New Erection Drugs on the Way

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Feb. 8, 2002 -- Move over, Viagra -- here comes the competition. New drugs -- and new interest in older methods -- mean more erections for more men.

Viagra's release in 1998 helped many of the 30 million U.S. men who have problems getting erections. Problem solved? Not yet. Viagra can't help everyone. Some men can't safely use it because they are on other medications, have other illnesses, or experience side effects. And for other men, Viagra just doesn't work. For these men and their sex partners, claims that Viagra has cured erectile dysfunction have been misleading and frustrating.

But the huge research effort that Viagra spurred has already provided new insights into male sexual function -- and new treatments, some of which will be available soon.

The Challengers

What's wrong with Viagra? Nothing, for men in whom it safely works. But that hasn't stopped two major drug companies from getting ready to release their own Viagra-like drugs. Eli Lilly and Company's much-anticipated drug, Cialis, may be ready to come to market later in 2002. Bayer's offering, vardenafil, should be ready some time in 2003. They work much the same way as Viagra, but they should have fewer side effects. Whether they will prove safer or more effective remains to be seen.

Cialis works faster than Viagra -- in about 15 minutes instead of half an hour. It lasts a lot longer, helping men get erections for 24 hours vs. the four-hour window Viagra provides.

Vardenafil -- yet to get a catchy brand name -- seems to work for men with many different types of erectile dysfunction. It seems to work especially well for men whose erectile dysfunction is related to diabetes. In one clinical trial, it worked even better for diabetic men with severe erectile dysfunction than for those with milder problems.

Other Oral Alternatives

Uprima was to have been the next treatment advance: By stimulating the brain rather than the muscles and nerves of the penis, Uprima placed under the tongue produced strong erections in most of the men on whom it was tested. It had preliminary approval from an FDA committee before it was withdrawn by the manufacturer: A small number of people passed out after taking it. It's available overseas, but plans for a U.S. release are on hold.

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That hasn't stopped Nastech Pharmaceutical Co. Inc. from developing a nasal version of the drug. In a preliminary study, it helped men with several different kinds of erectile dysfunction -- and none of them passed out. Large-scale clinical trials are planned this year.

Yohimbine is another popular nerve-blocking agent used to treat this problem. It's been available in the U.S. for many years, but carefully designed studies convincingly show that it isn't very effective in promoting normal erection and sexual performance.

The amino acid arginine has been touted as a natural alternative to other erectile dysfunction drugs. When studied under rigorous conditions, though, results have been disappointing.

What About Injections, Pumps, and Implants?

For men who haven't had success with oral treatments, there are other alternatives.

One highly effective treatment -- given by injection -- is called Caverject. This requires the man or his partner to inject the medicine into his penis near where it attaches to the body.

Injecting medications into the penis can make some men cringe. In others, it is a difficult and discouraging process to go through. But for many it has meant the return of a satisfying sex life. The dosage of these injections has to be carefully adjusted for individual men. It is extremely dangerous to experiment with somebody else's injection prescription.

There's also a system called MUSE (medicated transurethral system for erection). The man inserts a small pellet filled with the same medicine in Caverject directly into the urethra, the hole at the tip of the penis. Once inserted, the medication spreads through the penis tissues, producing an erection. As with injections, many men find this to be a highly satisfying means of restoring their sex lives.

The major side effect of MUSE and Caverject is pain in the penis.

Although it was once considered a last resort, vacuum constriction and external erection devices are actually preferred by a small number of erectile dysfunction sufferers. Most vacuum devices consist of a chamber in which the penis is inserted, a pump to create the vacuum that will draw blood into the penis, and constriction rings that are fastened over the base of the penis once it is erect.

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The design of external erection devices tends to be more varied.

Both of these technologies have been helpful to some. Remarkably, they've only gained acceptance in the medical community in the past 15 years, but the American Urological Association now promotes them as viable alternatives for treating erectile dysfunction.

And then there are implants. These come in two basic types: inflatable and flexible. Both require surgery. Men and their partners tend to be highly satisfied with the results.

Inflatable implants consist of fluid-filled rods (placed in the penis), a pump (placed in the scrotal sac), and a reservoir (placed in the abdomen). Pushing the top of the pump fills the rods with fluid and offers erection on demand; pushing the bottom of the pump deflates the penis. This type of implant has a lifetime of about six years.

Flexible implants are semi-flexible rods that allow the penis to be bent down after intercourse. This type of implant can last a lifetime but sometimes wears out.

Both types of implants can have problems. There always are risks from surgery, and about one in 20 men report pain or discomfort after getting the implant.

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