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Erection Drugs on the Way
New Drugs, New Interest in Older Erection Techniques
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By Daniel DeNoon
By Stephen Weber,MD
WebMD Medical News
Move over, Viagra here comes the competition. New
drugs and new interest in older methods mean more
erections for more men.
Viagra's release in 1998 helped many of the 30
million U.S. men who have problems getting erections.
Problem solved? Not yet. Viagra can't help everyone.
Some men can't safely use it because they are on
other medications, have other illnesses, or experience
side effects. And for other men, Viagra just doesn't
work. For these men and their sex partners, claims
that Viagra has cured erectile dysfunction have
been misleading and frustrating.
But the huge research effort that Viagra spurred
has already provided new insights into male sexual
function and new treatments, some of which will
be available soon.
The Challengers
What's wrong with Viagra? Nothing, for men in whom
it safely works. But that hasn't stopped two major
drug companies from getting ready to release their
own Viagra-like drugs. Eli Lilly and Company's much-anticipated
drug, Cialis, may be ready to come to market later
in 2002. Bayer's offering, vardenafil, should be
ready some time in 2003. They work much the same
way as Viagra, but they should have fewer side effects.
Whether they will prove safer or more effective
remains to be seen.
Cialis works faster than Viagra in about 15 minutes
instead of half an hour. It lasts a lot longer,
helping men get erections for 24 hours vs. the four-hour
window Viagra provides.
Vardenafil yet to get a catchy brand name seems
to work for men with many different types of erectile
dysfunction. It seems to work especially well for
men whose erectile dysfunction is related to diabetes.
In one clinical trial, it worked even better for
diabetic men with severe erectile dysfunction than
for those with milder problems.
Other Oral Alternatives
Uprima was to have been the next treatment advance:
By stimulating the brain rather than the muscles
and nerves of the penis, Uprima placed under the
tongue produced strong erections in most of the
men on whom it was tested. It had preliminary approval
from an FDA committee before it was withdrawn by
the manufacturer: A small number of people passed
out after taking it. It's available overseas, but
plans for a U.S. release are on hold.
That hasn't stopped Nastech Pharmaceutical Co.
Inc. from developing a nasal version of the drug.
In a preliminary study, it helped men with several
different kinds of erectile dysfunction and none
of them passed out. Large-scale clinical trials
are planned this year.
Yohimbine is another popular nerve-blocking agent
used to treat this problem. It's been available
in the U.S. for many years, but carefully designed
studies convincingly show that it isn't very effective
in promoting normal erection and sexual performance.
The amino acid arginine has been touted as a natural
alternative to other erectile dysfunction drugs.
When studied under rigorous conditions, though,
results have been disappointing.
What About Injections, Pumps, and Implants?
For men who haven't had success with oral treatments,
there are other alternatives. One highly effective
treatment given by injection is called Caverject.
This requires the man or his partner to inject the
medicine into his penis near where it attaches to
the body.
Injecting medications into the penis can make some
men cringe. In others, it is a difficult and discouraging
process to go through. But for many it has meant
the return of a satisfying sex life. The dosage
of these injections has to be carefully adjusted
for individual men. It is extremely dangerous to
experiment with somebody else's injection prescription.
There's also a system called MUSE (medicated transurethral
system for erection). The man inserts a small pellet
filled with the same medicine in Caverject directly
into the urethra, the hole at the tip of the penis.
Once inserted, the medication spreads through the
penis tissues, producing an erection. As with injections,
many men find this to be a highly satisfying means
of restoring their sex lives.
The major side effect of MUSE and Caverject is
pain in the penis.
Although it was once considered a last resort,
vacuum constriction and external erection devices
are actually preferred by a small number of erectile
dysfunction sufferers. Most vacuum devices consist
of a chamber in which the penis is inserted, a pump
to create the vacuum that will draw blood into the
penis, and constriction rings that are fastened
over the base of the penis once it is erect.
The design of external erection devices tends to
be more varied.
Both of these technologies have been helpful to
some. Remarkably, they've only gained acceptance
in the medical community in the past 15 years, but
the American Urological Association now promotes
them as viable alternatives for treating erectile
dysfunction. And then there are implants.
These come in two basic types: inflatable and flexible.
Both require surgery. Men and their partners tend
to be highly satisfied with the results.
Inflatable implants consist of fluid-filled rods
(placed in the penis), a pump (placed in the scrotal
sac), and a reservoir (placed in the abdomen). Pushing
the top of the pump fills the rods with fluid and
offers erection on demand; pushing the bottom of
the pump deflates the penis. This type of implant
has a lifetime of about six years.
Flexible implants are semi-flexible rods that allow
the penis to be bent down after intercourse. This
type of implant can last a lifetime but sometimes
wears out. Both types of implants can have problems.
There always are risks from surgery, and about
one in 20 men report pain or discomfort after getting
the implant.
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