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The Next Viagra?

Uprima was supposed to be the next hot drug for erectile dysfunction. What happened?
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Same Ends, Different Means continued...

So which drug appears to work better? "There is no answer yet," says Ira Sharlip, MD, an assistant clinical professor of urology at the University of California at San Francisco who has conducted clinical trials of both drugs. More research needs to be done, he says.

Clinical trials show that both Uprima and Viagra are between 50% and 60% effective, depending on the dosage and on what counts as success (May 14, 1998, New England Journal of Medicine and presentations at the May 2000 meeting of the American Urological Association). The best kind of comparison -- a head-to-head clinical trial pitting Viagra against Uprima -- has not been done.

Some patients would appreciate that Uprima reaches maximum effectiveness after only about 15 minutes, compared with an hour or more for Viagra. But again, Uprima's potency comes with a price. Like Robert Carelli, about 15% of men who took the drug in the clinical trial wound up feeling nauseated afterward -- or worse.

If Uprima does end up receiving FDA approval, many patients and their doctors may still continue to choose Viagra simply because it's more familiar to them, says Robert P. Nelson, MD, a professor of urology at the Medical University of South Carolina in Charleston. Having no competition, Pfizer, Viagra's manufacturer, has been able to put together a marketing and sales force that will be hard for Uprima to challenge.

A careful history and physical examination are necessary in order to determine if any drugs are needed to treat a case of erectile dysfunction. For starters, Viagra cannot be taken by anyone who is taking nitrate medications for heart disease because mixing these drugs can cause dangerous drops in blood pressure.

Uprima could be taken by patients on nitrates, but experts say more research would need to be done to convince them that the combination would be safe. In any case, patients with heart disease should check with their doctor about engaging in any strenuous physical activity, including sex.

The underlying cause of erectile dysfunction may also play a part in choosing a drug. Because Viagra acts at the level of the tissues, it may be more effective in the 50% of patients whose problem is caused by a vascular disease (such as diabetes), says John Morley, MD, a professor of medicine at the St. Louis University School of Medicine. Uprima, on the other hand, works in the pathways of the brain that control anxiety, so it could be more helpful for the 10% to 15% of patients whose erection problems stem from performance anxiety, says Morley.

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