Since the famous “little blue pill” exploded on to the market in 1998, becoming the fastest selling drug in history, the American pharmaceutical giant has made vast sums marketing it to erectile dysfunction sufferers all over the world. Within three months of its launch, Viagra had already earned Pfizer $400m, and over the past two decades, it has consistently generated annual sales to the tune of $1.8bn.
However, this will soon come to an end, as in 2020, Pfizer’s remaining patents on Viagra expire for good. A whole host of generic versions have emerged in the past six years, often in quirky forms such as mint strips or breath sprays, as Pfizer’s grip on the rights to the drug has slowly loosened.
Since Viagra was launched, few genuinely novel therapies have been developed, and while Viagra and similar drugs like Cialis and Levitra – which all increase blood flow to the penis by blocking an enzyme known as PDE5 – are effective in around 70% of patients, they come with significant downsides.
To start with, there are often prominent side-effects ranging from headaches to stomach pain. In addition, with Viagra taking more than an hour to work.
The drugs can often be unsuitable due to potentially dangerous interactions with medications for high blood pressure, or hypertension. For patients with the most severe forms of erectile dysfunction, often resulting from nerve damage due to diabetes or prostate cancer surgery, Viagra typically doesn’t work at all.
The only alternatives to Viagra consist of medications which need to be injected directly into the shaft of the penis in order to improve blood flow, or complex surgery to fit penis pumps or prosthetic implants. Neither are particularly palatable.
Viagra 2.0 - In the early 2000s, scientists at Futura Medical, a pharmaceutical company in Surrey, came across stories of a heart disease medication that appeared to accidentally induce erections.
“There were some anecdotal reports of people deliberately spraying this product on to their penises,” says Ken James, head of research and development at Futura. “These observations had been reported in the scientific literature, and the company thought there might be a commercial opportunity.”
The reported effects were due to a particular molecule known as glyceryl trinitrate or GTN, which causes the dilation of blood vessels in the penis, increasing blood flow. But the reason why Futura were so intrigued was because, while Viagra, Cialis and other drugs have to be taken orally – meaning they reach the target area via the bloodstream and so interact with other systems in the body – GTN could be rapidly absorbed into erectile tissue through the skin. This meant that it could potentially be applied directly as part of a gel or cream, with almost instantaneous results and none of the troublesome side effects associated with Viagra.
“There were some anecdotal reports of people deliberately spraying this product on to their penises,” says Ken James, head of research and development at Futura. “These observations had been reported in the scientific literature, and the company thought there might be a commercial opportunity.”
The reported effects were due to a particular molecule known as glyceryl trinitrate or GTN, which causes the dilation of blood vessels in the penis, increasing blood flow. But the reason why Futura were so intrigued was because, while Viagra, Cialis and other drugs have to be taken orally – meaning they reach the target area via the bloodstream and so interact with other systems in the body – GTN could be rapidly absorbed into erectile tissue through the skin. This meant that it could potentially be applied directly as part of a gel or cream, with almost instantaneous results and none of the troublesome side effects associated with Viagra.
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Even when Viagra works, one of the problems for people who need to take it indefinitely is that it becomes less effective over the course of months or years. They take Viagra for five, six, 10 years, and some days they feel that there is little improvement in function.
Desperation has pushed many patients towards unscrupulous private clinics around the world, who promise an ultimate cure, offering treatments like shockwaves, stem cell infusions and injections of platelet-rich plasma on an unregulated basis. But all of these therapies are highly experimental – as an example, shockwave therapy is currently only approved by the US Food and Drug Administration to stimulate wound healing, as scientists are still working on establishing the best doses for efficacy and investigating long-term safety.
In northern California, a group of scientists have identified a genetic switch which is thought to be unique to sexual function. They believe that this switch plays a crucial role in controlling the brain signals which initiate an erection, and new genome editing technologies such as Crispr-Cas9 could one day allow scientists to reactivate this switch in patients.
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