Oct. 8, 1999 (Atlanta) — Viagra may soon be able to improve matters of the heart in more ways than one. Two new studies presented recently at the Third Annual Scientific Meeting of the Heart Failure Society of America in San Francisco show that the impotence drug’s ability to enlarge blood vessels also may be beneficial in treating heart failure.

In one trial, Viagra (sildenafil) was more effective than placebo in helping to open up a blocked artery, the major cause of heart failure. In the second trial, Viagra increased the effects of inhaled nitric oxide in patients with chronic pulmonary hypertension, or increased blood pressure within the lungs. Pulmonary hypertension, a common condition seen in people with heart failure, leads to increasing shortness of breath over time. Nitric oxide is a gas that can dilate blood vessels, thus helping to lower high blood pressure within the lungs.

In the first study, Stuart D. Katz, MD, and colleagues at Columbia University in New York evaluated the effect of a single dose of Viagra on the dilation of blood vessels in patients with moderate heart failure. The study involved four groups of 12 patients. One group was given a placebo. The other three groups received doses of Viagra, ranging from 12.5 mg to 50 mg.

The group that received 12.5 mg of Viagra experienced a slight improvement in their arteries compared to the placebo, but the groups that took 25 mg or 50 mg had much more significant increases in the size of their arteries.

Still, Katz tells WebMD he’s somewhat guarded about Viagra’s use for long-term conditions. “I have to be somewhat about the results,” he says. “I think this study shows that in an acute setting, there is perhaps some potential for drugs like Viagra … as a strategy. This study evaluated a single dose of a short-acting compound. To extrapolate that to chronic use is a huge leap.”

Katz says “the findings are intriguing, but this work needs to be followed up with a longer-acting compound, which currently doesn’t exist.”

In a second study, cardiologists at Massachusetts General Hospital in Boston evaluated the effects of Viagra on patients with chronic pulmonary hypertension who inhaled nitric oxide to help their condition.

Researchers found that giving nitric oxide and Viagra in combination produced the greatest improvement in blood flow through vessels in the lungs. Individually, the two drugs caused improvement, but not as much as when working together. Researchers found that each of the drugs the ability of oxygen to improve blood flow.

“In other studies, we’ve shown that nitric oxide has beneficial circulatory effects in heart failure and beneficial effects on exercise capacity,” Marc J. Semigran, MD, co-director of the heart failure and heart unit at Massachusetts General, tells WebMD.

In contrast to Katz, Semigran says he believes that Viagra could possibly be used all the time, giving doctors another weapon in their fight against heart failure and pulmonary hypertension. “One of the big problems with inhaled nitric oxide is that it has a very short half-life, so the patient has to use it constantly. If Viagra can prolong the effects of nitric oxide, it might be possible to take puffs of nitric oxide to spike the pulmonary circulation,” he says.

Aug. 5, 2004 — Erectile dysfunction apparently isn’t just an older man’s problem anymore. Young men, even some who are college-aged, are leading the surge in Viagra use.

New research indicates that the use of Viagra skyrocketed 312% among men aged 18-45 between 1998 and 2002. There’s also been a twofold increase — 216% — among men between ages 45 and 55, says Tom Delate, PhD, whose research analyzed data on medical insurance claims by some 5 million patients across the country.

“We tried to see if these patients had an underlying medical condition and we couldn’t identify one in the majority,” says Delate, director of research for Express Scripts, Inc., a St. Louis-based firm that conducts pharmaceutical research for insurers, managed care organizations, and other companies.

“What we found was that problems typically seem to start in a man’s 40s and affected only about 40% of the men in these age groups.”

Enhancer Rather Than Remedy?

Does this suggest a growing trend in using the drug for recreational rather than medical purposes — such as for a sex enhancer?

“That would be my guess,” Delate tells WebMD.

While Delate notes that men older than age 56 continue to fill the lion’s share of prescriptions for Viagra, his study — published in the August issue of the International Journal of Impotence — also shows a 13% increase in Viagra prescriptions for women between ages 18 and 45. While some studies indicate that Viagra can increase sex drive and satisfaction levels in women, especially before menopause, this is not a finding.

Delate also finds that two in three prescriptions came from primary care , rather than urologists.

“One about what may be going on: It could be that patients are coming in, asking for the drug, and the prescriber wants to please the patients and meet their expectations,” he tells WebMD. “It could be the primary care physician doesn’t have a lot of time to spend with them, and may not be asking questions.”

July 10, 2000 — In the two years since it rocketed onto the market — and
became, almost overnight, a household word — the impotence drug Viagra has
helped men with erection problems enjoy satisfying sex. The little blue pill
fired the male imagination with the notion of an enduring and youthful virility
that could last into the golden years.

But truth is, Viagra is not the sexual cure-all that many men who have
problems with erectile believed it to be. As many as two in five
men who try the drug don’t get the desired results. And at least 39 Viagra
users have died, mostly men who were also taking other drugs, or who had
serious heart disease (see the 1998 issue of Clinical
Therapeutics).

No wonder that early reports of another, perhaps better, drug were so
— both to the media and to men who got no from
Viagra. The very name of the new drug — Uprima — conjured up images of
supremacy and conquest.

Then, last week, came the news that threw a splash of cold water on these
oh-so-fond hopes: TAP Pharmaceuticals, the maker of Uprima, unexpectedly –
perhaps temporarily — withdrew its application for approval by the Food and
Drug Administration (FDA).

Why did the company pull a product that just weeks ago had been widely
expected to gain FDA approval and give Viagra a run for its money in the
billion-dollar impotence market? Experts speculate that the agency may, in
fact, have been poised to reject the drug’s application or to severely restrict
its recommended use. The reason: serious questions about the drug’s safety at
higher doses and its efficacy at lower ones.

