“If you have an erection for more than four hours, call a doctor.”  It’s infamous.  Usually the reply is “Tell my doctor?  I’m telling everybody!”  But it raises the question…just how long does Viagra last in the first place?

The official statement is that Viagra lasts for about four hours, and kicks in between 15 to 30 minutes after taking it.  But that’s in a clinical environment, essentially testing the drug in a vacuum with no other factors.  It’s a good rule of thumb, but not the final word for anybody.  There are actually several things that can reduce or increase the amount of time Viagra is in your system…in some cases, by a pretty wide margin.

There are two specific and common factors that reduce Viagra’s effective time frame:

♦       Taking it with a high-fat meal.  This just is simply harder for the body to digest, and breaks down the Viagra before the full dose can get where it needs to go.  So if you’re going to be spending time with that special someone after dinner, order the salad.

♦       Drug interactions, which your doctor should be aware of before prescribing Viagra.  For example, rifampin, generally used to treat tuberculosis and…er…leprosy, reduces Viagra’s effectiveness significantly due to the effect it has on the body.  In extreme cases, Viagra just doesn’t work.  Why somebody being treated for tuberculosis or leprosy would be taking Viagra in the first place is just going to have to remain a mystery.

Increasing the time frame, on the other hand, can happen fairly easily with drug interactions as well: if you take Tagamet and Viagra, it can keep Viagra in the bloodstream for a significantly longer time, although it’s unclear as to why.  Similarly, taking CYP 3A4 inhibitors will increase the amount of time Viagra is in the blood because CYP 3A4 is the enzyme in your liver that breaks down Viagra.  Less of that, more of Viagra.  If you have liver or kidney disease, that will also slow the breakdown as they’ve got more important things to worry about than the little blue pill.

Another factor that can increase time frame is age.  Being over 65, you simply don’t process medicines as quickly, so they linger longer in the bloodstream.  And, of course, if you take Viagra with another ED drug (hint: DON’T), Viagra will spend more time with you.

All this may sound like a good thing, but it’s not.  The entire reason you have to see a doctor if there’s no erection loss after four hours is that priaprism is considered a medical emergency.  Blood is trapped in your penis and that can cause severe damage.  It’s extremely painful and may require surgery; otherwise, your penile tissues may begin to die as the blood inside them stagnates.

So, talk to your doctor about drug interactions before using Viagra, and always follow directions.  Also, don’t call your friends.  Really, they don’t want to know.

Viagra has been the number one treatment for erectile dysfunction for more than a decade.  In fact, it was a revolutionary approach to erectile dysfunction that has led the way in creating new treatments.  But what does Viagra actually do, inside your body?

To understand that, we have to first understand how the penis works.  As you experience some form of stimulation, blood vessels in the groin expand and blood fills sponge-like areas in the penis, enlarging it and pointing it upwards.  Erectile dysfunction, at its most basic level, is simply blood not flowing quickly enough to the penis, due to blood vessels being too narrow.  ED has many possible factors, including stress and diet, but Viagra goes straight to the source.

Viagra is a vasodilator, or a drug that opens up the blood vessels.  Specifically, Viagra targets an enzyme called cGMP-specific phosphodiesterase type 5, or PDE5, for short.  “cGMP” is cyclic guanosine monophosphate, which the body uses to relax smooth muscle tissues, such as the smooth muscle tissue found in the penis.

PDE5 breaks down cGMP; that’s its job.  However, if you have a combination of factors preventing blood flow to areas where you’d really like it to be, namely, your penis, this becomes a problem.  The PDE5 is just doing what it’s told, and it’s not going to stop however many Playboys you read.  This is where Viagra comes in.

Viagra introduced nitrous oxide to the party.  Nitrous oxide bonds with the PDE5 before it can break down the cGMP, allowing it to relax the smooth muscle tissue and give you an erection.  This is why one of the possible side effects of Viagra is priapism, or an erection that lasts more than four hours; if you have an excess of cGMP and lower levels of PDE5 in the first place, if you take out the PDE5, your cGMP will run wild.

It’s worth noting that just because the way is clear for an erection, though, doesn’t mean you automatically get one.  There needs to be some sort of stimulation to obtain an erection; Viagra only lays the chemical groundwork.  So, really, it only gets you halfway there: the rest is up to you.

