an on off switch in the off position

Not long after its introduction in 1998, Viagra had become a household name. Millions of men have asked their doctors for a prescription for the erectile dysfunction drug. Lots more would like to take it without a prescription, but so far that has not been legally possible.

Viagra Online: How Good Is It?

That hasn’t stopped men from seeking sildenafil (Viagra) online from websites around the world. An article in Forbes (Sept. 12, 2013) reported that:

“Up to 77 Percent Of Viagra Bought Online May be Fake, And Possibly Dangerous, Research Shows”

That was based on a 2012 study reported at the World Meeting on Sexual Medicine.  The Forbes article went on to note that large quantities of fake Viagra have been seized by FDA and customs officials:

“In January, 2013 customs officials intercepted 180,000 counterfeit Viagra pills at Miami International Airport….Here are a few of the ingredients found in confiscated counterfeit Viagra:

  • Blue printer ink
  • Speed or amphetamine
  • The antibiotic Metronidazole (Flagyl)
  • Drywall and plaster
  • Other ingredients and dyes used to mimic the texture and color of real Viagra

Official OTC Viagra…in Britain:

One could understand why a lot of men might be reluctant to ask their doctors for a prescription for Viagra. Sex is a sensitive topic. Many guys would prefer not to admit to themselves or their health professionals that they are experiencing erectile dysfunction (ED). That’s why the idea of OTC Viagra is so appealing.

Next year British men will be able to purchase Viagra Connect, an over-the-counter version of the drug, in their local drugstores. And while the men can skip the chat with their doctor, they will have to speak with the pharmacist.

British pharmacies have a behind-the-counter (BTC) status that does not have an American equivalent. The pharmacists will evaluate whether Viagra Connect is suitable for each adult patient. That allows them to check for dangerous drug-drug interactions.

Behind the Counter (BTC) Drugs:

For reasons that mystify us, the U.S. Food and Drug Administration has opposed the idea of a third class of drugs. These meds would be sold from behind the  counter with pharmacist approval and oversight. Countries like Australia, Canada, the Netherlands and the UK have this third BTC category.

Examples of drugs sold behind the counter is such countries include diphenoxylate (Lomotil) for diarrhea, diclofenac for pain and inflammation and nystatin for fungal/yeast infections. While small quantities of ibuprofen or naproxen are sold over-the-counter, larger amounts often require a conversation with a pharmacist.

Pseudoephedrine Is BTC to Prevent Manufacture of Methamphetamine:

There is just one example of a behind-the-counter drug in the US. It is pseudoephedrine (Sudafed). This oral decongestant can be used to make methamphetamine. The BTC category is used in this country not so much to protect the patient from complications as it is to prevent people from buying cold medicines and using the raw ingredient pseudoephedrine as a building block to create meth.

OTC Viagra in the UK:

A lot of men will read about OTC Viagra in Britain and wonder why they won’t be able to buy it the same way in the US. They will feel cheated. They may even start pressuring the FDA to allow OTC Viagra.

When drug companies lose their patent protection, they sometimes request permission to sell the prescription drug over the counter. Just think of Flonase, Motrin IB, Nexium, Nasacort, Oxytrol, Prevacid, Prilosec, Xyzal and Zyrtec.

Why OTC Viagra is NOT a Good Idea in the US:

Because the FDA has resisted the idea of the BTC drug category, we think OTC Viagra is a bad idea in the United States. Men with heart disease, liver failure, kidney damage or those taking medicines that interact badly with sildenafil will not be able to purchase Viagra in a UK pharmacy. That is why men must consult with their pharmacists. The UK Medicines and Healthcare Products Regulatory Agency, which made the decision to take the drug OTC, hopes that having Viagra available without a prescription will cut down on the amount of counterfeit Viagra men may encounter online or through other less legitimate channels.

Stories from Readers:

Rusty in California points out the price differential:

“I have bought both Viagra and Cialis from India for years. Initially I thought I was buying from a Canadian pharmacy, but it was just a front for an Indian supplier.

“The pills are not the same as the Cialis you get here. One Cialis from my local pharmacy lasted for 3 to 5 days and was good for multiple uses. The crap from India takes 2 to 3 pills to work anywhere near as good and it does not last more than 1-2 days.

“The difference is 200+ pills for $120 or no more than 6 pills (no matter what my doctor prescribes) at $40/ pill. I can live with the inefficiency at this price difference.

“I would much rather have the brand name drug where I know the quality, but not willing to pay that price or have my insurance company tell me how often I can have sex.”

