deaths among patients taking the drug, many from heart attacks, but there was no proof that the new medication itself caused the deaths.

CRISTINE RUSSELL

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