Q & A Library

Uprima and Cialis are only two of the new drugs for male sexual dysfunction headed toward the U.S. market. A third, Vardenafil, similar to Cialis, is also on the way. Uprima, probably the best known of these newcomers, is available in Europe and can be ordered on the Internet.

Unlike Viagra which works by increasing blood flow to the penis, Uprima stimulates the brain chemical dopamine, which sends the signal for an erection. Beause it is a sublingual (under-the-tongue) tablet, it is absorbed into the bloodstream faster than Viagra and takes less time to start working- 15 minutes as opposed to an hour. As far as side effects are concerned, one in 30 of the men testing Uprima developed fainting, nausea or low blood pressure, all of which are said to be worse when the drug is taken after drinking alcohol. But Uprima still might be a suitable alternative for those men who can't take Viagra because they take nitroglycerin for coronary heart disease (the combination can be fatal).

Cialis and Vardenafil work much like Viagra in that they boost cyclic levels of the penile blood flow activator GMP as well as causing an increase in nitric oxide, the chemical messenger that causes blood vessels to dilate. Cialis is said to be effective within 15-20 minutes of taking it. Unlike Viagra, Cialis seems to work whether or not a man has just eaten a meal or consumed alcohol.

The effects of both Cialis and Vardenfil may be longer lasting than those of Viagra. However, both drugs may cause headache, nasal congestion or upset stomach.

Since none of the Viagra alternatives are available in the U.S. at the moment, I can't compare costs. I have read that Viagra generates $1.2 billion in sales and have seen prices on the Internet ranging from $109 to $179 for 10 100mg pills. One British Internet site sells two 3mg Uprima pills for $55 and 20 for $375.

Bear in mind that some of the problems leading to erectile dysfunction may lend themselves to the following non-drug - and cost-free - solutions:

• Stop smoking (it can reduce genital blood flow and impair potency).
• Limit alcohol consumption (alcohol's negative affect on sex drive increases with age).
• Shape up (physical fitness affects sexual desire and performance).
• Deal with anxiety, depression and stress (all of which may undermine desire and potency).
• Don't worry about your age. Sexual activity needn't end because of age - that's a myth you can discard.

Andrew Weil, M.D.

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