Viagra is, of course, designed to boost anybody’s performance in a specific area.  But, it’s been shown to have other uses.  In fact, it was originally being tested as a heart medication, and is in fact used as one in certain applications.  But what about athletic performance?  Can Viagra really make you play a better game of baseball, or does it just put unnecessary strain on your jockstrap?

The truth is…the jury is still out.  Despite substantial testing, and a possible scientific basis, no real decisions one or the other are really possible.  But first, it’s important to understand how Viagra works.  It’s a vasodilator, that is, it expands the blood vessels to increase blood flow.  This is why Viagra can have side effects like swelling of the limbs: it opens up blood vessels in your entire body.  In theory, this means your exercise capacity, that is, your ability to run around playing, is increased.

In practice, it’s not so simple.  Viagra only lasts for four hours, so any effect it offers is only temporary.  While increased blood flow may bring more oxygen to the muscles, there’s no evidence that Viagra does so or that, if it does, how much effect it has on the field.

There is one area where Viagra definitely helps the performance of a certain class of athlete: namely, mountain climbers.  Mountain climbers and other athletes at high altitudes often face the problem of pulmonary arterial hypertension, or pressure on the main artery delivering blood to the lungs.  As this artery constricts, you receive less oxygen than normal and experience problems such as shortness of breath, dizziness, and fainting, all of which are less than ideal when you’re hanging off a three-hundred foot drop miles from any assistance.  Although Viagra is only a short term solution, it’s useful in high altitude situations and is often part of a climber’s gear as a medical necessity.  There has, alas, been no data on how many climbers have joined the “mile-high without an airplane” club.

But the truth is, not many athletes really face altitude conditions so extreme that Viagra could be of any scientific help.  It may be useful to cyclists or marathon runners at extremely high altitudes, but most athletes perform in areas well below the two or three miles of altitude it takes to generally induce lung problems and make it a factor.

On the other hand, never underestimate the power of the placebo effect.  If a person thinks a drug is working, the mind can often take over and give the drug an effect, even if it’s not scientifically possible.  In this respect, Viagra is like a baseball player’s lucky socks he never washes or a football player’s pre-game ritual: it’s not the physical effect, it’s the psychological one.

In that respect, as long as the athlete believes Viagra is really helping, it might as well be the greatest drug ever designed.  Unfortunately, it’s also a risky one; Viagra has side effects, like any prescription drug, and shouldn’t be taken without a doctor’s consultation.  Still, it sure beats not washing your socks, although we’re not sure what’s more awkward: the smell of rancid feet, or standing around the dugout with Viagra’s intended effect front and center.  We suppose it’s up to the athlete to decide.

Not everyone gets through their prescriptions quickly, and they find themselves looking at the expiration date and wondering “Does this last?”

It does, sort of.  Viagra, like any drug, loses its effectiveness over time as the molecules in the drug break down.  This is why most pharmacies recommend taking medication within one year of prescription; after that point, the drug will be less effective.

However, there are no side effects that come from taking expired Viagra, except for the side effects the drug itself may cause.  There’s simply less of it to affect you, in fact, so those side effects may be milder.  You should still not take Viagra, even “expired” Viagra, if you have a severe reaction to a full dose.

Five years from manufacture, it will be completely inert.  Until then, it will simply have a weaker effect than a full, fresh dose, and the older the  drug, the weaker the effect will be.  If you’d like to extend the life of your Viagra, put it in a refrigerator; the cold will keep more of the drug active for longer, due to the cold preventing molecular breakdown.  Otherwise, you can take the Viagra: just don’t expect quite as much of a lift.

-        It starts in Pfizer’s bulk production facility, which it operates in Ringaskiddy, County Cork, Ireland, along with other major drug manufacturers such as Novartis, GlaxoSmithKlein, Recordati, and Centocor.  Ten miles from the major port of Cork, the Ringaskiddy facility is responsible for putting together the bulk chemicals of the drug, using reagents and disposing of the organic waste generated by creating the custom molecules, which takes 1100 employees.  The waste adds up: for every pound of Viagra, three liters of organic waste is created.  Viagra demand can run as high as 45 tons of the drug a year.

