Health: Move Over, Viagra

After five years of Bob Dole commercials and veritable Viagra-mania, it's hard to believe that the pill that made "erectile dysfunction" a household phrase got its start as a potential treatment for chest pain. Today Viagra is the leading drug for impotence, with worldwide sales of $1.7 billion. Its manufacturer, Pfizer, boasts that nine of the little blue pills are popped every second.

Soon pill poppers in the U.S. will have some new options. The Food and Drug Administration approved Levitra last week as a treatment for impotence. The drug, from GlaxoSmithKline and Bayer, works pretty much as Viagra does, increasing blood flow to the penis and reducing muscle relaxation. Both pills begin working within 30 minutes (although some say Levitra works sooner), both last four to five hours, and both are effective nearly 70% of the time. They also share side effects, which include headaches, nasal stuffiness and stomach upset. But for those who consider a romantic dinner an important part of foreplay, Levitra offers one advantage: it can be taken with food, whereas Viagra requires an empty stomach.

A third pill for treating impotence will probably win approval later this year. Eli Lilly's Cialis has the distinction of remaining effective for up to 36 hours. In Europe, where it is already in use, it has been fondly dubbed the weekender.

Nearly 30 million men in the U.S. suffer from impotence. Remarkably, only 1 in 5 seeks treatment, and many who do are disappointed. "A little more than half the men drop out of Viagra therapy, and probably a third don't get the effect they want," says Dr. Irwin Goldstein, director of Boston University's Institute for Sexual Medicine, "so there is room for options."

About 85% of impotence is due to such physical ailments as heart disease, prostate cancer and diabetes. Some 10% of cases have a psychological basis; the rest are unexplained.

If you think you've seen enough ads dealing with this delicate issue, brace yourself. The folks bringing you Levitra have recruited former NFL star and coach Mike Ditka for a broad promotional campaign called "Tackling Men's Health." The manly ads roll out with the start of football season. --By Sanjay Gupta, M.D.