Bloomberg - Doctors Say Viagra Scare Should Alert Patients to Dangers
Bloomberg News
May 25, 1998, 2:03 p.m. PT
Doctors Say Viagra Scare Should Alert Patients to Dangers
Pasadena, California, May 25 (Bloomberg) -- News that at
least six people died while taking Pfizer Inc.'s Viagra
underscores the potential dangers of the impotence drug, which is
still expected to generate annual sales of more than $1 billion,
doctors said.
''Viagra is the source of many jokes and now people are
treating it like it's candy,'' said Dr. Jaime Corvalan, a
urologist in Pasadena who's written more than 100 prescriptions
for Viagra. ''These problems warn people that dangerous things
can happen when you're taking drugs.''
The hype surrounding Viagra -- one of the hottest new drugs
ever with more than 1 million prescriptions written since it was
introduced in April -- led scores of men who struggled with
erections to rediscover sex, encouraged others to see if it can
enhance normal sexual function and even attracted some women to
determine if the benefits are universal.
While it's not known whether the deaths were caused by
Viagra, analysts say the drug is on track to be a blockbuster,
with some forecasting it will dominate an impotence market that
could have annual sales of $4 billion.
Pfizer last week sent doctors a warning latter about the
dangers of Viagra combined with certain heart medications.
Although physicians said they're convinced Viagra is safe and
effective when those warnings are heeded, many remain concerned
the drug will be used irresponsibly.
Prescriptions Available
After the U.S. Food and Drug Administration on Friday
disclosed the six deaths, a healthy 33-year-old Bloomberg
reporter was able to get a prescription for the drug in less than
two hours by contacting a osteopathic physician in San Antonio,
Texas, who was referred over the Internet. He did so without
speaking to the doctor or giving a detailed medical history.
The doctor charged $100, paid in advance by credit card, for
a nonrefillable prescription for 10 pills based on a brief
medical questionnaire in which the reporter said he wasn't
impotent. The doctor, who could only be contacted through an
answering service that faxed a medical questionnaire to the
reporter, didn't return phone calls on Friday and Monday to
discuss the prescription.
''This drug, like any other drug, must be used carefully,''
said Stephen Auerbach, a Newport Beach, California-based
urologist and one of Viagra's national researchers. ''But people
are taking it like water, and it's not a drug for a Saturday
night special or casual use.''
Dangerous Combination
Viagra should never be taken with nitrates, common drugs
that dilate arteries in patients with chest pain, because the
combination can lead to severely lowered blood pressure, a heart
attack or death. Still, many heart patients are automatically
given nitrates by emergency medical professionals who might not
ask about Viagra use, and some men might lie about their
prescriptions out of embarrassment, doctors and analysts said.
Complicating the issue is Pfizer's unwillingness to discuss
the deaths or disclose details about those who died.
Although it's possible the deaths were completely unrelated
to the drug, they could have resulted from nitrate interactions,
excess exertion during sex by men with heart conditions or some
other adverse reaction to the drug.
While the government is investigating the deaths, FDA
officials say they still believe Viagra -- which lengthens the
stay of chemicals in the body needed for erections -- is safe
when used properly.
Ethics Question
Since the FDA doesn't regulate how doctors prescribe
medicine, Viagra can be available to just about everyone.
Ira Sharlip, a San Francisco-based urologist who serves on
the American Urological Association's impotence guidelines
committee, said his group would ask the doctor who's prescribing
Viagra based on a faxed questionnaire to stop doing so.
Although writing a prescription for a never-seen patient is
considered unethical by some and could be investigated by state
medical boards, it's not against federal law.
One reason for concern is that unexpected side effects or
previously undetected problems can crop up when large numbers of
people start taking a drug.
That's a lesson well understood at Madison, New Jersey-based
American Home Products, which took two obesity drugs -- Redux and
Pondimin -- off the market that were linked to heart
complications after millions started taking them.
Million Mark
''Once you get usage in a million people instead of 5,000,
rare side effects can emerge,'' said Alex Zisson, an analyst with
Hambrecht & Quist who has a ''buy'' recommendation on Pfizer.
''That's what happened with Redux. That's obviously the knee-jerk
worry with Viagra.''
New York-based Pfizer cautioned doctors last week to watch
out for women having heart troubles who might also be on Viagra
when it sent out a warning letter about the potential
consequences of combining Viagra and nitrates.
The bottom line for Viagra remains that caution is needed
when taking it, and patients must understand unexpected side
effects are possible.
''Everybody wants to take a pill and get better, or have a
better life, but often the downsides are devastating,'' said
Phillip Nalbone, an analyst at Volpe Brown Whelan.
--Michelle Fay Cortez in Ithaca, New York, with Jim Finkle in San |
