How abuse of the 'blue pill' could cost you your life

Concerns have been raised about the abuse of sexual performance enhancing drugs by Kenyan men and the dangers such use may pose.

Men are buying Viagra or Cialis — common drugs used to treat erectile dysfunction — over the counter in pharmacies and in online shops without being diagnosed with erectile dysfunction, also known as impotence. Some use them to prolong intercourse or to show off their sexual prowess.

The famous blue pill, Viagra, was approved 25 years ago and lately, its users seem to be getting younger, some misusing it to treat weak erections caused by performance anxiety. Others overdose on it, mix it with alcohol or other recreational drugs, or take it when they have high blood pressure, causing serious damage.

The ease of access, thanks to online shops where you can order the drugs and have them delivered to your door, has also contributed to their misuse.

A quick online search shows that more than 100 pharmacies in Kenya now sell Viagra and Cialis, indicating easy access to the drugs. Some pharmacies, where the cost ranges from Sh100 to Sh2,500, easily run out of stock due to high demand.

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The Nation.Africa sought expert opinion on who should use the drugs, and how.

Dr Ahmed Yousef, a consultant urologist at Aga Khan University Hospital in Nairobi, says the pills must be prescribed by doctors after a careful clinical examination of the patient's general health to ascertain his ability to handle the drugs.

"Normally, the strength of an erection decreases with age. However, men who suffer from erectile dysfunction may be unaware of this or may have refused to come to terms with the fact, and still want to have an erection similar to what they had in their 20s and 30s," says Dr Yousef.

Most men who experience weak erections panic and wonder what the problem could be, he says.

"That's when they start looking for easy solutions, most of them end up in pharmacies in the hope of regaining their strong erections," he explains.

So how do the pills work?

Dr Kassim Abdalla, a Mombasa-based urologist, says erectile dysfunction drugs essentially help one get and keep an erection, but they only work if one is stimulated.

"You don't just take Viagra and expect to get an erection. It doesn't work like that. You only get a good erection if you are stimulated," he says.

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Dr Yousef adds that using the pills is a step-by-step process. First, you need to lose excess weight by exercising, eating healthy foods and doing Kegel exercises, which help strengthen the pelvic floor muscles that help maintain an erection.

"Once your weight is under control, you need to undergo a cardiovascular risk assessment. If your heart is in good shape, we'll start you on the pills that you'll use while you're being checked by your doctor. For most men who have trouble getting an erection hard enough for intercourse, these drugs work well and have few side effects," he says.

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If there is no response to the oral pills, he says, a further test is carried out using a procedure in which a drug is injected to induce an erection.

"If there is a response, you will continue with that line of treatment. If you don't respond to the injection, we'll do a penile prosthesis. This is an operation on the penis to insert a prosthesis into the penis," he adds.

When does one stop taking the drugs?

Dr Yousef says that not all patients with erectile problems are allowed to use the pills.

"This is because erectile dysfunction can be a symptom of a chronic disease, most commonly cardiovascular disease, diabetes, kidney disease, neurological disease or stress. If you have these conditions, you may have experienced erectile dysfunction at some point. To qualify for the use of pills, you have to meet a clinical criterion," Dr Yousef stresses.

He adds that patients are assessed and categorised according to their cardiac risk.

"Firstly, you should not have an underlying medical condition that could be aggravated by the pills. Secondly, you need to be evaluated by a heart specialist to determine if you have any heart or high blood pressure problems and, of course, you should not have a history of heart disease," he says.

"Once you have been assessed by a heart specialist, the results of the assessment are sent to an urologist who will analyse the results and determine whether or not you are eligible to take pills, and which type," adds Dr Yousef.

Two years ago, the Pharmaceutical Society of Kenya warned men not to use sexual enhancement drugs such as sildenafil (sold under the brand name Viagra), tadalafil (Cialis), vardenafil and avanafil without the advice of a qualified doctor and a valid prescription. But some Kenyans are still buying them indiscriminately.

"The use of these drugs without prior medical evaluation makes one more vulnerable to their harmful effects," it said.

There are medical risks associated with misusing the drugs. "Men who don't have erectile dysfunction but use the drugs can become psychologically dependent on the drug, to the point of needing it to get an erection. This can eventually lead to erectile dysfunction," says Dr Kassim.

Misuse of these drugs can also lead to nosebleeds, insomnia, vision loss and heart problems. Some people may experience dizziness, headaches, prolonged erections and difficulty breathing. In more serious cases, misuse of the drugs can lead to irregular heartbeats, heart attack, stroke, and even death.

However, doctors say the pills remain safe for patients for whom the drugs have been properly prescribed.

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