Viagra's Debut in Canada is Richly Rewarded

It has been one year since Viagra (sildenafil citrate) was officially approved in Canada on March 9, 1999. Since then, Canadians spent over $41 million dollars on 535,000 prescriptions. According to the Intercontinental Medical Statistics described by the Toronto Star, "Ontario led the nation with more than 215,000 prescriptions, followed by Quebec with 110,500 and British Columbia with 80,000." In fact, the first three months of sales following approval made Viagra the hottest drug after Celebrex (an arthritis pill). The high demand is not set back by the price ($15 per pill) and the lack of coverage by the governmental drug plans (some private plans cover it).

Viagra is a vasodialator effective in the treatment of erectile dysfunction in up to 80% of patients who take it. It is also safe. Common side effects are headache, facial flushing and diarrhea. Less common side effects are bluish vision and sensitivity to light. According to Health Canada, forty five adverse drug reactions to Viagra have so far been reported. Twenty two of them are considered serious, i.e. they required a hospital stay, caused disability or were life threatening. However, none of these reactions resulted in death. Several deaths did occur in the United States but were attributed to excessive exertion during sex, not to the drug. Rare incidents of erection lasting over four hours have also been reported.

While up to 80% of patients benefit from Viagra, over 20% do not. Viagra is often ineffective in heavy smokers, patients with advanced diabetes or with a long history of impotency. Also, Viagra will not help if the lack of erection is due to marital problems. In this case, counseling is recommended.

Viagra is contraindicated in men taking nitrate drugs, such as nitroglycerin, because the combination can result in an unsafe or even life-threatening drop in blood pressure. These patients may benefit from a local vasodialator MUSE (alprostadil), approved in Canada several months prior to Viagra. Despite beating Viagra to the Canadian market, MUSE never gained wide popularity probably due to its route of administration--it is a urethral micro-suppository. However, it is very safe and effective in 65% of men with erectile dysfunction.

In conclusion, Canadians have good pharmacological options for erectile dysfunction with Viagra being by far the most popular option. Fortunately, patients with a contraindication to the drug can benefit from a local vasodialator MUSE.

Sources

1. Bailey S. Viagra use frisky in its first year. Toronto Star. March 9, 1999.
2. www.viagra.com

Lilia Malkin, BSc

Although many men consider a decline in sexual desire and sexual function a part of the "normal" aging process, this common misconception is being replaced by the increasingly positive outlook on sexuality that is becoming more prevalent among the geriatric population. A large proportion of older men regularly engage in sexual activity and many are addressing physical and emotional barriers, as well as some prevalent myths about sexuality.

A recent study conducted by The National Council On the Aging (NCOA) surveyed 1,300 older Americans and found that 61 percent of American males aged 60 and over are sexually active. The percentage of men who enjoy an active sex life does decline with increasing age; while 71 percent report being sexually active in their sixties, only 27 percent remain so in the 80 and over age group. However, lack of a steady partner presents one of the major barriers to continued sexual activity in the elderly, since 50 percent of men over 80 years of age who do have a partner engage in sex. Furthermore, while 39 percent of American men aged 60 and over stated that they were satisfied with how often they participated in sexual activity, the same percentage of respondents wished to increase the frequency of occasions in which they have sex.