Cheap and effective: Desi version of Viagra finally in India

Help is now just a pill away for the Indian men facing the ignominy of impotence. Cheap and effective, the desi version of Viagra is finally here.

To begin with, the Drug Controller General of India (DCGI) has allowed three pharmaceutical companies Ranbaxy, Zydus-Cadila Healthcare and Torrent Pharmaceuticals to market the newly developed versions. While Penegra, a Zydus-Cadila product, has already been introduced, Ranbaxy’s Caverta is scheduled to step in within a week. About 11 other companies will follow suit in the next few months.

The pill treats erectile dysfunction or ED, as doctors term male impotence, with the disorder affecting one in every three men who suffer from mild to severe forms of the disease. Explains Ajit Saxena, senior consultant urologist at Delhi’s Apollo Hospital: “These patients have a normal blood supply to the penis but for some reason cannot effect local dilation of the blood vessels, so no erection takes place.”

The reasons can range from diabetes, hypertension and neurogenic causes (where the nerves are severed) to liver damage and sheer performance anxiety. Sildenafil citrate, as Viagra is scientifically known, acts by inhibiting an enzyme that blocks the blood supply to the penis.

This consequently increases the supply and leads to erection. It isn’t as if the disorder doesn’t have optional cures, but no treatment matches the drug in the sheer simplicity of its administration. Which explains the euphoric reception to its arrival.

“We can now give oral tablets to the patients,” says Saxena, “and it will also stop them from going to the quacks.” For eminent Mumbai-based andrologist Vijay Kulkarni, “it’s one more tool for treating the patient”.

Tempering the ebullience, however, are experts who sound a word of caution. Viagra is not, they emphasise, an aphrodisiac, as is widely assumed. The potential danger arising from its misuse is why it has been cleared only as a prescription drug.

Says DCGI Ashwini Kumar: “It has been approved on the condition that it be used cautiously under therapeutic conditions.” For the genuine patient though, the readily available, cheap, effective tablet is nothing but good news.

After Viagra’s four-year run in the market worldwide, the drug’s effectiveness is not disputed and is bound to have a big impact. But there’s a flipside. Sildenafil can be fatal for people on nitrates and those with cardio-vascular problems.

If taken with nitrates, it reduces the patients’ blood pressure dramatically. Possible temporary side-effects are headache and nausea. A more serious effect is loss of blue-green colour vision. The correct dose is, hence, of prime importance; all Indian versions of sildenafil will be available in 25 mg, 50 mg and 100 mg doses.

Misuse of sildenafil can also lead to tragicomic mishaps. Doctors cite numerous instances where normal people took Viagra to enhance their sexual performance. The result was an embarrassing and painfully prolonged erection that lasted for days and required surgery to rectify. Both doctors and manufacturers emphasise that sildenafil is a treatment, not a cure.

It temporarily acts on a specific part of the body but it does not solve the underlying reason for the disorder. “Sexual dysfunction is about more than just Viagra,” says Kulkarni, “Psycho-sexual counselling is very important.” All companies Torrent, Cadila and Ranbaxy emphasise the need for patients to be educated by urologists, endocrinologists and psychiatrists.

Other companies provide similar estimates. But with so many vying for a slice of the pie, a bit of shine may rub off soon. Stiff competition will define price and profit margins to the patient’s benefit. The approximate price of the new drug is Rs 20 per tablet, which is already a big gain for patients who are currently shelling out Rs 500 per tablet for the imported Viagra in the grey market.

The affordability of the genuine sildenafil brands could also adversely affect the popularity of the anti-impotence herbal drugs.

With the product being identical, marketing strategy will decide the winners and losers in the Great Indian Sildenafil Contest. Brand name, colour and even the shape of the tablets are being depicted as distinguishing features to gain an edge in the market.

As for Ranbaxy’s brand, Caverta, “the name derives from the cavernosa, the part of penis that plays a vital role in erection”, explains Kaul. Torrent’s choice, Androz, derives from andrology a science that deals with the study of the masculine constitution, according to R. Balasubramanian, vice-president, marketing, Torrent.

Penegra was Cadila’s choice both because it refers to problems of penetration, and the penis, says President Ganesh Nayak. Blue and diamond shaped, the Penegra pill is an exact copy of Viagra. Ranbaxy’s red triangular tablets are deliberately designed to be different, while Torrent’s tablets are blue and round.

“We have made a conscious effort to retain the round shape like regular tablets to tell the patients that ED is neither fun nor serious. It’s just another curable condition,” says Balasubramanian.

An India-specific marketing challenge for the companies is people’s reluctance to talk openly about sexual matters. Says Kaul: “We don’t just have to create a brand but also a market, as ED is a hush-hush affair here.” Besides, impotence is not just any other disease like diabetes or malaria.

Striking at the very core of manhood, its impact finds an echo in every aspect of man’s life: the wife doomed to a celibate existence and the boss stuck with a depressed, less-productive employee. Small wonder then that the drug is seen as the best thing to happen to the Indian male in a long, long time.

Some of the optional cures available to erectile dysfunctional patients in India are:

The most popular and affordable treatment so far has been the papaverine injection. At Rs 15-20 per shot, it is the price, not convenience, that dictates its popularity. The drug has to be injected locally into the phallus, a painful procedure that can lead to infection unless done in aseptic conditions, according to Professor N.K. Mohanty, head of urology at Delhi’s Safdarjung Hospital.

The vacuum erection device is the only non-invasive treatment that has no side-effects, says Mohanty. There are no injections, no tablets – only a hollow tube that creates a vacuum and sucks blood into the penis, leading to an erection. At Rs 10,000- 20,000 one-time cost, the price at least induces a sense of satisfaction.

Some men – such as traumatic paraplegics – suffer from extreme impotence. A penile implant is then the only option. The device is designed to last a lifetime. But, insists Ajit Saxena, senior consultant urologist at Delhi’s Apollo Hospital, implants should be prescribed only after a thorough psychological assessment, when all else fails. This procedure involves placing an artificial implant into the phallus. The price can range from Rs 40,000 to Rs 2 lakh but the result is near-normal function. The biggest drawback is infection and rejection by the body, which occurs in about 2 to 3 per cent of the surgeries.