VIAGRA CAUSES STIR IN WAR AGAINST IMPOTENCE; MANY WHO TRY IT SING THE PRAISES OF NEW `WONDER DRUG'.

Byline: Carol Bidwell Daily News Staff Writer

When Bob, a 34-year-old San Fernando Valley businessman, suffered a back injury in a traffic accident six years ago, he needed surgery to regain the ability to walk.

But nothing could save another important function; he resigned himself to the loss of sexual potency and kissed his sex life goodbye.

But two weeks ago, his doctor wrote him a prescription for Viagra, the first in a new class of oral medications designed to enable impotent men to have erections again without unconfortable-to-painful implants or injections. Bob wasted no time downing the first dose and putting it to the test.

``All of a sudden, it's like ... Wow! You go! It's working again!'' marveled the Viagra booster, who declined to reveal his last name. ``Does it work? On a scale from 1 to 10, it's about a 15. It's like a wonder drug.''

According to a drug industry study, Bob is one of more than 100,000 impotent men nationwide who've pinned their hopes of a normal sex life on a little blue diamond-shaped pill. And, despite medical experts' warnings that Viagra doesn't work for all men with erectile dysfunction (ED), more than 70 percent of 4,500 men who took the drug in test studies have been ecstatic with the results.

Since mid-April, Dr. Vincent Gualtieri, a Sherman Oaks urologist, has prescribed Viagra for 50 to 60 men, and more stream into his office every day.

``I've written so many prescriptions, I'm getting writer's cramp,'' Gualtieri said. ``I've heard back from a few patients, and they're very happy. One individual who's in his late 60s said he felt like he was in his 20s - but that's not going to happen for everyone.''

Gets the blood moving

Viagra, generically known as sildanafil citrate, is a phosphodiesterase type 5 inhibitor that improves blood flow to the penis. The drug, produced by Pfizer Pharmaceuticals, was originally formulated as a treatment for high blood pressure, but tests revealed a better, more lucrative use.

Industry experts say sales of Viagra as an impotence treatment could top $5 billion a year in a field where $1 billion in sales is considered a blockbuster level for a new drug.

Viagra's appeal is simple: Until now, impotence treatments ranged from inconvenient to painful. The most popular involved injections of a drug into the base of the penis or insertion of an implant into the urethra.

Now, men can simply take a pill an hour before they expect to have intercourse.

But, unlike other impotence treatments that make the penis painfully erect almost instantly for an uninterrupted four or five hours, Viagra provides a more natural effect. But it needs some help to work.

Patients are told to take a 50-milligram tablet, then fill the next hour with the kind of sexual stimulation that used to get them in the mood for romance naturally. Once an erection is achieved and intercourse accomplished, the erection subsides until further stimulation occurs; with the proper stimulation from a sex partner, a man taking Viagra can have sex as many times as he - or his partner - wants during a four- or five-hour period.

The most common side effects of Viagra are headaches (although some patients say they suffered a headache only the first time using the drug), facial flushing and indigestion. But pharmacists and doctors say patients are putting up with these minor discomforts in exchange for a normal sex life.

Patients are warned to take only one dose a day. And doctors have been cautioned not to prescribe Viagra for men taking nitrite inhalants, nitroglycerin for chest pain or other nitrite-based drugs because the combination could make their blood pressure plummet dangerously.

Popular pill

The drug some men hail as a medical miracle was approved by the U.S. Department of Agriculture in late March, and began showing up on pharmacy shelves in mid-April.

``It's been the fastest-selling drug I've ever seen,'' said Danny Ruiz, a pharmacist at Capitol Drugs in North Hollywood, one of the first Los Angeles-area pharmacies to dispense the drug. ``We had a waiting list before we even got the drug. People who have had problems with ED are singing praises to God. I had one client saying it made him feel like a 16-year-old boy. He had sex four times in one night.''

The new drug is the talk of the town. On television, on the radio, even in chat rooms on the Internet, would-be Casanovas are discussing whether they could enhance their normal sexual performance with Viagra. Even women who want to improve sexual function are asking doctors whether the impotence drug will help.

