The Book on Viagra and Other ED Drugs

By Dr. Cynthia Paulis Erectile dysfunction or impotence occurs when a man can no longer get or keep an erection firm enough for sexual intercourse. If this is an ongoing problem, it can be a sign of a serious health condition that needs evaluation, such as heart disease or poorly controlled diabetes. Oftentimes treating the underlying problem can reverse erectile dysfunction, but if it still occurs there are alternative treatments. Dr. Aaron Katz, chairman of the department of urology at Winthrop University Medical Center, said, "The goal of oral medications is to restore or enhance blood flow to the penis." He said Viagra, which comes in three dose levels, works for about four hours. "It can be very helpful for men recovering from prostate cancer surgery, where the nerves and the blood supply to the penis may have been damaged during the surgical removal of the prostate," he said. "We typically would use this medication much earlier after the surgery than we had in the past. "In the past, we had the philosophy of just watch and wait and maybe the blood flow and the nerves will be restored. But some of the more recent studies have shown that if you use these drugs early on?the long-lasting effects can be much greater," he said. "Viagra can be used as a bridge and hopefully it will restart, almost like a battery, and then maybe-hopefully-Viagra will not be used for long-term use." One of the other well-known drugs on the market is Cialis (tadalafil), which has a much longer-acting component but works in a similar way to Viagra. What makes this drug unique is that it can work for 36 hours. "It does give you much more spontaneity than Viagra does," Katz said. "Cialis is known in Europe as the 'weekender.' You can take it on a Friday and have sex for the entire weekend." Cialis comes in a 20-mg dose, but the company has now come out with 2.5-, 5- and 10-mg doses that can be taken daily. Both Viagra and Cialis take effect within an hour of taking them. Side effects of both drugs are minimal; some men can develop back pain after taking Cialis, and both medications can cause flushing and headaches. However, they are fairly safe drugs as long as you are not taking them with nitrates, drugs commonly prescribed for chest pain such as nitroglycerin, Nitro-Bid, Nitrostat, Imdur, Monoket, Dilatrate and Isordil. Other medications that can cause problems with erectile dysfunction meds are blood thinners, alpha blockers for benign prostatic hyperplasia and high blood pressure medication. A third oral medication is Levitra, which works similarly to Viagra and has a four-hour window. A recent call to a pharmacist broke down the prices as following. Their best-seller was Viagra, with a six-pill pack costing roughly $135; Levitra was the least expensive, at $10 a pill; and Cialis ranged in price from $134 for the 20-mg pill to $147 for the lower dose of 5 mg, which is taken daily. Most of these are covered by insurance but according to the pharmacist, Viagra seems to be the one favored by insurance companies. There are two other, non-oral medications used to treat erectile dysfunction. The alprostadil penis suppository is a small suppository that goes into the opening of the penis and delivers blood flow there. Erections usually begin within 10 minutes and last 30 to 60 minutes. It is not used often because it can cause pain and bleeding in the urethra, along with the formation of fibrous tissue. Another method is alprostadil self-injection (brand names Caverject, Edex), wherein a fine needle is used to inject alprostadil into the base or side of the penis. The injection will produce an erection that occurs within a few minutes and lasts an hour. Side effects from this method include bleeding, prolonged erection and formation of fibrous tissue at the injection site. Katz said, "More than 50 percent of [male] diabetics have erectile dysfunction, so this may be very helpful for those patients." Testosterone replacement for men with low levels of testosterone have helped some men who are menopausal and experiencing erectile dysfunction. If medications fail, the patient may have to seek alternative treatments such as a penis pump, a penile implant or blood vessel surgery. Katz said he has patients in their eighties with very active sex lives. One thing he emphasizes is that "you need to take care of your body. It's all about flow and cholesterol and preventing arterial plaque that builds up in the heart and the small arteries to the penis. Men who are overweight and want to have sex, they want to take the quick fix, they want to take the Viagra-well, that's not the answer. "The answer is to get in shape, work out, do yoga, meditate, be mindful of what we take into our bodies," he explained. "Eat less fat, less red meat, eat more vegetables and practice more healthy living, do more aerobic exercise-running, jogging, swimming, biking-then you will have a better sex life and you won't need the Viagra."