Rich in Charlotte, NC, also complained about the cost:

“My pharmacist just called to say that Viagra has jumped 25% in price since I last filled it and 100% since 2014. Viagra hasn’t been covered by my insurance for at least 10 years. I just wrote my two Senators – one of whom states that he favors free-market solutions to rising health-care costs. I urged him to lead the charge in Congress for applying that free-market approach to where we can buy our drugs, including Viagra, outside the U.S.”

J.F. and her husband found an alternative to Viagra:

“My husband has been taking a much-needed antidepressant (Effexor) and we’ve had no sex life. He just ate a can of beets and wow: we’re back in business.

“He hadn’t wanted to take Cialis or Viagra for fear of side effects and interactions, but considers beets perfectly safe. I looked online and apparently in some ancient cultures beets were considered an aphrodisiac.”

Viagra Side Effects:

J.F.’s husband was right to worry about side effects and interactions. Just because a medication becomes available over the counter does not mean it will lose its potential to cause adverse reactions.Here are some complications associated with Viagra:

Viagra (Sildenafil) Side Effects:

Headache, dizziness, fainting

Flushing, stuffy nose, congestion

Changes in vision or hearing, hearing loss

Digestive tract upset, indigestion, diarrhea,

Skin rash, sensitivity to sunlight

Persistent erection (requires emergency medical treatment)

Bleeding problems, hemorrhage

The People’s Pharmacy Perspective:

We have long encouraged the FDA to consider a BTC drug category. Pharmacists are highly trained. They could determine who might safely have access to drugs like Viagra. Such decisions should be based on the person’s medical history and other medications. Who better to prevent drug interactions than the pharmacist who already has a list of everything you take?

What do you think? Should the FDA ever permit OTC Viagra? Should it be behind the counter? Share your own experience with Viagra or Cialis. Did these drugs work? What about side effects?

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  1. Pat
    GA
    Reply

    Get a prescription for sildenafil from your primary care doctor. So much more reasonably priced. A pharmacist told us about it, in place of the outrageously priced Viagra.

  2. K
    USA
    Reply

    I agree that BTC for more drugs is a good idea, just not sure that this one is a good candidate for several reasons. One, not all pharmacists are interested or take the time to talk to people and this adds another un-funded mandate to their already pressured time, two, will a guy really want to talk to a female pharmacist about this? and three, I see the potential for misuse by younger men who will want a harder or stronger hard and use it to abuse the woman they have sex with. That last one can already happen, but it’s less likely to probably when you have to talk to a doctor and go through your insurance company not pay cash.

    Some years ago when these drugs first became available, Ann Landers or Dear Abby ran a survey about whether women were glad or sad when their husband had access to the drugs, Overwhelmingly, the response was no, they were not happier. I doubt the results would be much different now.

  3. vincent n.
    Reply

    As a family physician, I support BTC and generic Viagra. It is disgraceful how the price has escalated and the patent protection been extended in this country, but not other countries. Lobbyists at work! It is a generally safe and effective medication that is being denied to the men of this country.
    VN

  4. Larry M
    Raleigh, NC
    Reply

    > Pharmacists are highly trained.

    Yes, but not so highly motivated. For a year a Raleigh pharmacist filled my late wife’s prescriptions for an anti-seizure medication and for Ultram, known to cause seizures in at least 5% of patients. He never mentioned the conflict.

    You might wonder whether he was really unmotivated or just too busy. I think I figured out which when I called him on it–asked why he hadn’t mentioned that Ultram might be causing the seizures–and he said “Not my job.”

    Making Cialis BTC would result in two cases:
    –Some pharmacists would approve it for everyone with minimal, cursory checks.
    –Some pharmacists would deny it to everyone, on religious or moral grounds, without saying why.
    Neither of those is a useful result.

    I’ll stick with ordering sildenafil from a CIPA-certified Canadian pharmacy. The generic is less than 50 cents per 5mg tablet. Real Cialis is about 75 cents per 5mg tablet.

  5. Charles R C
    Houston Texas
    Reply

    The FDA is a corrupt organization with government protection. They sell their permissions to market a drug to the highest bidder. Maybe at one time the FDA operated as it was originally intended but big money and perks from the pharmaceutical industry (which is now protected by the USA government) has changed their focus. Don’t forget to include the cost of your doctor visit in the cost of your medications which runs up the price considerably. Consider the mandates on vacicnes which are not so safe but required by law.

  6. Peggy S
    California
    Reply

    Hey J.F. I want to know if the beets work for women as well?

  7. Michael
    FL
    Reply

    Ask your doctor for generic 20mg pills (qty 90 or “3 month” supply which are available NOW. Start with one and check it out increasing if necessary. Use GoodRX coupon at Costco 90 pills work out to 50 cents each!

