1. Buy generic drugs instead of name brands. Check with your doctor first, but often generics are much cheaper alternatives to name brand drugs that do the exact same thing. This tip is especially true if you have taken a certain medication for a long time. It’s likely that in the years you have been taking it, the original patent expired which allows generic medications to be formulated. You could literally cut your costs in half just by checking into generics.
2. Consider a different brand name of medication. This tip requires that you pull out the prescription drug list for your insurance company. That’s because they group medications into categories usually called tiers and each tier is more expensive. The categories are usually called generic, non-preferred, preferred, formulary, etc. All this means is that certain brands cost more. Again, check with your doctor to see if you can switch brand names of medications to allow you to get cheap prescriptions.
3. Use your AAA Discount. If you are a member of AAA, then you may or may not know that you are automatically eligible for a 15% discount on brand-name prescriptions and a 35% discount on generic prescriptions. Just go to the AAA website and print out a card. You will present this card along with your AAA card to get the discount. Most places won’t give you a discount if you already have insurance. But if your insurance doesn’t cover a certain drug, then pull out the AAA discount.
4. Use your AARP prescription discount. This works very similarly to the AAA discount, but check them both because your prescription may cost less with one plan than the other.
5. Sign up for drugstore discount cards. Every major drugstore now has their own discount prescription program including Walgreens, CVS and Rite-Aid. These plans are usually free or very low cost, so look into them and see if they can provide you with discount medication.
6. Buy your prescription medications at Walmart. Love them or hate them Walmart saves you money. They offer a large number of prescription drugs for only $4 for a months supply. They call this program 4 prescriptions. To view the entire list of discount medications, go to: http://www.walmart.com/4prescriptions
7. Investigate prescription medication prices at Costco and Sam’s Club. Like Walmart, both Costco and Sam’s Club have prescription programs too, don’t leave them out when you are calling around for prices.

Tips & Warnings

• The best advice is to call all of the above places with a specific drug name and get the pricing. This will save you the most money and get you cheap medications.
• Unfortunately, you may have to place different prescriptions with different pharmacies. While inconvenient, it can be extremely cost effective.
• Although pharmacists are usually very well trained, don’t switch medications without consulting with your physician first.

Cialis, a drug marketed by Lilly-ICOS, a joint venture between Eli Lilly and ICOS Corp., emerged as the top option in one trial, and Levitra, sold by Bayer and GlaxoSmithKline led its rivals in the other.

The studies are to be presented at the sixth congress of the European Society for Sexual Medicine in Istanbul on Monday.

The results are likely to give the companies ammunition in their fierce battle for market share with Pfizer’s Viagra, the first drug of its kind on the market that revolutionized the treatment of erectile dysfunction, or impotence.

Excerpts from a study of 150 patients carried out by Hamburg urologist Hartmut Porst showed that 45 percent of patients preferred Cialis, 30 percent Levitra and 13 percent Viagra.

Twelve percent had no preference.

“The overwhelming majority of the patients prefer the two new drugs with tadalafil being ahead due to its long duration of action,” the study said.

Tadalafil is the name of the active chemical in Cialis.

Another study, led by Frank Sommer at the University Medical Centre in Cologne, showed that 43 percent of men in a high dose, three-way preference trial preferred Levitra.

Forty percent of the patients preferred Cialis and 17 percent preferred Viagra.

Levitra was also found to be the preferred option at a lower, initial dose, with Viagra second and Cialis third.

Currently 86 men have completed the maximum dose trial and 47 the lower dose trial.

Viagra, Levitra and Cialis all work by blocking an enzyme called PDE-5, which affects blood flow and is important in treating erectile dysfunction.

Their relative merits with respect to speed of action and duration of effect are disputed, but analysts say the two new drugs have widened the market for anti-impotence treatments.

Researchers at the University of Wisconsin-Madison report this month that Viagra increases the amount of oxytocin released by stimulation of the posterior pituitary gland, a small structure directly underneath the brain that regulates hormone levels in response to neural signals.

The finding is the first indication of a chemical mechanism through which erectile dysfunction drugs like Viagra may have physical effects besides increasing blood flow to sexual organs, says study author Meyer Jackson, a physiology professor at the UW-Madison School of Medicine and Public Health.

Sometimes called the “love hormone” or “cuddle chemical,” oxytocin plays several important roles in social interactions and reproduction, including triggering uterine contractions and lactation. It is also released during orgasm and has been linked to sexual arousal.

Oxytocin release is regulated by an enzyme that acts like a braking system, limiting hormone release by dampening neural excitation of the cells. This same enzyme, phosphodiesterase type 5, also limits blood flow by contracting the muscles around blood vessels.

In both places, sildenafil works by blocking this enzyme, essentially releasing the brakes, explains Jackson. In blood vessels, relaxing smooth muscle increases blood flow, which corrects erectile dysfunction, and in the posterior pituitary, the cells become more responsive. “The same stimulation will produce more [oxytocin] release.” He says, “I think this is a missing link in terms of trying to sort out the issues around whether there are additional effects of phosphodiesterase type 5 inhibitors,” which include Viagra, Levitra and Cialis.

