Here is another element ol the Viagra Myth has pervaded our culture! many young men, nervous or insecure about their sexual prowess and performance, assume that having a guaranteed superhard penis is the ultimate path to happiness. Is this true! Does Viagra actually increase rigidity for men without erection problems! And does an extra-hard penis really reward the man who already functions normally, even if this requires a drug to help him accomplish such a goal? Or is this another Faustian bargain with i profound but hidden cost to pay further down the road?

In examining the severity of ED , those patients with mild to moderate ED , which is defined by IIEF erectile function domain scores of 17-21 , 35 % responded to placebo with improved erections compared with 87 % with sildenafil ( P < . 0001 ). For patients with severe ED , which is defined by IIEF erectile function domain scores of 6-10 , 12 % responded to placebo compared with 65 % to sildenafil ( P < . 0001 ). Sildenafil also has been effective across multiple etiologies . In the same 1 I double-blind , placebo-controlled , flexible-dose studies at week 12 , patients were divided into organic , psychogenic , and mixed etiologies of ED and were asked about improved erectile function at the conclusion of the study. In those patients with organic ED , 18 % of placebo patients responded compared with 69 % of those administered sildenafil ; in psychogenic patients , the response was 38 % for placebo versus 86 % for sildenafil ; in mixed etiology patients , the response was 28 % placebo compared with 85 % for sildenafil . All of the responses were highly statistically significant at P < . 0001. When counseling patients , it is important to identify the response of any ED treatment agent by organic etiology such that they can be counseled based on the evaluation of their risks and their likelihood to respond to treatment . Sildenafil citrate improved erectile function across etiologies. In a group of patients in 11 double-blind , placebo-controlled , flexible-dose clinical trials at week 12 , diabetic patients responded quite well. There was an 18 % place- bo response for Type I diabetics versus 59 % with sildenafil. For Type Il dia- betics , there was a 17 % placebo response compared with a 63 % sildenafil cit- rate response . Both of these were high statistically significant . Stuckey et al . evaluated 188 Type I diabetic men with ED treated with sildenafil . In assessing SEP-4 , 68 . 4 % of the patients treated with sildenafil compared with 26 . 5 % of those treated with placebo responded ” yes ” ( P < . 0001 ). Other end- points also showed a high efficacy and adverse events were rare. There is some reduction in response for patients with complications of diabetes . In these patients , the more complications of diabetes there are and the more dif- ficult the diabetes is to control , the weaker the response is to sildenafil . In these studies , of those patients without any complications of diabetes , 8 % of place- bo patients responded compared with 69 % of those administered sildenafil . With one complication of diabetes , placebo response was 12 % compared with 43 % for those who administered sildenafil . Of those patients with two or more complications of diabetes , 10 % of those administered placebo responded com- pared with only 43 % of the sildenafil patients. Complications included neuropathy , ocular changes , and other vascular disease . Hypertension is a well-known risk factor for ED , increasing the prevalence of ED beyond normal age increases . Although sildenafil has a mild hypoten- sive effect , it has been proven to be safe and effective in treated and untreated hypertensive men. Sildenafil was also demonstrated to cause an excel- lent response in patients with treated and untreated hypertension who had ED. In a mixed group of hypertensive patients , 18 % responded to placebo versus 70 % to sildenafil ( P < . 0001 ). In patients taking two or more antihy- pertensive medications , patients were well treated and responded well to silde- nafil treatment. In evaluating the improvement in erections , 17 . 6 % of patients improved with placebo compared with 71 % with sildenafil . When evaluating the percent of successful attempts at intercourse , 26 . 1 % of patients had successful intercourse on placebo compared with 62 . 9 % on sildenafil . This translated into an increase in successful numbers of intercourse attempts per week from . 66 for placebo to 1 . 6 for patients treated with sildenafil . These efficacy measures were consistent with no increase in adverse events includ- ing headache , vasodilation , or dizziness. Smoking has been widely demonstrated as a risk factor for ED. Furthermore , sildenafil has been shown to augment endothelial-dependent vasodilation in smokers. Sildenafil citrate appears to be effective in improving erections in patients who are current and ex-smokers . In those patients who smoke currently , 25 % responded to placebo compared with 80 % to sildenafil . In ex-smokers , there was an 18 % placebo response compared with a 76 % 7 sildenafil response . When comparing these groups with patients who had never smoked , 26 % of patients responded to placebo and 74 % responded to sildenafil citrate . All of these values had a statistical significance of P < . 0001. Psychologic etiologies are also significant risk factors for ED . Depression has been demonstrated in a number of epidemiologic studies to be as high as second behind severe vascular and cardiac disease as a cause of ED. It is also widely known that patients who are more severely disabled by depres- sion are more severely disabled by their ED. In a 12-week study of place- bo versus sildenafil that reviewed the response of patients with mild untreated depression and ED , patients who responded to sildenafil or placebo had a decrease in their depression scores , which was measured by the Beck ‘ s depres- sion inventory and the Hamilton depression rating scale. Patients taking selective serotonin reuptake inhibitors ( SSRIs ) for depression also respond well to sildenafil treatment . Nurnberg et al . compared more than 3000 patients with significant depression , more than 1000 of them taking placebo and more than 2000 of them taking sildenafil . The endpoint measured was the ability to obtain and maintain an erection satisfactory for vaginal penetration comparing placebo , baseline , and treatment at the end of 12 weeks . In all of the groups , sildenafil improved erectile function more than placebo and baseline at a highly statistically significant value . Although the patients treated with SSRIs had a slightly less response than those without SSRI treatment , the difference between SSRI-treated and untreated patients was not statistically significant . In patients with major depressive disorder ( MDD ) treated for depression , silde- nafil appears to be effective in treating pre-existing ED that persists after MDD therapy. In SSRI-involved ED , sildenafil has been demonstrated to be effective in open-label and placebo-controlled trials. Other neurologic conditions can also be treated effectively with sildenafil . In a study by Giuliano et al . , a group of patients with spinal cord injury were queried regarding their ability to maintain an erection with baseline placebo compared with sildenafil . The responses to sildenafil , although less than those of patients without neurologic injury , were highly statistically sig- nificantly better than those of baseline or placebo ( p < . 0001 ). In men with spinal cord injury , ED treatment will improve erections and have a major impact on self-esteem and quality of life.

