Four Shades of Blue

Believe it or not, it has been seventeen years since the introduction of the blue pills, which had changed the landscape of the treatment of men with erectile dysfunction. On 27th of March 1998, sildenafil, which is the generic term for the blue diamond, became the first oral treatment for ED approved by the FDA in the United States. For those of us who lived through the nineties may also recall, it was the same year Bill Clinton was also in trouble with the Lewinsky Scandal.

Sildenafil was initially developed in Sandwich, Kent and subsequently studied for use in high blood pressure in Wales. The medicine had minimal impact on blood pressure on the research subjects, but induced a marked penile rigidity. The participants consistently reported the “accidental” side effect, and Pfizer had decided to develop the compound as a treatment for the men with erectile dysfunction. I guess the rest was simply history.

The famous British Novelist, Mary Augustus Ward once said: “But a girl of seventeen is not always thinking of books, especially in the Oxford summer terms”. On the other hand, the famous American Gymnast, Dominique Moceanu claimed: “When you have travelled the world, won the Olympic gold and gone through a very public court battle against your parents all by the age of seventeen, surprises don’t come easily. So at the age of seventeen, what impact has the “Blue diamond” create on our world?

Needless to say, the pills had a great impact for the company. On the tenth anniversary of the pills’ approval, the annual sales of sildenafil peaked in 2008 reaching nearly 2 billions US Dollars. This translated to 6 tablets prescribed per second worldwide. And the sales had clearly played a role in positioning Pfizer to the top of Pharmaceutical rankings.

On the other had, the emergence of other players in the market had also changed the course of the treatment of men. Exactly how the others differ against the blue diamond is often the subject of discussion in my clinic.

Dear Dr. G,

I am 54 and have been suffering from diabetes and high Cholesterol.
Needless to say years of smoking and uncontrolled blood pressure also has been negatively impacting on my generally health.

I recently went for a health screening check up and was discovered to have blocked coronary arteries. Thankfully, I underwent angioplasty uneventfully.

Now, I am feeling great and I intend to change my lifestyle. I am exercising regularly and eating healthily. My blood pressure and cholesterol are all under controlled now. The only matter that is still bothering me is the fact that I am still suffering from Erectile Dysfunction despite the healthier lifestyle.

To be honest, I suffered from ED when I reached 50 years old, and always assume it will go away. Sadly it is getting worse. My cardiologist had recommended me to take the blue pills. He assured me it is safe. I understand there are three types of the magical pills in the market. How do they differ? Which is better for me? 

Michael.

The occlusion of the penile arteries can occur many years before the blockages in the coronary arteries. Therefore, erectile dysfunction can be a barometer for a “broken” heart. Many men assumed the reversal of cardiac risk factors such as smoking, hypertension and dyslipidemia returns all the bodily function to its formal glory, including the sexual function. Unfortunately the reality is ED is often treatable but not curable.

The doctor is the best person to judge the fitness for taking the “magic” remedy.  In fact, the assessment is simple, if one is not on the nitrite pills for the heart and can manage several flights of stairs with no difficulties. The pills are generally safe for consumption.

There are actually four “shades of blue” emerging in the market in recent years, instead of three. There are sildenafil, Vardenafil, Tadalafil and Udenafil. These are all medications that belong to a class of drugs called PDE5 Inhibitors. Five years following the approval of blue tablets, Vardenafil and Tadalafil were both introduced in 2003.

As the name may suggest, this class of drug work with an identical mechanism, which is the prevention of the degradation of a component (cGMP), which enhances the blood flow to the penis. This would have the impact to prolong the erectile rigidity during sex. The only differences the four pills have are the pharmacokinetics for the different timing for onset and side effects.

The on demand dosing of sildenafil allows the men to see the effect of the medication one hour after taking it, and its efficacy lasting six hours. All the other three are competing to be the fastest acting and longest lasting magic pills, with the least side effect. Vardenafil’s relatively short effective time is claiming giving advantage to men with history of diabetes and prostate cancer. On the other hand, the distinctively long half-life of Tadalafil (17.5 hours) compared to sildenafil and Verdenafil (both 4.0-5.0 hours) may result in longer action, hence coined “The weekend pills”. For the readers who are terrified by the horror of an erection that last between 4 to 17 hours, your can be rest assured it is the readiness of achieving the erection rather than the actual erection itself.

The new kid on the block from South Korea, Udenafil, is also gaining momentum in helping men with ED. It can reach the maximum plasma concentration after one hour and the half-life of up to 13 hours also had become a favorable option for many men.

The Scottish Theologian and author William Barclay once said: “There are two great days in a person’s life- the day we are born and the day we discover why” The accidental birth of the blue pills had not just sparked the discoveries of medicines for the treatment of sexual Dysfunction; it also changed our views on the taboo subject of Sexual health. On that note, I wish the magic pill a Happy Birthday on its Sweet Seventeen!