Before submitting its application to the drug agency, TAP Pharmaceuticals
tested Uprima on more than 2,700 men in final clinical trials. The experience
of two of those men, by WebMD, offers a glimpse at the drug’s
possibilities — and drawbacks.

Aug. 18, 2000 — The impotence treatment Viagra might seem an unlikely drug to find at nightclubs or raves, the all-night dance parties popular with teens. But experts say Viagra has begun making the club scene — especially as an adjunct to ecstasy and “poppers,” a combination that is questionable at best.

One rave fan says the combination of Viagra and ecstasy makes some sense. “Ecstasy makes it so you can’t get an erection,” says Soren Roinick, a Boston-based member of the group DanceSafe, which promotes “healthier” raves. At the same time, he says, it’s not as if every raver’s got his hand out for a little blue pill. “Ecstasy lowers all your aggression, including your sexual aggression,” he says. “You might bond with someone per se, but generally, people at raves are not going home and sleeping with someone.”

Still, researchers have taken note of the phenomenon. The practice of combining Viagra and ecstasy is mentioned in an article on the health risks of raves by Erica Weir, MD, a resident in community and family medicine at McMaster University in Hamilton, Ontario, in a recent issue of the Canadian Medical Association Journal. And in a letter to the British Medical Journal last year, researcher Judith Aldridge of the University of Manchester wrote that her study of 2,000 people found Viagra was being sold illicitly in English nightclubs within weeks of becoming available in that country.

Many interviewed by the British researchers reported having taken Viagra along with illicit drugs and alcohol. The combination with “poppers” — vials of amyl nitrate or isobutyl nitrite sometimes used illicitly as an aphrodisiac — is particularly worrying, Aldridge writes: “Both drugs dilate blood vessels, which can result in a dangerous drop in blood pressure and possibly heart attack or stroke.”

In the U.S., Roinick says he has seen Viagra use at raves on the West Coast — though nothing too extensive — and suggests it’s probably more common with older crowds at sadomasochistic offshoots of the dance parties. “Normally, raves are a kind of place,” Roinick says. “There’s a big drug scene that’s not part of the rave scene.”

Still, there’s little doubt those positive vibes emanating from some of these dance parties have something to do with drugs — in particular ecstasy, also known as MDMA. Roinick, who admits to being an occasional ecstasy user, says there’s a good reason young people are attracted to the drug: “It just makes you feel really, really happy.”

But there’s little that’s happy about the ultimate effects of ecstasy, one expert says — and, although it’s not entirely clear what happens when people take it along with Viagra, the results of mixing Viagra and poppers are definitely grim.

Ecstasy “is a bad, bad, bad drug, no matter what you read” says Wilkie Wilson, PhD, professor of pharmacology at Duke University Medical Center in Chapel Hill, N.C., and co-author of Buzzed: The straight facts about the Most Used and Abused Drugs. The drug, Wilson says, may very well have a long-term effect on mood. “What happens is, as we age, we lose serotonin function. So if you’re kicking off a bunch of it when you’re young, the end result is depression.”

Roinick says the common “cure” for ravers who feel depressed after taking the drug is to lay off ecstasy for a couple of weeks to give the brain time to recover. But Wilson says some studies have shown there is no such thing as recovery from ecstasy — and further, that the drug can dangerously increase both body temperature and blood pressure.

Viagra, on the other hand, can cause a decrease in blood pressure, and Wilson says he can’t say whether combining the two drugs is necessarily dangerous. But Marshall Forstein, MD, medical director of Mental Health and Addiction Services at Boston’s Fenway Community Health Center, warns that it’s a bad idea.

“A lot of the ecstasy is not pure,” he says. “It’s a mix of different amphetamine salts. But even so, ecstasy affects the liver metabolism of Viagra … they inhibit enzymes which metabolize each other.” That can cause a potentially dangerous rise in blood levels of each drug. ” He also says there have been reports of strokes in people who take the two drugs together.

As for using Viagra with poppers, which are particularly popular in the gay community, there’s no uncertainly as to the dangers. “The risks with the poppers is serious,” Forstein says. “They lower blood pressure precipitously.”

So why would someone want to take these two drugs together? “Poppers dilate blood vessels. So they make people get a rush,” he explains. “The problem is, many men become sexually dysfunctional with constant use and that’s when there’s a tendency to want to use Viagra.” Even men who don’t intend to use the two drugs together can get into trouble in clubs, where vials of poppers sometimes get shoved under unsuspecting nostrils, Forstein says. Men who have used Viagra hours earlier can be affected, since the erection drug stays in the body for such a long time.

In an article distributed by the Canadian Press news service, a spokesman for Viagra manufacturer Pfizer says the company warns against using Viagra with poppers or ecstasy. “Viagra is not an aphrodisiac and has no effect on libido,” says Don Sancton, director of corporate affairs for Pfizer, Canada.

No one can say at this point the extent of drug-mixing going on in the nightclub and rave scene — and, in particular, the use of Viagra there. Conrad Roberson, of the Drug Identification section of the Georgia Bureau of Investigation, says it’s unlikely authorities would take much notice of the illegal possession of Viagra when they’re arresting someone for the far more serious offense of possessing ecstasy. And because Viagra falls outside the list of federally “controlled” substances, its use is not of legal concern to the Drug Enforcement Administration.

But according to one advocate, the very nature of the rave culture is not conducive to the widespread use of Viagra.

“The rave community is not a super, highly charged sexual community,” says Jennifer Keys, media for DanceSafe’s Seattle, Wash., office. “It’s supposed to be based on mutual self-respect. There are very few rapes at raves. You’re much more likely to have that at rock concerts.”