Viagra fever

Natural Health, Sept-Oct, 1998 by Rob Ivker

Holistic physician Rob Ivker has a different take on the hot new impotence drug, Viagra.

I'm 47 and have been impotent for six years. It hasn't ruined my marriage--yet--but it's put a terrific strain on it. I'm going to ask my doctor for a Viagra prescription, but I'd like to know if you have any thoughts on its possible downside, short- or long-term.

Viagra, or sildenafil, is one of the most highly publicized drugs in recent history. And it's one of America's biggest news stories of 1998. Viagra was introduced on March 27, and it's expected that more than a million prescriptions for Viagra will be written by year's end. However, even though the initial reports on this drug are extremely promising for men like yourself who suffer from impotence, you need to know what risks it might pose and what its limits are.

This is the first pharmaceutical pill found to be effective in treating impotence, or as it's known medically, erectile dysfunction. The drug increases a man's ability to achieve and maintain an erection when he is sexually stimulated. It does so by relaxing the muscles lining the arteries of the penis, thereby increasing the flow of blood into the spongy tissue (corpus cavernosum) comprising the shaft of the penis.

Depending on which study you look at, the drug is effective between 60 and 90 percent of the time. It works best for men with milder forms of impotence that are either psychological in origin or a side effect of medication (especially drugs used to treat high blood pressure and depression). However, in men with physical and physiological causes, it works less well. This would include men with diabetes and heart disease (with concomitant arterial narrowing), or those who have had prostate surgery for cancer or an enlarged prostate.

Viagra should be avoided if you are taking nitroglycerin or similar nitrate-based drugs for treating the chest pain associated with heart disease. Viagra and nitroglycerin can combine to lower blood pressure to a dangerously low level. There have been no deaths conclusively linked to Viagra, but during the first several months of its sale there were reports of at least 30 men who died while taking the drug. The fact that 85 percent of the prescriptions filled for Viagra were for men age 50 and older, many of whom have other medical conditions like heart disease, makes it difficult to blame these deaths specifically on Viagra. As of this writing, the FDA continues to approve its sale, although there is enough suspicion of serious risk that several foreign countries, including Australia, Canada, Israel, and Japan, have yet to approve sale of the drug.

As with any potent drug, there can be uncomfortable side effects. The most common are severe headaches, skin flushing, indigestion, diarrhea, stuffy nose, urinary tract infection, and abnormal vision (a bluish tinge that can diminish sight by up to 50 percent and last up to six hours).

If you take Viagra, you should follow your doctor's prescription strictly and not take it more frequently than prescribed or in higher dosages.

Is there a natural, nonprescription alternative to Viagra?

Yes, the herb yohimbe. Before Viagra, yohimbine, the active component of the herb, was the only FDA-approved "drug" for impotence, although the FDA also lists the herb as unsafe. Like Viagra, yohimbe, or yohimbine, heightens potency and maintains erections by increasing blood flow to the penis. But unlike Viagra, it does so by increasing the body's production of the adrenal hormone norepinephrine, which is essential for erections. A 1987 Canadian study showed yohimbe to be especially effective for treating impotence in men with diabetes and heart disease. The overall success rate was 44 percent. Risks associated with taking yohimbe include both low and high blood pressure, elevated heart rate, anxiety, hallucinations, headache, and skin flushing; however, anecdotal and physicians' reports suggest that the herb is safe. It was primarily the concern with blood pressure that led the FDA to rate it as unsafe.

You can buy yohimbe in natural food stores or get a prescription for yohimbine from your doctor. Some believe that the prescription drug is more likely to be effective since the quality of over-the-counter products may vary considerably. In either case, if you have a health problem, particularly a heart condition, you should consult your doctor before taking this herb.

Another herb, Tribulus terrestris, sometimes referred to as "Puncture Vine," has been clinically shown to restore sexual potency and sexual desire by boosting levels of the male hormone testosterone. Tribulus has been used in China and other Eastern cultures for centuries as a folk medicine for impotence, and has recently been introduced to the West. Since 1981, the herb has been widely used in mainstream medical practice in Eastern Europe for both impotence and infertility. So far, Tribulus terrestris appears to be safe and no serious side effects have been reported. It can be found in a few men's health products available in health food stores.