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    The Lowdown on Viagra?

     

    Everyone is talking about Viagra, but really, how does it work? How safe is it? Are there any side effects? Is there an herbal alternative?

    In November the FDA and Pfizer Inc., the manufacturer of Viagra, sent a letter to health professionals and issued new labels discouraging use by men for whom sexual activity is not advisable due to underlying cardiovascular disease. They also note that Viagra should be prescribed with caution, if at all, to patients who suffered a heart attack, stroke, or life-threatening arrhythmia within the previous six months; had significant low blood pressure or blood pressure higher than 170/110, had a history of heart failure or coronary artery disease causing unstable angina or had the eye disorder retinitis pigmentosa. The new labels also warn that the drug can cause painful, prolonged erections, a serious condition requiring immediate medical attention. Although reports of this are rare, you should seek medical help if an erection lasts longer than four hours.

    I've been getting e-mail about Viagra since late last year from people eager to know when it would be available and how to get it. Frankly, I'm amazed at the tremendous craze created by the introduction of this drug.

    Viagra (sildenafil citrate) from Pfizer, Inc., was approved by the FDA in late March and owes a lot of its popularity to the fact that the drug is delivered in pill form and not as an implant or injection like most other impotency medications. Also, unlike other impotency drugs, it works by enhancing the body's natural response to sexual stimulation. Taken about an hour beforehand, Viagra increases blood flow to the penis and, through a series of chemical interactions, makes it easier for an erection to happen. According to the American Urological Association, more than half of all men over 40 years old suffer from some sort of impotence, but only 5 percent of them have sought treatment. Clearly, from the flurry of prescriptions being written, the number seeking treatment has skyrocketed.

    According to the FDA and Pfizer, of more than 3,000 men with varying degrees of impotence enrolled in clinical studies, Viagra returned normal erectile function to 50 percent to 80 percent of them. These included men with a range of medical problems including high-blood pressure and heart disease. It worked for men with psychological causes of impotence as well as known physical ones such as diabetes, spinal cord injury or prostate surgery (though diabetics and men with radical prostate surgery had less improvement than other groups.)

    So it does work, but you're right to wonder about side effects. The package insert notes that headache, facial flushing and indigestion are most common. Apparently some men also experience blurred vision or see everything tinged blue. The average dose is 50 mg. The maximum is 100 mg and the FDA advises the proper dosage be determined by your doctor. If you take it, do so only once a day. In general, I'm cautious about new drugs. I'll be interested to see how people feel about Viagra a year from now.

    You may have also heard about supposed herbal alternatives sold under the names Viagro and Vaegra. I don't know anything about these products, and Viagra's manufacturer has a temporary restraining order against them. A more reliable choice, however, is Yohimbe bark, from an African tree (Pausinystalia Yohimbe), which contains an alkaloid, yohimbine, the only drug currently listed in the Physician's Desk Reference as a sexual booster. It is available only by prescription and may boost erectile and ejaculatory ability, and is thus worth trying. For increasing sexual energy in general, experiment with Ashwagandha and ginseng but be aware that their effects are cumulative over several weeks.

     






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