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Biotech / Medical : VVUS: VIVUS INC. (NASDAQ) -- Ignore unavailable to you. Want to Upgrade?

To: Gene Voss who wrote (4795)	1/20/1998 12:47:00 AM
From: Zebra 365	Read Replies (1) \| Respond to of 23519

<<Muse has addressed this by virtue of its extensive use and in light of the fact PGE1 is naturally occuring.>> Good point, and I would add the fact that MUSE (alprostadil) is administered locally, metabolized locally, and any that is not metabolized locally has a 97% first-pass deactivation in the lungs. <<<How is sildenafil metabolized. What % is affected by first pass elimination? What are the metabolites and to what degree do they also serve as enzyme inhibitors? At what dose does Viagra begin to inhibit the remaining PDE enzymes? What is the half life of Viagra and what effect does age and medical status play in its metabolism?>>> Here I would add, "What are the known drug-drug interactions?" This is something we worried about with Seldane (now off the market, it had a clinically significant interaction with several presciption drugs and even with Grapefruit juice which raised Seldane blood levels.) None of this is really PFE bashing because these, for the non-technical readers, are the questions a physician asks after hearing the drug rep's glowing report on the benefits of ANY new drug. In the case of ED, any serious risks will not easily be overshadowed by the clinical benefits. And these are questions where the answers are difficult to impute from our experience with other PDE-V inhibitors on the market (there are none.) These questions of risks are far more important than benefits to those of us in the medical profession who really do take seriously the duty to protect our patients. Any drug that is more risky than current therapy, may take time and a lot of Phase IV data before gaining wide acceptance. The best recent example of this is the HMG-CoA inhibitors, which were Second line drugs for hyperlipidemia for years after approval, simply because good old "bloats-me-up tastes-like-sand" cholestyramine resin had no hepatotoxic or myopathic potential. Gene, I'm curious, too. Guess we'll have to wait til we get the Viagra package insert into our hands to see what the answers to these questions will be. Zebra

To: Gene Voss who wrote (4795)	1/20/1998 1:27:00 AM
From: Tunica Albuginea	Respond to of 23519

Gene, " I am not sure any of the Urologists involved are competent to supply the answers ", watch it now; BigK is listening. You are directly attacking Padma's and Irwin's pad my seat Goldberg credibility!! Heresy! Are you telling us these guys don't know hill-o-beans about pharmacologic studies? After all this years of cutting and dilling with tubes you'd figure they'd know something.... TA

To: Gene Voss who wrote (4795)	1/20/1998 6:03:00 AM
From: BigKNY3	Read Replies (1) \| Respond to of 23519

Gene <<This entire discussion is much more pharmacologic and transcends ordinary urologic investigations.My main point is that these oral agents should be aggresively reviewed on a biochemical level not just whether or not an erection results in healthy men>> Gene: I respect and appreciate your reply and agree with you. I recommend reading the International Journal of Impotence Research article "Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treament of penile erectile dysfunction: (1996, 47-52) for a review of its pharmacokinetics and pharmacodynamic properties. BigKNY3