Honeymoon With Viagra Could Be Over, Say Doctors

June 9, 2011— -- Sales of the little blue pill that promised men they could be sexually active well into their 70s and 80s are going soft after flying off the shelves for more than a decade.

The market for Viagra-type drugs has stalled in the United States. Last year the total number of prescriptions for so-called ED drugs declined by 5 percent after growing just 1 percent annually the previous four years, according to IMS Health, a heath-care data and consulting firm. Viagra prescriptions were off 7 percent; those for Levitra plummeted 18 percent.

The market for these virility drugs still top $5 billion in annual sales to tens of millions of men. But for many, who saw the drugs as a powerful aphrodisiac that would cure all the things that were wrong in their lives, the drugs, some of the safest in the world, just didn't live up to expectations.

"It's not that these drugs don't work. If one doesn't work, all three don't work," said Dr. Thomas Jarrett, head of urology at George Washington University.

Cialis, which has a 24- to 36-hour window of effectiveness -- for when the "moment is right"-- is predicted to outpace the short-acting drugs this year.

Many insurance companies don't cover these so-called "lifestyle drugs," and those that do only pays for four pills a month. Out of pocket, they cost $12 to $15 a tablet, not exactly a cheap thrill.

"We still write a lot of prescriptions, but without any objective evidence, it doesn't seem like we write as many as we used to," said Jarrett.

A poor economy, coupled with market "over-saturation," and even disenchantment among men when more sex didn't improve their lives, may explain why prescriptions are down, he said.

"When people have money to spend, they are willing spend on their sexual health," said Jarrett. "But if it's a choice between the blood pressure medicine and their Viagra, you would hope most would choose to maintain their health."

Erectile dysfunction becomes more prevalent as men age. Though problems in their 20s is not unheard of, most men don't face ED until they are well into middle age.

"They get into their 50s and 60s unscathed, then they get hit with larger medical issues like diabetes and vascular disease, all of which put them at risk," said Jarrett.

These drugs work on about two-thirds of all men.

"You can't take someone who has no erections and give them strong ones," he said. "But it can improve what you have. People reach the point where they won't work anymore because of the aging process."

Couples often find that the drugs doesn't fit into their idea of spontaneous sexuality and it has side effects: headache, congestion and heartburn.

Doctors say that about 40 to 50 percent of all men who are given a first prescription for these drugs don't ask for a refill.

"You can't always get in the mood," said Jarrett. "You have to time it when you think you'll need it so it's at its peak efficiency. With cialis you avoid that and but lots of people have side effects from headaches to blurry vision."

Still, Jarrett writes a good number of prescriptions for older men who want to continue relations with their long-term spouses or new spouses.

But with Internet sales of the drugs, there is a lot of off-label use with younger men.

"You get the 24-year-old who thinks he has erectile dysfunction if they stay up all night and can't get up and do it five times the next morning," he said.

Chewable Viagra on the Horizon

And new discreet pills are on the way, perhaps to compensate for flagging sales, according to a report in The New York Times. Viagra is launching a discreet chewable pill in Mexico. Levitra has countered with a fizzy, dissolvable tablet. And Cialis has a 36-hour "weekender."

Viagra, known generically as sildenafil citrate, hit the market in 1998.

At the time, studies showed 52 percent of all men between 40 and 70 had some degree of erectile dysfunction and its spectacular debut helped its manufacturer, Pfizer, increase profits by 38 percent.

In its first year, 2.7 million prescriptions were filled, and the company posted $411 million in sales, according to reports at the time.

Viagra works by allowing the smooth muscles of the penis to relax so that the organ can be filled with enough blood to sustain an erection.

ED drugs increase blood flow, but it can't do everything, according to Dr. Abraham Morgentaler, director of Men's Health Boston and author of "The Viagra Myth."

"The partner nixes it," he said. "It works, but the guy decides he's OK without it and doesn't really need it. It doesn't meet expectations."

"For many men, the myth of Viagra is greater than what it can deliver," he said. "It doesn't necessarily improve relationships or make a man more attractive."

But Morgentaler, who began his practice a decade earlier in 1988, said Viagra changed everything culturally.

"Sex was always an issue then and there was no Viagra or pill," he said. "When it came out it was a total revolution and it's hard to understate the impact."

Suddenly, people talked about sex. TV and the press struggled with what words they could use to describe the drug. In ads for breast cancer, writers were only allowed to use the word, "breast," not "nipple," because it was to sexual, he said.

"Could you use erection?" said Morgentaler. "What about penis?"

Scares about the drug -- heart attacks and blindness -- were quickly dispelled.

Even warnings about going to the emergency room if an erection lasts longer than four hours is bogus. While priapism is dangerous, it is not caused by Viagra, he said.

"The cultural idea was that the drug could help, but you pay the price to the devil," said Morgentaler. "Now those obstacles are gone."

But while Viagra was a billion-dollar drug, it still failed to live up to expectation as a quick fix for men's disappointing sex lives.

"It turns out although the idea was great -- all men are interested in sex -- for some men, they may try Viagra once or twice, but realize I have other issues in my relationship," he said.

"And with women -- I hear this all the time -- they say, 'Of course I want to have sex with you. But you have to take a pill to have sex with me? It's totally unromantic."

The short-acting drugs, Viagra and Levitra, reach their peak in two hours and take "some guesswork" about when to have sex.

"You take the pill and you don't get lucky," said Morgentaler. "Your wife gets a phone call from her sister or your teen decides to stay home instead of going out."

Even the free samples that pharmaceutical companies leave in doctors' offices have slowed. "We used to be inundated," he said.

Still, Morgentaler said the importance of erectile drugs cannot be understated.

"They totally revolutionized the ability of men and their partners to engage in an incredibly important intimate physical relationship beyond the point where they were able to in the past," he said.

"The fact the numbers have flattened shouldn't distract from the idea that they are still in wide use and many men still rely on them. For men, sexuality is a big part of who they are."