Pharmacists Step Up Warnings About Impotence Pill
FDA investigating deaths of 6 who had taken Viagra
Sabin Russell, Chronicle Staff Writer
Saturday, May 23, 1998
As concern grows about potentially fatal drug
interactions with the popular impotence pill Viagra,
pharmacists are stepping up efforts to make certain
they don't sell the drug to patients taking heart
medications that should not be combined with
Viagra.
The Food and Drug Administration is investigating
the deaths of six patients who had taken Viagra
since it came on the market last month. It is
uncertain whether the drug played a role in any of
the deaths, but Viagra maker Pfizer Inc. has
reissued warnings about mixing the pill with drugs
like nitroglycerine taken for heart pain.
Stephen Roath, president of Walnut Creek-based
Long's Drugs, said the company reissued an alert
yesterday to all 353 West Coast pharmacies about
the danger of Viagra to patients also taking
nitroglycerin tablets to treat chest pain.
''Pharmacists are uniquely trained and equipped to
have knowledge of the drugs a patient is taking,'' he
said. Computers can automatically flag a potentially
dangerous drug interaction for a customer who is
prescribed two medicines that should not mix.
The catch, Roath noted, is that the patient must fill
his or her varied prescriptions at the same
pharmacy, or the dangerous interaction won't show
up.
News about life-threatening interactions with
nitroglycerine may have come too late for Maynard
''Frenchy'' Gallant, a 70-year old Hayward man
with a history of heart disease who may have taken
Viagra hours before he died.
His niece, Lanis Wooley, said she found a small
manila envelope containing a single Viagra pill in her
uncle's jacket when it was sent with his other
effects from the Pinole hospital, where he died one
week ago.
''If only he had waited a week, he would be alive
today,'' said Wooley. ''He would have heard the
news.''
Wooley said his urologist told her that he had given
Gallant two Viagra pills and that he was unaware
his patient was taking nitroglycerine tablets.
Pfizer medical director Dr. Richard Diegal issued a
''Dear Doctor'' letter yesterday through the FDA
warning of potential interactions with drugs
containing nitrates.
Nitroglycerin is the most commonly prescribed
nitrate drug. It dilates blood vessels, lowering blood
pressure and easing the workload of the heart.
Viagra reacts with nitrates to lower blood pressure
to potentially dangerous levels. It is a condition the
company warned of when Viagra was approved on
March 29, and is so noted on its product label.
The latest Pfizer warning lists 27 different
formulations of nitroglycerin pills, ointments and
patches that put Viagra users at high risk of a
sudden drop in blood pressure.
Pfizer also listed 16 other prescription drugs
containing nitrates, and the illegal street drug butyl
nitrate -- known in the gay community as
''poppers,'' which can intensify a sexual
experience.
Shortly after the approval of Viagra, the Gay and
Lesbian Medical Association issued a warning that
there could be a potentially dangerous drug
interaction with the impotency drug and poppers.
The Pfizer warning also notes that sexual activity
increases stress on the heart and urges doctors to
''consider the cardiac status of patients for whom
they are planning to prescribe Viagra.'' It outlined
scenarios where Viagra users could run into serious
trouble:
-- A patient with a history of taking Viagra engages
in sex and experiences an angina attack. With
Viagra ''still on board,'' he places a tiny
nitroglycerin pill under his tongue to ease the chest
pain -- and suffers an acute loss of blood pressure.
-- A person with no history of angina has his first
attack while engaging in sexual activity. He is
rushed to the hospital and is given nitroglycerin --
routinely administered for chest pain.
Noting that there are reports of women taking the
drug to enhance sexual sensation, Siegel also
warned doctors to ask about Viagra use in treating
angina for both men and women.
c1998 San Francisco Chronicle Page A3
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