-        The locals at Ringaskiddy believe the fumes from the Viagra plant make them more sexually athletic and fertile.  The birth rate in Ringaskiddy is a little higher, but Pfizer denies the fumes from the plant have any effect, especially since the plant has no chimney and releases no emissions.  That hasn’t stopped two scripts from being written about Ringaskiddy, including one optioned by Madonna for $2.6 million (http://www.telegraph.co.uk/news/worldnews/europe/ireland/1432373/Love-is-in-the-air.html)

-        From Ringaskiddy, the bulk elements are shipped to production facilities in America and France in shipping containers.  This is to prevent the finished drug from being stolen and sold on the black market, especially in the Third World, where counterfeit and stolen medication are booming business and 60% of the drugs for sale are counterfeit.  Similarly, the exact location of these facilities is kept quiet to reduce thievery and hijacking.  Stolen Viagra can be worth $20+ per pill on the black market, and the raw ingredients can be worth even more.

-        At the combination facility, the ingredients are combined and packaged.  Included in each bottle is a RFID tracking chip to verify quality and prevent forgery.  Viagra is one of the most commonly forged medications in the world, and the RFID chips help keep the percentage of fake medicine on the market lower than 1% in the developed world, according to the WHO (http://www.who.int/mediacentre/factsheets/fs275/en/index.html).  RFID tags are also attached to each case and each pallet of Viagra, and all of these tags will be checked before the medication is stocked.

-        From there, each package is shipped to warehouses in each country Pfizer sells pharmaceuticals in, and then to individual pharmacies.  At every port, the RFID tags are checked, right up until it reaches pharmacy shelves.

Pfizer’s patents on Viagra have either already expired, or are going to by the end of 2012.  That paves the way for producers of generic drugs to start making their own versions of sildenafil, and compete directly with the name brand product.  But this doesn’t mean Viagra sales will dry up…simply that Pfizer has to choose its strategy more carefully.  Here’s how it’ll keep Viagra profitable even when sales for erectile dysfunction start to droop.

3)      Stick With the Name Brand

Unlike other drugs, such as Prozac, Viagra doesn’t serve a vital health purpose necessarily; after all, nobody needs an erection for health.  They just really, really enjoy them.  This plays straight to Pfizer’s needs, and in fact ties into their strategy.

When Cialis and Levitra hit the market, Viagra went from 92% of all erection medication to 50%.  Still nothing to sneeze at, but a 42% loss stings any company.  Pfizer went on the offensive: while its competitors were recycling its advertising strategy of using famous older men talking about erectile dysfunction in advertisements, it emphasized its name brand.

And that’s really all it needs, for at least some of the market.  Sure, you pay more, but you get it from the people who have been making it for more than a decade.

2)      Emphasize the Other Uses

Viagra wasn’t originally developed for erectile dysfunction; it was being researched as a blood pressure and angina medication.  Pfizer simply noticed the high number of erections, presumably documented as awkward conversations with the study participants, and chose to focus on that.

Viagra has been also found to help with pulmonary edema, a common problem for mountain climbers and others dealing with high altitude situations and, oddly, it’s even shown to cure jet lag, at least in hamsters.

It may require some different brand names and marketing, but there’s no reason Pfizer can’t bring Viagra to new markets, and keep at least some of its profits.

1)      Keep On Selling

The worst case scenario for every pharmaceutical company is what happened to Eli Lilly when Prozac, their revolutionary antidepressant, went off-patent.  Within a year, generics had taken over 70% of the market for Prozac, causing them to miss an earnings target and generally wreaking fiscal chaos on them in the late ’90s.

But Eli Lilly is not only alive, but continuing to make money off of Prozac, both by rebranding it for PMDD treatment as Sarafem, and selling Prozac itself even to this day.  True, it’s not the money maker that it was…but it’s still a money maker.  And that might be the moral of the story; even with a patent running out, people will always want the original.

In 2011, the answer to who is selling the most has one drug that it definitely won’t be: Viagra.  Viagra in 2010 saw a number drop that really no drug designed to prop things up should face.  Where in 2008, it was still selling in the billions, 2009 brought a 42% drop in sales, and 2010 seems to be the first time Viagra has sold less than $1 billion world-wide.  In fact, it sold approximately half of that, $499 million, according to Pfizer’s financial reports.  Even worse, it’s about to go off-patent in 2012, but even with Pfizer’s attempt to extend that, the writing is on the wall: Viagra is wilting away.

