Sildenafil citrate. This is the less popular name of a drug that is extremely popular with men. Viagra, as it is known, improves erectile function.
Interestingly, this drug was not initially synthesised for use for treatment of erectile dysfunction.
It was meant to treat high blood pressure and heart diseases, but since it acquired approval for use as a treatment for erectile dysfunction in 1997 from the Food and Drugs Administration (FDA) in the US, millions of men have used it to boost their sexual performance.
For example, in its first two decades on sale, over 30 million men in 120 countries, including Kenya, bought this drug, making it one of the fastest drugs to penetrate the market.
Almost immediately after its launch in the US, it was prescribed at the rate of at least 10,000 users per day.
Within three weeks, 150,000 prescriptions had been made. This popularity has spread from the US and touched all parts of the world, including Kenya, where the drug is legally approved by the Pharmacy and Poisons Board Kenya (PPB).
The board has also approved a second brand of Sildenafil known as Revatio.
Dr Gitobu Mburugu, a consultant urologist at Kenyatta National Hospital (KNH) and chairman of the Kenya Association of Urological Surgeons, says there are three common types of drugs used to improve erectile dysfunction.
“It’s not only Viagra that is present in Kenya. There is also Cialis and Vardenafil, which are PDE5 (also known as phosphodiesterase 5) inhibitors used for the treatment of erectile dysfunction,” the doctor says.
Vardenafil is sold under the trade names Levitra vivanza and Staxyn.
The popularity of Viagra, though, has also given rise to multiple counterfeit drugs claiming to resolve this disorder, which are also flying off the shelves.
For example, a 2011 poll conducted by the manufacturer of Viagra, Pfizer, showed that 80 per cent of the pill randomly bought online is fake.
In Kenya, the PPB in 2017 also raised the alarm over the rising availability and usage of fake and substandard sex-enhancing drugs in the country.
According to the board, such drugs are the most smuggled into the country. “The major counterfeited drugs in the country include lifestyle drugs, such as Viagra, due to their high demand,” says Dr Peter Mbwiiri Ikamati, the Deputy Director at the Directorate of Product Enforcement and Regulation at the PPB.
In 2015, a Kenyan man was arrested at Jomo Kenyatta International Airport with a whopping 440,000 libido boosting pills that were estimated to be worth Sh44 million.
The man had imported the tablets, labelled Vega 100mg, from India. He told the police that he had intended to sell the drugs at Sh100 a tablet.
In March, the Kenya Revenue Authority (KRA) issued a notice through the Kenya Gazette on an impending destruction of unclaimed goods at the Eldoret International Airport.
Among these goods were drugs meant to correct erectile dysfunction that included 6,000 tablets of Vigrx Plus, 35 pieces of Viagra (50mg), and nine pieces of Cialis 20mg.
The local market for sex-enhancing drugs is growing fast. On Kenya’s online pharmacy platforms, Viagra is currently the most ordered medication.
Early this year, a report by Pfizer announced that Viagra is the most purchased drug in Kenya’s e-pharmacies.
The company’s director for regional projects, Patrick Holtz, said these high sales are being boosted by the advent of mobile technology and the internet.
The availability of the pill over the counter has also played a major role in boosting usage.
For example, a spot check by DN2 revealed that generic performance-enhancing drugs can be easily accessed over the counter at local chemists for as low as Sh50 per 50mg tablet and Sh100 for two tablets.
There are also gel and spray options, which are available over the counter and on e-commerce sites in Kenya.
For example, a gel known as Beast, claims to offer “maximum duration, pleasure, and penile enlargement”, costs Sh6,500 on Kenyan e-commerce site, Jiji.
On G Spot Kenya, a site that sells sex toys and other related products, a spray that claims to delay a man’s climaxing for up to 60 minutes costs Sh2,000. This spray is touted as an alternative to Viagra.
Viagra costs Sh1,000 a tablet while Cialis goes for Sh1,200. A packet of four tablets ranges from between Sh3,260 to Sh7,500.
The original Sildenafil citrate (Viagra) pill was sold for as much as Sh6,500 per tablet by Pfizer.
