THURSDAY, Aug. 5, 2004 (HealthDayNews) -- After Viagra became the first impotence pill on the market, former U.S. Sen. Bob Dole, now 81, became its most famous pitchman, sharing his sexual dysfunction problems on national TV.
But Viagra is no longer the drug of just the geriatric set: Its use by younger men has grown more than threefold since it was launched in 1998, according to a study appearing in the Aug. 5 issue of the International Journal of Impotence Research.
The most surprising finding, said study author Tom Delate, is "the fact that there was less use for medical necessity." Many younger users, he suspects, are simply trying to enhance normal performance. While Viagra is not dangerous for these men, Delate wonders about the wisdom of spending health-care dollars on what amounts to recreational use of a prescription drug.
Delate, former director of research for Express Scripts, a pharmacy benefit management company, and his team undertook the study to evaluate the use of Viagra and other so-called lifestyle drugs. "We wanted to look at who is receiving them, if there is an increase in use among age groups, who is prescribing them, and do they have a medical need for these medications," Delate said.
Viagra, which helps men get erections by increasing blood flow to the penis, has been joined by two other prescription drugs for erectile dysfunction, Cialis (tadalafil) and Levitra (vardenafil), also heavily advertised to consumers.
Delate's team examined nearly 163,000 prescriptions for Viagra dispensed to nearly 49,000 patients over five years. Once those facts were obtained, he said, those who manage pharmacy benefits can decide better about coverage, Delate said. "With the cost of health care going up, are we willing to pay for lifestyle drugs for some?" he asked.
Overall, use by men increased and by women decreased (Viagra is not indicated for women). But use among younger men has escalated faster than in older men, Delate found. It use increased 312 percent in men ages 18 to 45, while it rose 216 percent among men 46 to 55 years old, he said.
However, men 56 and older continued to receive the majority of prescriptions for Viagra, Delate said.
When Delate's team looked at claims for drugs that might trigger erectile problems, they found the proportion of users who had two or more claims for that medicine had decreased, leading them to assume much of the use was for enhancement.
"It's a safe drug, particularly for young, healthy men," said Dr. Ira Sharlip, a San Francisco urologist and a spokesman for the American Urological Association. In a healthy population, he said, side effects are usually minor and temporary, such as headache, facial flushing, stuffy nose, and blurred vision.
In combination with nitroglycerin medication for heart problems, however, Sharlip said Viagra can cause a dramatic drop in blood pressure and, if the user has undiagnosed coronary artery disease, there is a risk of heart attack.
But Sharlip said many healthy users with normal erections expecting the drug to give them very lengthy erections are apt to be disappointed. "It might reduce the refractory time," he said, referring to the time lag between erections.
Many physicians, including Dr. Stephen Ross, a family medicine physician at Santa Monica-UCLA Medical Center in California, say they won't prescribe Viagra or similar drugs for healthy men who just want to enhance their performance.
"I have no trouble prescribing it for someone with a psychological problem [or] with erectile dysfunction," he said. He has prescribed it, for instance, for divorced men who have a new partner and have problems getting an erection.
But in healthy young men, the drug can backfire, Ross said. He recalls a healthy 25-year-old patient who obtained a Viagra tablet from a friend. Anticipating a romantic evening, he took the pill, soaked in a hot tub and enjoyed a glass of wine.
But when he got out of the hot tub, he fainted and ended up calling Ross, who examined him and concluded that the combined blood vessel dilating effects of the hot tub, wine, and Viagra were probably the cause of the fainting spell. The man was soon feeling fine, Ross said, but his evening didn't end as planned.
More information
Learn about the causes and treatments for impotence at the American Foundation for Urologic Disease.