Cialis, meanwhile, is rock-solid.  Eli Lilly’s entry into the market is notable for its ability to last longer: available in 24 and 36-hour doses, Cialis has been nicknamed “the weekender”, and compares favorably to the four hours Viagra has to grant a rise in desire.  In 2009, the latest year Eli Lilly has data available, Cialis sold a whopping $1.56 billion, only $300 million or so off from Viagra at its sales peak.  And with Cialis not off-patent until 2017, it’s pretty clear those numbers are going to stay firm for a while at least.

Finally, there’s no question who’s coming in third: Levitra, made by Bayer.  Unlike Cialis and Viagra, Levitra has never cracked the billion dollar sales mark.  Part of this is just that it’s between a rock and a hard place; Viagra, the rock, was the drug that beat it to the market and which Levitra has failed to distinguish itself against, and Cialis, the hard place, is the drug that makes even a brand name like Viagra look less distinguished.  True, Levitra lasts longer than Viagra, but not nearly as long as Cialis.  And if there’s any market where length matters, it’s this one.

On the other hand, Levitra has shown small, but steady sales growth, adding a few percentage points to its total with each passing year.  In fact, if trend continue, it’ll likely come in second in the erectile dysfunction market.  True, that’s because Viagra is taking a precipitous fall, but winning is winning, and if Levitra can outlast Viagra, it may have a chance at outlasting Cialis.

We may make fun of the Vice President, especially since in the last twenty years the office has been filled by a robot, somebody we’re pretty sure is actually a Bond villain who got the job by mistake, and some doofus who can’t spell “potato”.  But it’s a hard job, and it can weigh heavily on the mind, so can’t we all use a little lift?

Far be it from us, the American people, not to pitch in and help Mr. Biden.  So here’s how you do it.

-        Secure a prescription for Viagra.  Drugs shouldn’t be played around with, and any drug should have a prescription.  Viagra really shouldn’t be taken if you don’t need it, which is why we’re giving it to our Vice President.

-        Make sure Mr. Biden has a prescription, and that they match.  For some reason, the Vice President’s office wouldn’t give us an answer to this (in fact, they just hung up on us, didn’t even transfer us to him or anything!), so we’ll just go ahead and assume he does.  Still, his staff could stand to be more polite.

-        Choose a reputable online pharmacy with a good customer service ranking.  Ideally choose one familiar with delivering pharmaceuticals to government employees: you might want to call their customer helpline and ask, although again for some reason nobody would give us a straight answer on this one.

-        Give the shipping address as 1 Observatory Circle, Washington D.C., 20007.  You really don’t want to send it to his office.  That would just be awkward for him to have to explain to everyone involved.

-        Make sure to include a nice gift note and your return address, in case he needs to return it or would like to get in touch with you.

Sit back, relax, and enjoy, knowing that you’ve helped your fellow man.

(Editorial Note: This article is just a joke. You really shouldn’t be sending our Vice President prescription drugs of any kind in the mail.  It’ll probably get you added to some sort of list, or possibly visited by the FBI.  So don’t do it.  Or if you do do it, say you got the idea from Glenn Beck or something.)

The National Center for Health Statistics (NCHS) reported data from 2005 showing that, of people 12 years of age and older, more than 8% had used illicit drugs in the past month. 

For the dealers, however, making a living selling illegal narcotics is a risky business.  The Bureau of Justice Statistics reported that there were 195,000 felony convictions in state courts for drug trafficking in 1998, as well as nearly 25,000 federal trafficking offenses.

Being the entrepreneurs that they are, some drug dealers are opting to sell a less risky and more profitable drug – fake Viagra. Don’t fall into that trap as generic Viagra can be dangerous to one’s health.

With one in ten men having some degree of erectile dysfunction (ED), there is an incredibly large market for ED treatment drugs.  There are currently three drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of ED – Viagra, Cialis, and Levitra.  The sale of these three drugs creates a multi-billion dollar industry, but so does the sale of counterfeit versions of these medications.  In fact, Pfizer, manufacturer of Viagra, claims that it loses nearly $2 billion each year to the counterfeit version of Viagra.

The sale of counterfeit Viagra is much more profitable for drug dealers than the sale of, say, cocaine.  According to the European Alliance for Access to Safe Medicines (EAASM), the sale of counterfeit Viagra is roughly 2,000 times more profitable than the sale of cocaine.  Additionally, the penalties for dealers who get caught selling counterfeit Viagra are less severe than those for dealers selling other illegal drugs.