  8. Bob
    Virginia
    Reply

    I tried the expensive stuff. Ok but the out of sight price made me try by cutting a pill in half. It worked, so I tried cutting it in quarters. It worked as well. (I kept the quarter pills in a “dry” bottle with desiccant.) It just took a little longer to work but don’t wait too long or you will forget what you were planning to do. (86 year old, Ha Ha)

  9. lthough
    Reply

    I have purchased & used generic Tadalafil (Cialis) with great results. Although both branded Cialis & Viagra were very inexpensive & required no prescription in the Dominican Republic, where I first began purchasing them, they are extremely expensive in the USA.

  10. Wally
    florida
    Reply

    When I lived in Costa Rica I bought generic Viagra OTC for years and never had any problems and it worked fine.

  11. Joseph B.
    Texas
    Reply

    Permitting BTC viagra or authentic Generic forms would counteract the fraudulent marketing of sex performance concoctions that do not work. What an enormous amount of money is being extorted by these alchemists from desperate men. Shame on Phyizer(?) for such high pricing of its product. A lower price would increase their profit.

  12. John
    Raleigh, NC
    Reply

    I recently got a prescription for sildenafil, 30 pills. I think the cost was around 2 or 3 dollars a pill. I break them in half and take a half tab, just to put a little more charge in the battery… a little more octane in the tank. It works very well for me and, at this price, the sildenafil is incredibly affordable.

    I think requiring a prescription for this type of medication limits use of the drug to those who need it enough to be motivated to ask their doctor for a prescription. Making Viagra/Cialis available BTC would make these meds more accessible, but also more accessible to those who would abuse them and use them improperly. It’s a double edged sword.

  13. Wythe
    Georgia
    Reply

    ED drugs should be avail able at least BTC. Also, alprostadil cream should be made available, as it is in other countries.

  14. Bill
    Ontario
    Reply

    I’ve been buying cialis from India for years, and at $1.50 per pill it is much more affordable than the $15.00 per pill charged by the pharmacies in Canada. The quality is very good, and the effects last for three days. I have to have them shipped to a mailbox in the U.S., as the Canada Customs seizes any shipments of medications, however small. The U.S. customs don’t seize any package containing less than 200 pills. The trick is to find a pharmacy in India that sells a good product. There is also a generic cialis sold in the Dominican Republic for about $1.50 per pill, and it’s very good quality.

  15. David
    Texas
    Reply

    Mylan makes or rather sells a generic Cialis through Canadian Pharmacies. Also generic Cialis made in India is available from Canada. Be more selective in the products you allow to be dispensed. It is your prescription. Canadian pharmacies will work with one as regards the source of their material. What continues to be disturbing is the price differential between the same products in Canada and the USA.

  16. Greg
    Dallas, Tx area
    Reply

    I started purchasing generic sildenafil citrate. 50 pills for $85. Take 3-4 and just as good as the VERY expensive Viagra, A much better alternative.

  17. Carol
    Reply

    Not all of us have a neighborhood pharmacist who knows all the drugs we take. I have two pharmacies I use – the local one for short term meds and the required mail order one my insurance company chooses. Does each know of the other’s meds supplied? Maybe the mail order one does but that doesn’t help me with the local pharmacy. Or maybe I don’t understand the connection of my local pharmacy to the insurance company’s data.

    • Sally
      WA
      Reply

      You can always tell the pharmacy what medication you take. I always have a list in my purse what I’m taking and the dose.

  18. Bob
    Durham
    Reply

    The problem is not talking to my doctor or a pharmacist. The problem is the cost. Last time I filled a perscription for viagra they wanted $400 for 6 pills. That’s insane. I pushed the perscrption back accross the counter and walked out.

  19. nathan
    dallas
    Reply

    I used to take one pill of 100 mg Viagra from Canadian Pharmacy, and I was in business. Now, I need to take 3 or 4 pills, and it weakly works. It causes me severe stomach upset. I don’t know: is it me or the pills? Any advice is appreciated. NM

  20. Annie
    Reply

    FYI. Viagra is available in pharmacies in NZ after consultation with the pharmacist. Price $1 to $3 per tab depending on strength. This is for genuine Viagra or Cialis.

    Also we have no pseudoephidrine available OTC in NZ. It was prohibited several years ago because of the illegal meth labs. It may still be available on specialist prescription, I don’t know for sure.

  21. ed
    Texas
    Reply

    Forget OTC why not generic ? Right now Viagra is $40 a pill , that’s insane!

    • Joe
      Dundalk, Md.
      Reply

      Annie, how do I get in touch with a pharmacy in NZ?

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