Introduction

Erectile dysfunction ( ED ) is a highly prevalent condition affecting as many as 50 % of men 40 years of age or older . ED , defined as ” the inability to obtain and maintain erections sufficiently to allow sexual intercourse “, has been widely studied for many decades . The first breakthrough in effective , minimally inva- sive , safe treatment was the establishment of the oral agent sildenafil citrate for the treatment of ED . ED can be caused by systemic diseases , especially those effecting the vascular system or nervous system and can be associated with pri- mary or secondary psychologic complaints . The incidence and prevalence of ED increases with age , with the incidence doubling with each decade of life after the age of 50 . As men age , conditions of aging appear and medications for treating these chronic conditions are used widely . Many of the medications used to treat chronic conditions such as diabetes , hypercholesterolemia , renal disease , and depression will exacerbate ED . The most common culprits for medically-induced ED are antihypertensive drugs and antidepressants . Pelvic surgery and radiation therapy for conditions of aging such as prostate cancer and colon cancer may also produce ED . Life style conditions , such as cigarette smoking , obesity , sedentary life style , and the metabolic syndrome are also associated with ED .

Sildenafil

Sildenafil citrate ( Viagra , Pfizer , New York ) was first introduced to the US mar- ket in April 1998 . During the past five years , more than 20 million men world- wide have been treated with Viagra , with more than 10 million men in the US alone . More than 24 million prescriptions have been dispensed . This accounts for more than 100 million prescriptions worldwide , including 700 million tablets . It has been estimated that 8 . 6 sildenafil tablets are dispensed every sec- ond worldwide . More than 500 , 000 physicians are prescribing sildenafil ; it has been approved , widely used , and accepted in more than 110 countries.

Why not brand drug and why generic?

1. Generic drugs have all the active elements of a brand name drug. But still you get it at reasonable rates. The pharmaceuticals that produce these drugs don’t have to spend money on research, advertising or even marketing the drugs. So there is no extra cost involved while selling these generic drugs. And it comes to you at a very reasonable rates. Generic drugs are as much as 70% cheaper than their brand name drug.
2. Generic drug is less expensive.
3. Generic drugs, as effective as brand-name drugs.

Makers of Generic medicines must prove their drug quality to get an approval. It should be:

• Safe as brand name drugs.
• Made under proper manufacturing laws.
• Includes the same ingredients but can vary in color, shape etc.

Since generic drugs are made under strict regulations, it is as safe and effective as brand name drugs.

Generic drugs, similar in strength.

• It has the same therapeutic effect as that of brand name drug.
• Both drugs are similar in its strength.
• Their effectiveness lasts for the same period.
• It’s similar in dosage and administration.

Who makes Generic drugs?

Some times, companies who make brand name drugs engage themselves in making generic drugs as well. Because of its growing popularity, pharmacies sell two versions of the same drug. The first one using the expensive brand name and the second one using the generic name. Some drug companies only make generic drugs. No matter who makes them, these drugs should meet the standards before it is brought out into the market.

Price: It is the vital element, which helps sell generic drugs. When you get the same effect of a drug, meeting all the essential standards, in a much low priced drug, you wouldn’t want to waste a penny. That’s why generic drugs have flooded the world drug market and its popularity is increasing with each passing day. Today, you will not find a generic drug for all brand name drugs. But, with more and more people reaching out for generic drugs, it’s certain that pharmaceutical companies will come forward to help us lead a better ‘less expensive life’.