In 2017, this company developed a generic version that would go on to sell at half the original price.
What most buyers of Viagra may not know is that the sale of the drug over the counter is illegal. “Viagra is approved for treatment of erectile dysfunction and is scheduled as a prescription-only medicine,” Dr Ikamati says.
He attributes the rush for the blue pill and its subsequent abuse to misconception where sex is concerned.
“There is a misconception that the pill powers sexual activity; it should only be used if there is erectile dysfunction involved and as recommended by a physician,” he warns.
Women could get their own pill if recent medical developments are anything to go by.
In June this year, US drug regulator FDA approved a drug known as Vyleesi, which is designed to increase sexual desire in women yet to reach menopause.
The drug is being manufactured by Palatin Technologies and Amag Pharmaceuticals and will target premenopausal women with the hypoactive sexual desire disorder (HSDD), a disorder caused by low sexual desire.
This drug is expected to fly off the shelves once it hits the market in September this year with estimated annual sales of over Sh103 billion in the US, where Amag Pharmaceuticals says that one in 10 women (or 5.8 million women) suffer from HSDD.
While common assumption would be for men with erectile dysfunction (ED) to be at the forefront in purchasing the drugs, it is men with no erectile challenges leading the way.
Dr Ikamati attributes this to the misconception among sexually active men that Viagra is the key to longevity during sex.
This, he says, “is the reason most users don’t go for prescriptions”.
This is echoed by Dr Gitobu, who blames the proliferation of pornographic material as fuelling abuse of these drugs among men with no erectile disorders.
“We’re witnessing a big number of traumatised young men who are coming in with psychological impotence due to the pressure, performance standards and duration contained in pornographic materials,” he says.
Psychological impotence is a condition in which the man is unable to get an erection, struggles to get an erection, or has difficulty maintaining an erection.
When administered for its rightful use, though, Viagra can be a solution for men with erectile problems.
For example, a study titled “Sildenafil (Viagra) in the management of male erectile dysfunction in Nairobi”, which was conducted by Prof George Magoha in the year 2000, then-professor of surgery and a consultant urologist at the College of Health Sciences of the University of Nairobi, found that 91.32 per cent of men with erectile dysfunction reported improved sexual functioning after treatment with Viagra.
This improvement included better erectile and orgasmic abilities and general sexual satisfaction.
The study included 219 men with erectile dysfunction who were aged 33 years and above.
It was conducted at urology clinics at Kenyatta National Hospital and the Nairobi Hospital and was published by the University of Nairobi.
A majority of men in the study responded positively to therapy when 50mg of Viagra was used.
However, the least response level was reported by men who used the 100mg Viagra tablet.
In the same vein, usage of the blue pill without a medical prescription can be deadly.
“It can end up killing you if you use it while taking nitrate medications. These medications will cause your blood pressure to drop to very unsafe levels,” Dr Gitobu wwarns.
He explains that nitrates, such as nitroglycerin, are used to treat or prevent angina, a condition that occurs when blood flow to the heart muscle cells is insufficient.
Nitrates are also used to treat chest pains caused by heart diseases that affect the arteries in the heart.
Pfizer also says that the medication should not be taken if the user is on guanylate cyclase stimulators such as Adempas, which are used for pulmonary hypertension — a type of high blood pressure that affects the arteries that go from the heart to the lungs.
“When getting a prescription, you must tell your doctor if you have had heart surgery in the last six months; if you have had a stroke, deformed penis, sickle cell anaemia or leukaemia, kidney disease or are undergoing dialysis, liver problems, bleeding problems, or stomach ulcers,” says Pfizer in its prescription information.
In addition, continuous over-the-counter purchase and use of Viagra can result in the body developing tolerance.
This, Dr Gitobu says, means that the body will not respond to the use of Viagra, especially in a man’s later years when treatment for erectile dysfunction may be needed.
Other common side effects of using Viagra include nasal congestion that resembles the onset of a cold, backache, drop in blood pressure, photophobia, headaches, prolonged or long-lasting erection, known as priapism, and decreased blood supply to the optic nerve, which can cause sudden vision loss in people with heart disease, hypertension, diabetes, and high cholesterol.