Sildenafil is the generic name for Viagra. Its discovery as a treatment for erectile dysfunction came about by chance. Serendipity is a fancy word for “by a happy coincidence” Where “by a happy coincidence.”
You’re looking for an answer to a question and you come across a better answer to a question you’ve never asked. For scientists and doctors, the word serendipity is loaded with meaning. We just know that not all discoveries are useful, some just happen. Therefore, the word serendipity rolls off my tongue like the best of wines.
In the case of Sildenafil, it happened like this: Pfizer, a giant pharmaceutical company headquartered in New York, was working on a compound called UK-92,480. The drug was earlier shown to produce enlargement of the coronary arteries (the blood vessels supplying the heart) in hypertensive dogs, rabbits and rats.
Pfizer scientists looked at the compound’s effects in treating angina pectoris and chest pain caused by narrowing of the coronary arteries. Clinical trials in humans began in 1991-1992.
Several of the participants in these earlier studies reported a curious side effect: spontaneous penile erections! Did I mention serendipity?
UK-92,480 was later named Sildenafil (generic name). Its brand name is Viagra. He was nicknamed the “Little blue pill.”
How does Viagra work? The short answer is: by increasing blood flow to the erectile tissue of the penis. The long answer is a bit complex and beyond the scope of this article (if you’re curious, email me, and I’ll send you a full explanation).
The FDA approved Viagra in March 1998. A testament to its effectiveness and popularity is its market success. According to Fortune magazine, Viagra brought in $1.6 billion in global sales in 2016.
Clinical trials tell the same story from a different scientific point of view. In a 1996 clinical trial of 329 patients with a diagnosis of erectile dysfunction lasting six months or more, 69% of attempts at intercourse were successful compared to just 22% in patients who took a placebo.
The side effects of Viagra are mostly tolerable and reversible. The most common side effects are headaches and facial flushing. Less common side effects include nasal congestion, back pain, muscle aches, dyspepsia, blurred vision and a change in color perception – when taking it you may start to see a blue or purple tint. Other extremely rare side effects include priapism (prolonged erections), loss of vision and loss of hearing.
Do not take Viagra if you take nitrates, such as nitroglycerin. Nitrates are generally used to prevent chest pain (angina pectoris) or to treat symptoms of heart failure. Viagra enhances the effect of nitrates and taken together, a severe drop in blood pressure or even death can occur. There are other contraindications. Therefore, before taking Viagra, you should consult your health care provider.
This is what I tell patients: Viagra does not cause erections. It just makes erections stronger. To get an erection with Viagra, you need to be physically stimulated. For best results, take Viagra about an hour before sex. Take it on an empty stomach or after a light meal.
You can drink a small amount of alcohol on the nights you plan to use Viagra. Start with a low dose (25 mg) and, if your response is insufficient, try a higher dose on another day (50, then 75, then 100 mg). Do not take more than one dose per day and do not exceed 100mg per day. And, to eliminate stress and frustration, consider experimenting with the drug for yourself before trying it with your sex partner.
If you fail a trial of Viagra, you can try other drugs from the same group. Vardenafil (Levitra) is as effective as Viagra. Its main advantage is that it does not alter color perception: you will not see blue or purple. Tadalafil (Cialis) also has a similar success rate to Viagra, but has a longer duration of action (24-36 hours versus 6-8 hours with Viagra). Tadalafil can be taken daily, eliminating the need for planning before intercourse.
Viagra was discovered by accident. He joins many other “happy accident” which have turned into great scientific discoveries. Other chance discoveries include the discovery of penicillin by Alexander Fleming and the discovery of X-rays by Wilhelm Roentgen. These findings were not fully “out of the blue” chance of pure chance. In all of these events, one question had to be asked; an honest attempt should be made to answer this question; an unexpected pattern had to be recognized. The words of Louis Pasteur sum it all up: “Chance only favors prepared minds.”
Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and author of “Is life too long? Essays on life, death and other trivial subjects. Contact him at [email protected]