Seeing blue after popping the ‘little blue pill’

Dear Dr. G,

I am a 60-year-old-man who is just reaching the age of having problems to “rise to the occasion”.

I understand, technically I suffer from erectile dysfunction (ED), and am tempted to take “the little blue pill”.

I am usually a careful chap and will not consume any medication without considering the risks.

However, because of the embarrassment of seeing a doctor about my condition and worried about its cost, I procured the blue pills through some friends.

I know Dr G would disapprove of such a practice of consuming medication without a doctor’s prescription, however I am simply too shy to discuss bedroom matters with anyone.

After taking the pills on several occasions, I felt symptoms of heartburn and flushing.

I must say most of the side effects are bearable.

The one I am most curious about is “seeing blue” when I take the blue pills. I wonder if it’s just my imagination or a serious side effect.

I would like to put Dr G on the spot about the risk of taking the blue pills.

What are the common side effects of the blue pills?

Are there medical conditions that prohibit men from taking the pills at all? Any serious risks such as heart attack and sudden death?

Regards

Seeing Blue Benjamin

Before the 1990s, the understanding of the physiology of erection was deficient, and the treatment such as penile prosthesis; vacuum pumps and injections directly into the penis were the only treatment options for men with ED. The emergence of the blue pills did not just transform the treatment modality for ED, it also reduced taboos in sexual medicine, facilitated research and changed the landscape of men’s health.

On March 27, 1998, Sildenafil (commonly known as the blue diamond pill) was approved by the FDA as the first oral treatment for erectile dysfunction in the United States. The drug initially termed compound UK-92-480 was synthesised by a group of chemists in England, for use in hypertension and angina. In the first phase of clinical trials, the drug was noted to have minimal impact on the heart, but a tremendous response on the hard-ons. Sildenafil and a group of medications called phosphodiesterase 5 inhibitors (PDE5-I) have become the first-line therapy for men with ED.

There are four “shades of blue” emerging in the market in recent years. These are Sildenafil, Vardenafil, Tadalafil and Udenafil. Five years following the approval of blue tablets, Vardenafil and Tadalafil were both introduced in 2003. The new kid on the block from South Korea, Udenafil, is also gaining momentum in helping men with ED. All the medicine works 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 reality is, no other medication warrants the level of scrutiny, induces myth and causes than the blue pill – more than 20 years after its arrival.

It is because sex itself is too “hard” to talk about, and the sense of “guilty pleasure” will always raise the question of whether too much of a good thing is bad for you? It is now obvious the initial fear of sudden death, stroke and heart attacks following the consumption of the blue pill, is completely a myth and unfounded. The most common adversity of Sildenafil includes headache, flushing, indigestion, and nasal congestion. Other PDE-5 inhibitors such as Tadalafil also have the side effects of transient backache.

Another unique, but common side effect is cyanopsia or blue vision, which is often a strange experience that users may associate with the “punishment” of the overconsumption of the blue pill. The reason behind this peculiar side effect of sildenafil is related to the activation of a subtype of the enzyme PDE6, which is found in the retinal cells, the light-sensitive cells at the back of the eye. It is thought that high doses of PDE5-inhibitors would lead to the build-up of the molecules, causing blurring of vision and difficulties in differentiating blue and green. Most of these side effects are transient and completely harmless.

Erectile dysfunction can also be a barometer for a “broken” heart, as the condition is a precursor for many non-communicable diseases, such as diabetes, hypertension, and dyslipidemia. Therefore, it is important to consult a doctor before taking this “magic” remedy. In fact, the assessment is simple, if one is not on nitrite pills for the heart and does not suffer from a rare condition called retinitis pigmentosa, then the pills are generally safe for consumption.

The famous scientist, Stephen Hawking once said: “Look up at the stars and not down at your feet. Try to make sense of what you see and wonder about what makes the Universe exist. Be Curious”. Many men are lured by the curiosity of a magic pill that can create sparkles in the bedroom and forget the real health reasons behind erectile dysfunction.