Alas, Pfizer said it only completed testing the drug on impotent men, so it's unknown what effect, if any, it would have on men with normal sexual abilities - or on women.

And the new drug is only available by prescription. It's prescribed only for men who are considered to be medically impotent, with a consistent inability to achieve or maintain an erection sufficient for intercourse.

That doesn't include men who occasionally can't perform sexually, say medical experts. Every once in awhile, doctors say, just about every man's mind writes a check that his body simply can't cash.

Enormous market

Viagra could potentially help a lot of men.

As many as 30 percent of American males suffer from chronic impotence, medical experts say.

Erectile dysfunction is most often caused by diabetes, hardening of the arteries or other vascular diseases, central nervous system injuries or hormone imbalances, or by medications such as diuretics and other blood-pressure medications, tranquilizers and anti-depressants. Long-term use of tobacco, alcohol or street drugs can also cause impotence.

And although 95 percent of ED is treatable, medical sources say only 5 percent to 7 percent of men ever seek medical help. Instead, they suffer from loss of self-esteem, depression and marital problems that can lead to separation or divorce.

``Sex has always been proof of manhood,'' Gualteiri said. ``And not being able to have sex normally ... can be devastating with some couples.''

The convenience of popping a pill to overcome impotence has already encouraged more men to seek help for the problem, said Dr. Donald Motzkin, a Van Nuys urologist who for years ran a group called Impotents Anonymous of San Fernando Valley.

``This pill is going to tell men, `You don't have to lose interest in sex,' '' Motzkin said. ``Most men are too embarrassed to talk to their doctor about erectile dysfunction. They're too macho to mention it. And it's so personal that most doctors are uncomfortable even asking about it. But this is going to increase the number of people coming to doctors for treatment because it's so easy.''

In the three weeks since Viagra has been available, the number of men seeking impotence cures has skyrocketed, according to IMS America Inc., a private drug industry researcher. In the first week of April, only 11,549 men nationwide had prescriptions filled for impotence cures; last week, there were 119,810 new prescriptions filled - and nearly 95 percent of them were for Viagra.

It's not cheap

The good news is, Viagra works.

The bad news is, the drug is really expensive, wholesaling for about $8 and retailing for about $10 to $12 per pill.

Kaiser Permanente, one of the nation's largest HMOs, is still pondering whether to allow its doctors to prescribe Viagra and whether the HMO should pay most or all of the cost of the drug for patients, a spokeswoman said.

But most major insurance companies - when assured that the drug is medically necessary to treat impotent patients - are paying for anywhere from a half-dozen a month to a 30-tablet monthly prescription, said Allen DeWaal, pharmacist at Capitol Drugs in Sherman Oaks.

According to pharmacists,Blue Cross of California is ``rationing'' the drug.

The insurer will pay for only six pills a month - and only if a patient's impotence stems from diabetes, prostate surgery or other identifiable medical cause, said Blue Cross spokesman Peter O'Neill.

``It's a very complicated issue,'' he said. ``It's the first time we've dealt with this. It begs the question, what is the normal amount of sex per month? There's no easy answer.''

Blue Cross made the six-pills-a-month decision after consulting with university medical sources.

``We knew if we restricted it to one or two (pills a month), the (Blue Cross) members would be up in arms,'' O'Neill said. ``But if we came up with 30 a month, that would be cost-prohibitive.''

DeWaal said many of his customers are dismayed to learn that their insurance won't pay for Viagra, ``but most of them will pay for it themselves, they want it so bad.''

Customers say it's worth whatever it costs to have a normal sex life again.

``Let's face it: Sex sells,'' Ruiz said. ``It's almost like we're in another sexual revolution.''

CAPTION(S):

3 Photos

Photo: (1--Cover--Color) RX FOR SEX

Hot-selling Viagra revolutionizing impotence treatment

(2) Local pharmacists and physicians are having trouble keeping up with the demand for Viagra, which retails for about $10 to $12 per pill.

Myung J. Chun/Daily News

(3) Originally formulated to fight high blood pressure, Pfizer Pharmaceuticals' Viagra now dominates the market for anti-impotence drugs.

Associated Press