Medicinal magic
Viagra finding competition among two newer drugs
By Jack Garland
Associated Press

Viagra, the little blue pill that has revolutionized the sex lives of millions of men, since it was approved five years ago has two potential rivals knocking at the door of the big U.S. market.

One, called Cialis, is known as "Le Weekend" pill in France for its reputed long-lasting effect. The other, Levitra, prides itself as the choice for those who want more spontaneity because it works in as little as 15 minutes, less time than the hour Viagra requires.

The Food and Drug Administration approved Levitra recently, and the makers of Cialis, Eli Lilly & Co. and Icos Corp., expect approval later this year.

All three drugs are effective about 70 percent of the time, and the side effects – headaches, nasal congestion and flushing – are similar. They all work by increasing blood flow in the penis in response to sexual stimulation by blocking an enzyme called phosphodiesterase-5, or PDE-5.

Both new drugs went on the market in Europe this year. They apparently prompted more men to seek treatment, creating an expanded market, one that Viagra still easily dominates. However, analysts say it is too early to tell how much Viagra will be affected by the newcomers.

"With the exception of the U.K., in the European markets they like innovation, and when something new comes along they want to try it," said industry analyst Brian Benedetti of IMS Consulting in London. "Once the enthusiasm for the new drugs dies down, we will see how it settles."

Benedetti believes the chances of Cialis or Levitra unseating Viagra as market leader are slim because, he says, the two products share more similarities with Viagra than differences, and Viagra is already a household name.

Dr. Mark Smith of Shoals Urological Associates said Viagra would continue to be the main pill he dispenses until doctors and patients in America have more experience with the newer drugs. The "weekender" pill also may not be suitable for all patients with erectile dysfunction because it's long-lasting effect may interfere with other treatments in case a man needs emergency care – during a heart attack for example, he said.

"Viagra has revolutionized ED treatment in this country," Smith said. "It's the frontline treatment."

Originally a drug tested to improve blood flow for patients with problems like heart disease – the side effects were erections –Viagra is a leading moneymaker for drug giant Pfizer. More than 30 million prescriptions have been dispensed worldwide, Smith said.

Besides becoming a name recognized worldwide, the drug also has helped men take care of themselves in ways that don't involve their sex lives, he said.

Men coming into Smith's office have been referred to cardiologists, he said. Doctors now believe that restricted blood flow in the penis may be an early warning sign of diabetes, high blood pressure, high cholesterol, depression, stress and some nerve conditions.

"ED could be the tip-off of problems that are life-threatening," Smith said.

Britain-based GlaxoSmithKline and German-based Bayer AG, who make Levitra, acknowledge that Viagra's brand recognition is formidable.

"We've found, and I think Cialis has found, that Viagra is synonymous with erectile dysfunction. It's like Hoover and vacuum cleaners. That is what we're up against," said GlaxoSmithKline spokesman Geraint Thomas.

Viagra's sales hit $1.7 billion last year; the drug has been taken by about 20 million men worldwide. The U.S. market, a big target for the new drugs, accounted for just over $1 billion of Viagra's sales, or 60 percent of last year's total.

Some experts say the new pills, particularly Cialis, may offer patients a strong alternative. Cialis's longer lasting effect has formed a central part of its marketing campaign; Viagra can last up to five hours.

"I have had patients come back to me after trying Viagra saying that the time scale is a problem," said Dr. Clive Gingell, a consultant urologist at the Nuffield Hospital in Bristol, England, who conducted the earliest experiments with Viagra in 1994.

"They sometimes waste a tablet because they find it difficult to tie themselves down to sexual activity in a particular few hours and here Cialis can be important because of the flexibility," said Gingell, who has prescribed all three drugs for his patients.

"I found Levitra and Viagra to be very similar drugs. The efficacy is about the same, duration of effect is about the same, and the side-effect profile is about the same," he said.

"Because Cialis does not make the patient have to plan sexual activity so tightly I think that will be a particular advantage for its sales," Gingell said.

TimesDaily Staff Writer Emilio Sahurie contributed to this report.

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