See blue after popping the “little blue pill”


​​​​​​Dear Dr G,

I’m a 60-year-old man just getting to the age where I’m having trouble “rising up”.

I get it, technically I have erectile dysfunction (ED), and I’m tempted to take “the little blue pill”.

I am generally a cautious guy and will not take any medication without considering the risks.

However, due to the embarrassment of seeing a doctor about my condition and worried about its cost, I procured the blue pills through friends.

I know Dr. G would frown on such a practice of consuming drugs without a doctor’s prescription, but I’m just too shy to discuss bedroom matters with anyone.

After taking the pills several times, I experienced symptoms of heartburn and flushing.

I must say that most of the side effects are bearable.

The one that interests me the most is “seeing blue” when I take the blue pills. I wonder if it’s just my imagination or a serious side effect.

I would like to make Dr. G aware of the risk of taking the blue pills.

What are the common side effects of blue pills?

Are there any medical conditions that prohibit men from taking the pills? Are there serious risks such as heart attack and sudden death?


View Blue Benjamin

Prior to the 1990s, understanding of erectile physiology was deficient, and treatments such as penile prosthesis; vacuum pumps and injections directly into the penis were the only treatment options for men with erectile dysfunction. The emergence of blue pills has not only transformed the modality of treating erectile dysfunction, it has also reduced taboos in sexual medicine, facilitated research, and changed the landscape of men’s health.

On March 27, 1998, sildenafil (commonly known as the blue diamond pill) was approved by the FDA as the first oral treatment for erectile dysfunction in the United States. The drug originally called Compound UK-92-480 was synthesized by a group of chemists in England, for use in hypertension and angina pectoris. In the first phase of clinical trials, the drug was noted to have minimal impact on the heart, but tremendous response on erections. Sildenafil and a group of drugs called phosphodiesterase 5 (PDE5-I) inhibitors have become the first-line treatment for men with erectile dysfunction.

Four “shades of blue” have emerged on the market in recent years. These are Sildenafil, Vardenafil, Tadalafil and Udenafil. Five years after the blue tablets were approved, vardenafil and tadalafil were both introduced in 2003. Newcomer from South Korea, Udenafil, is also gaining momentum to help men with erectile dysfunction. All drugs work with an identical mechanism, which is the prevention of the breakdown of a component (cGMP), which improves blood flow to the penis. This would have the impact of prolonging erectile rigidity during sexual intercourse. The only differences between the four pills are pharmacokinetics for different times of onset and side effects.

The reality is that no other drug warrants the level of scrutiny, myth and causation that the blue pill does – more than 20 years after its arrival.

That’s because sex itself is too “hard” to talk about, and the sense of “guilty pleasure” will always raise the question of whether too much of a good thing is bad for you? It is now apparent that the initial fear of sudden death, strokes and heart attacks from taking the blue pill, is completely a myth and without foundation. The most common sildenafil adversity includes headaches, flushing, indigestion, and nasal congestion. Other PDE-5 inhibitors such as tadalafil also have the side effects of transient back pain.

Another unique but common side effect is cyanopsia or blue vision, which is often a strange experience that users may associate with the “punishment” of overusing the blue pill. The reason for this particular sildenafil side effect has to do with the activation of a subtype of the PDE6 enzyme, which is found in retinal cells, the light-sensitive cells at the back of the eye. High doses of PDE5 inhibitors are thought to lead to buildup of molecules, causing blurred vision and difficulty in differentiating between blue and green. Most of these side effects are transient and completely harmless.

Erectile dysfunction can also be a barometer for a “broken” heart, as the condition is a precursor to many non-communicable diseases, such as diabetes, hypertension, and dyslipidemia. Therefore, it is important to consult a doctor before taking this “magic” remedy. In fact, the assessment is simple, if one is not taking nitrite heart pills and one does not suffer from a rare condition called retinitis pigmentosa, then the pills are generally safe for consumption.

The famous scientist Stephen Hawking once said: “Look at the stars and not at your feet. Try to make sense of what you see and ask yourself what makes the Universe exist. Be curious”. Many men are attracted by the curiosity of a magic pill that can create sparks in the bedroom and forget about the real health reasons behind erectile dysfunction.​​​​​​​


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