Move over, Viagra: New drug hits market
Levitra claims erections occur in 20 minutes rather than an hour; third drug is on the way
By LINDA H. LAMB
Staff Writer

New for the man who has not-quite-everything: a little orange pill that promises to be like Viagra, only better.

Levitra is the latest medication for erectile dysfunction, and men for whom Viagra doesn't do the trick are eagerly seeking doctors' samples of the new drug.

"We had almost 70 calls about it on Monday," said Christopher Laughter, administrator of the National Men's Health Clinic, off Two Notch Road.

If you haven't seen TV commercials for Levitra, you will soon. For some of them, Levitra developers Bayer HealthCare and GlaxoSmithKline have enlisted "Iron Mike" Ditka, the former NFL star and coach.

By year's end, a third oral drug for erectile dysfunction is expected to hit the market, which only can expand as baby-boom guys encounter the plumbing problems of middle age and beyond.

"Forty percent of guys in their 40s experience some sexual dysfunction, to the point that at least some of the time, they can't get an erection to have sex," said Dr. Shawn Stinson, an internist and an associate professor of medicine at the University of South Carolina medical school.

Patients troubled by impotence also can try injections, vacuum devices and even surgery. But, for most, oral medications "are a good place to start," said Dr. Wayne Weart, professor and chairman of the pharmacy practice department at the Medical University of South Carolina.

"They have good efficacy, they're easy to use, and they don't require as much preplanning as the other interventions do," he said. "The nice thing about Levitra is that it adds another option."

SOME PRECAUTIONS

However, it's not a good option for everyone.

Levitra is a selective phosphodiesterase type 5 inhibitor -- in the same class of drug as Viagra. Cialis, the third medication that's due out soon, is in that class as well. They produce erections by enhancing the blood flow to the penis and trapping it there. (Sexual stimulation is needed; erections aren't automatic.)

All three drugs pose risks for patients with heart disease, low blood pressure or angina (chest pain). They also interact with drugs called alpha-blockers, used to treat the urinary problems of prostate enlargement. The combination could produce blood pressure that's dangerously low.

Most seriously, these drugs shouldn't be taken by men who use nitrate medications for heart trouble. That combination has killed men who used both types of medication.

"You need to rule out certain things before you throw Viagra at people, which is why I don't think people should go to the Internet and get it," Stinson said.

Levitra claims results in 20 minutes, while Viagra takes up to an hour to work. The duration of effectiveness is similar, about three to five hours. Levitra marketers say that unlike Viagra, it can be used successfully when taken on a full stomach.

"I'm not sure that this new one's going to overwhelm us like Viagra did," Stinson said. "It's not going to offer that much more, compared to Viagra."

By contrast, the third medication, Cialis, claims effectiveness of up to 36 hours.

"In Europe, it's called 'Le Weekend,'‘" Weart said.

CAUSES AND EFFECTS

Even with some caveats, treatments for erectile dysfunction have become a multibillion-dollar business since former U.S. Sen. Bob Dole discussed "ED" in those early, somber Viagra commercials.

The "little blue pill for men," originally developed to treat heart trouble, turned out to have sexual benefits as "sort of a serendipitous side effect," said Dr. Randall Rowen, chairman of the pharmacy practice department at USC.

Men who got the medicine during clinical trials didn't want to give it up, he said.

An estimated 20 million American men suffer erectile dysfunction to some degree, according to "The Johns Hopkins Medical Guide to Health After 50."

Up to 75 percent of cases have medical causes such as nerve disorders, vascular problems and effects of medications such as those for hypertension or depression. All can interfere with the blood-flow process that produces an erection.

Older men are more likely to be on these medications, which is one reason they are more likely to suffer from ED. It also can result from prostate surgery, obesity, diabetes, smoking, low testosterone levels or excessive drinking.

At the National Men's Health Clinic in Columbia, one of about 30 such clinics around the country, patients range from age 18 to 98. The average is 55 to 64.

The men's most common complaint is that they cannot achieve or maintain an erection, Dr. W.R. Ameen said.

Dr. Rex Dillingham added: "They're not personally happy about it, and they feel obliged to do better, for their wives if for no other reason."

Whatever you think of the Viagra commercials featuring Dole and others, they brought a difficult subject out into the open.

Many a male patient now feels comfortable asking a female nurse about Viagra samples, said Stinson, who practices with University Specialty Clinics.

"Viagra really helped to break down people's inhibitions," said Ameen, a longtime family and emergency physician before he went to work at the clinic.

"Years ago, a big he-man wouldn't come in and tell you he couldn't get" an erection.

Ameen and Dillingham see tougher cases of ED at the clinic, which draws about 50 patients a day, six days a week. Most of their patients already have tried Viagra. Many come from out of town.

The clinic's doctors often prescribe Viagra with other therapies. Dillingham said given the similarities between Viagra and Levitra, there may not be a vast difference in how they work.

"But to some patients, it could be an important difference," he said.

Some men find Viagra is less effective over time, he said. And doctors treating other diseases, such as hypertension, sometimes find subtle differences in how patients respond to similar drugs.

Ameen said the main benefit for some men might be mental: new drug, new name, perhaps new success.

"It's common knowledge how much the psychological effect plays a part with sex," he said. "The sexual act itself is complicated as all get-out."

Also, he joked, "Clemson fans will certainly think it's going to work because it's orange."

AN ONSLAUGHT OF ADS

Makers of Viagra, Levitra and Cialis have commented on their marketing strategies -- though none satisfactorily has explained why products to boost male virility all have names like department-store perfumes.

Viagra is appealing to younger patients with spokesmen such as baseball player Rafael Palmeiro and NASCAR driver Mark Martin.

That makes sense, Rowen said.

"There's a large number of people with erectile dysfunction who are younger than the Bob Doles," he said. "I think they're trying to tap into a market that doesn't typically go to the doctor a lot but could benefit from this drug."

Besides being marketed in the Mike Ditka ads, Levitra is being promoted in a "happy couple" ad that also has a football motif. A man practices hurling a football through the opening of a tire swing, then goes off arm-in-arm with his wife. The message is, "Sometimes you need a little help staying in the game."

As for Cialis, with its claim of 36-hour effectiveness, it is tempting to suggest a celebrity with staying power -- Cal Ripken? Michael Jordan? Tony Bennett?

But Eli Lilly and Co. and partner ICOS Corp. say they will eschew celebrities for advertising that emphasizes a normal, spontaneous sex life.

Diagnostic work for erectile dysfunction may be covered by insurance, but medications might not be. Nor is there anything but anecdotal evidence to suggest that Viagra works for women.

Prices for Levitra are comparable to those for Viagra at about $10 a pill.

"Maybe the competition will drive prices down," Stinson said.