Eager Canadians get their Viagra at last
Ottawa approves anti-impotence drug after two-year review
Wednesday, March 10, 1999
CAROLYN ABRAHAM
Medical Reporter
The Blobe & Mail
The little blue pill that has caused a very big fuss
is to penetrate the Canadian market in three
weeks and the bedrooms of an estimated three
million Canadian men soon after.
Health Canada has approved Pfizer's
anti-impotence drug Viagra after a two-year
safety review and pleading phone calls from
sex-hungry Canadians. It's expected in
pharmacies by the end of March.
Since the United States approved the drug a year
ago, Canadians have had countless prescriptions
filled across the border at what some doctors
dubbed "Viagra Falls."
Originally developed to treat heart conditions,
Viagra proved to have the unexpected side effect
of sparking strong and long-lasting erections in
men who otherwise suffered penile dysfunction.
Ironically, the manufacturer's main public
relations battle has since been countering reports
that the drug actually causes heart problems.
Viagra has nevertheless become a cultural icon
for a different kind of sexual revolution, a hot
commodity in more than 70 countries and one of
the fastest-selling drugs in medical history.
Gerald Brock, a urologist at St. Joseph's Health
Centre in London, Ont., and an associate
professor of urology at the University of Western
Ontario, said "We are very happy that Health
Canada has finally decided, as many other
countries have, that Viagra is a safe and effective
treatment for erectile dysfunction."
The drug is reported to help seven in 10 men
with erectile problems and Pfizer is now testing
its sexual effects in women.
Urologists who appeared on behalf of Pfizer at a
news conference yesterday, said reports that
Viagra might be harmful have been misleading.
They said deaths linked to the drug in the United
States included a homicide and a drowning of
men who just happened to have prescriptions for
Viagra.
They also denied that Viagra increases the risk of
cardiac problems, which the U.S. Food and Drug
Administration concluded after reviewing the data
in November, 1998. To date, about seven million
American men have taken 60 million Viagra pills
and about 130 men have died.
"What's confusing is that guys with erectile
dysfunction are at a higher risk of . . . cardiac
problems," Dr. Brock said. He explained that
such men should perhaps no more be having sex
than they should be shovelling snow or running
up the stairs.
"Sex is exercise," he said. "We are just hearing
about this now because we are seeing a landslide
of men coming forward for [Viagra]."
Diseases of aging, like diabetes and heart disease,
also tend to put men at higher risk of erectile
problems.
But both the drug company and doctors are
adamant that Viagra must not be taken by
patients who are also taking any form of
nitroglycerin, which is usually prescribed for
cardiac patients. The two drugs together could
result in a nitroglycerin overdose.
Side effects reported during international clinical
trials -- which involved 498 Canadians -- included
headaches, flushing and indigestion. A blue tinge
in vision has also been reported. But all men are
advised to see their doctor with their partners and
have a medical exam before taking the drug.
"I don't know how many of you would like to
stick a needle in your penis," said Jack Barkin,
chief of urology at the Humber River Regional
Hospital, referring to the injections, vacuums and
implants currently used in treatment.
Viagra -- sildenafil citrate -- helps the flow of
blood into the penis necessary to obtain and
maintain an erection. But, Dr. Barkin warned,
"You can't just pop the pill and watch Oprah and
expect something to happen to you." Men still
require natural sexual stimulation after taking
Viagra, he said, which is to be taken 30 minutes
to an hour before the patient expects to have sex.
The urologists also emphasized that Viagra is not
an aphrodisiac, nor is there evidence that it
enhances the erections of normal, healthy men.
In Canada, Viagra is to sell for $12 to $13 per
pill, excluding the dispensing fee. This would
make it comparable to the U.S. price, although
for Canadian sales the drug company has
significantly changed the packaging to blister
packs of four or eight tablets. Theresa Firestone,
Pfizer Canada's vice-president of government
and public affairs, said this was partly done to
prevent counterfeit production of the drug --
which has been a problem in other countries.
THE LITTLE BLUE PILL
How it works: Viagra aids blood flow into the
penis, enabling men to obtain and maintain an
erection.
Success rate: Pfizer Inc. reports that the drug is
effective in seven out of 10 men with erectile
problems.
Dosage: Men with erectile problems are
supposed to take a single tablet 30 minutes to an
hour before they expect to have sex.
How do you get it? By prescription only from
pharmacies.
Side effects: Headaches, indigestion and feeling
flushed. Viagra is not recommended for people
taking nitrate-based heart medication and all
cardiac patients should fully discuss its use with
their doctors. Use of the drug by men who don't
need it could cause permanent erectile problems.
Cost: Just under $100 for a pack of eight pills,
excluding dispensing fee.
THE DRUG: HOW IT WORKS
Erectile dysfunction may be caused by
insufficient amounts of chemical messages being
received by the penis or by the smooth muscle's
inability to relax. How Viagra can help
1. In the penis's flaccid state, the smooth muscle
cells in the erectile tissue are contracted,
constricting the arteries and limiting blood flow to
the penis.
2. Sexual stimulus causes chemical messages to
be produced that should have the effect of
relaxing the smooth muscle, allowing blood to fill
the erectile tissue. These messages are gradually
broken down by enzymes.
3. Viagra works by blocking the specific enzymes
that would break down the chemical messages.
This allows for the production and reception of
sufficient quantities of chemical messages,
allowing and erection to form.
4. As the Viagra wears off, enzymes are no
longer blocked and break down the chemical
messages. The erectile tissue contracts, reducing
blood flow into the penis and opening veins,
which carry blood away.
...
Erectile dysfunction is associated with many
underlying conditions and risk factors.
Age-related illnesses rather than aging itself, are
usually the cause. Here are a few:
Diabetes
High cholesterol
High blood pressure
Spinal-cord injury
Alcohol use
Depression
Smoking
Pelvic surgery
Multiple sclerosis
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