Erectile dysfunction drugs are readily available for purchase on the internet.  A large number of online retailers sell counterfeit Viagra under the guise of “generic Viagra.”  With Pfizer holding the patent on Viagra, any “generic” version of the drug is illegal.  “Generic” Viagra is also potentially dangerous, as the actual ingredients of the pills are unknown and unregulated.  In fact, recent reports from Singapore cited counterfeit impotence drugs as responsible for the death of four men.

With a substantially higher profit margin, less risk, and easier access to buyers (internet), it’s not surprising that dealers are dumping cocaine and pushing counterfeit Viagra instead. However, this trend has not escaped the attention of several organizations, including the FDA, the Pharmaceutical Research and Manufacturers of America (PhRMA), Health Distribution Management Association (HDMA), and the National Association of Chain Drug Stores (NACDS). All are actively working against the booming pharmaceutical counterfeiting industry. 

Still, the lure of selling counterfeit Viagra instead of illegal narcotics like cocaine is strong for many dealers, which leads the Center for Medicine in the Public Interest to project that the counterfeit medication industry will become a $75 billion a year industry by 2010.

What are your thoughts on drug dealers selling Viagra? At edrugstore.md, we strive to provide educational articles and informative information on the latest drug news. eDrugstore.md only promotes authentic Viagra online, where consumers must provide our physician with their complete medical history in order to be considered for a prescription of Viagra. 
 

Ever since the arrival of Viagra and its explosive growth as a blockbuster drug to treat erectile dysfunction in men, there has been growing interest in a "female Viagra". After all, it’s estimated that up to 43% of all women suffer from some form of female sexual dysfunction (FSD).

That translates into millions of women who either can’t get excited about sex, find it painful, or cannot achieve an orgasm. Most of these women (three quarters) are post menopausal but there are other reasons for FSD, including the use of anti-depressants.

So with all these women not having or not enjoying sex, the demand for some sort of Viagra for women is a marketing vacuum waiting to be filled.

Is there anything currently available that really works as a female version of Viagra (not counting all the herbal / natural aphrodisiacs of dubious effectiveness and safety)?

In 2001, there was a flurry of interest when the British Journal of Obstetrics and Gynaecology reported that women with FSD who take Viagra have more sexual fantasies, have sex more often, are more likely to enjoy it, and have far more orgasms. Although Viagra isn’t recommended for women, some doctors have been prescribing it "off label" for their female patients. (Viagra hasn’t been studied in pregnant or breast feeding women, so caution is advised.)

There was also talk of a womens Viagra cream (containing the same Viagra’s active ingredient, sildenafil) that could be applied to the genital area. In early trials, it seemed to have the desired effect but has so far not made it to market.

The Patch: Is a New Viagra for Women On The Way?

The Intrinsa patch showed great promise as the latest candidate for "Viagra for women". It works by boosting testosterone levels in the blood, which can help women whose hormones are declining with age or as a result of a hysterectomy.

Intrinsa was recently approved in the UK for prescription-only use by post-menopausal women. But it hasn’t been approved for sale in the US because the FDA denied Procter & Gamble a license in 2004, concerned about long term effects of the hormone.

Womens Viagra Spray

Meanwhile, another company called Palatin Technologies is racing with P & G to get their "womens Viagra" on the market first. Palatin’s product, Bremelanotide, is an inhaled drug delivered by atomizer. It works on the brain to encourage sexual arousal rather than by increasing blood flow to the genitals. And, Palatin says, Bremelanotide is effective for both men and women.

The company says a single dose of Bremelanotide "results, in most cases, in a stirring in the loins in as little as 15 minutes. Women feel ‘genital warmth, tingling and throbbing’, not to mention ‘a strong desire to have sex’."

The bad news? The New Jersey company is still conducting clinical trials and FDA approval is long way down the road.

Drug manufacturers are rumored to be working on about 25 formulations to treat female sexual dysfunction. So as the "little blue pill" for men’s sexual enjoyment approaches its tenth anniversary on the US market, women continue to wait for a product just for them… a female Viagra capable of rocking their world.

In the meantime, it appears the best alternative for women is to find a man who uses Viagra.