The new report was published online and appears in an upcoming issue of the Journal of Physiology. In the study, the scientists measured oxytocin released from rat pituitaries in response to neural stimulation. When the pituitaries were treated with sildenafil, they responded to the stimulation by releasing three times as much oxytocin as they did without the drug. Importantly, the drug had little if any effect on hormone release in the absence of stimulation, Jackson says. “Erectile dysfunction drugs do not induce erections spontaneously, they enhance the response to sexual stimulation,” he says. “The same thing is happening in the posterior pituitary — Viagra will not induce the release of oxytocin on its own, but it will enhance the amount of release you get in response to electrical stimulation.”

Though he doesn’t think his findings raise any significant safety issues related to Viagra use, he does think it provides strong rationale for studies of additional effects and new potential uses. “A big question raised by our study is, will sildenafil do the same thing to the nerve terminals that release oxytocin [in the brain]?” he says. The cells that supply oxytocin to the pituitary come from a brain structure called the hypothalamus, which also sends hormones throughout the brain.

Though sildenafil’s effects on these pathways are still unknown, work by other researchers has shown that oxytocin-sensitive cells in the brain play a role in the neural control of erectile responses, suggesting that Viagra and its kin may work through multiple channels.

The famous blue pills could have other uses as well. Oxytocin has been linked to the ability to make strong social bonds, while sildenafil was recently shown to improve hamsters’ abilities to adjust the timing of their internal clocks to overcome simulated jet lag. “This is one piece in a puzzle in which many pieces are still not available,” Jackson says. “But it raises the possibility that erectile dysfunction drugs could be doing more than just affecting erectile dysfunction.”

[tags]viagra, oxytocin, sildenafil, erectile dysfunction drugs[/tags]

AIDS Healthcare Foundation, (AHF) the nation’s largest AIDS group and a direct provider of HIV/AIDS medical care to tens of thousands of AIDS patients in the US, Africa, Central America and Asia, issued a warning today that it expects Pfizer, Inc., the world’s largest pharmaceutical company, to run a Valentine’s Day-themed ad for Viagra as part of its ongoing shameless holiday-themed advertising campaign for its blockbuster sex drug.

For the past several months, Pfizer has been running a direct-to-consumer holiday-themed print ad campaign that AHF believes promotes unsafe sex by encouraging the recreational use of Viagra on holidays such as New Year’s Eve and the Super Bowl. AHF fully expects that Pfizer will not overlook Valentine’s Day as another prime opportunity to play on men’s vanity and fears in order to increase its profit margin and push its erectile dysfunction product at the expense of public health with another irresponsible Viagra ad.

Previous ads in Pfizer’s Viagra campaign included the New Year and Super Bowl print ads. Some of those full-page, color print ads ran in such papers as The Los Angeles Times, the Wall Street Journal, the Los Angeles Daily News (and likely appeared in other markets throughout the nation). The ads depict a handsome, over-forty male grinning knowingly at the camera with the taglines:

• “Be this Sunday’s MVP” (Super Bowl Viagra ad)
• “What are you doing New Year’s Eve?” (New Year’s Eve Viagra ad)

The Super Bowl advertisement also included the following carefully worded reminder: “ED is an issue with half of all men over 40.” The use of the word “issue” seemed designed to capitalize on men’s fears, while giving Pfizer wide latitude to imply that as many as half of all men over 40 are afflicted with the medical condition Erectile Dysfunction, and could benefit from its product. AHF is concerned that the ads encourage recreational use of the drug, which in turn contributes to the spread of HIV/AIDS, and other sexually transmitted diseases.

“This shameless campaign for Viagra is soft on science and heavy on hype,” said Michael Weinstein, President of AIDS Healthcare Foundation. “While Pfizer may be following the letter of the law in its ads with disclaimers and FDA-mandated product information and warnings at the bottom of its ads, we believe it fails to honor any spirit of the law or sense of truth in advertising, and we are asking the FDA to immediately crack down on this irresponsible direct to consumer ad campaign. By using such non-scientific and open-ended language as saying ‘ED is an issue’ in its ad, Pfizer all but states that half of all men over 40 need Viagra or another such drug. Pfizer is deliberately capitalizing on Viagra’s reputation: it feels that these men need only to be reached out to and treated on national holidays that are known for partying, binge-drinking, over-indulgence and excess such as New Year’s Eve, the Super Bowl-and we expect, Valentine’s Day.”

By advertising a drug that is designed to treat a diagnosed medical condition as a way to enhance a holiday celebration, Pfizer sends a reckless message to consumers. In mid-January, AHF sent a letter to the FDA calling for a fast-track a review of Pfizer’s irresponsible Viagra advertising campaign. In its January 10th, 2006 letter to Andrew C. von Eschenbach, M.D., Acting Commissioner of the Food and Drug Administration (FDA), AHF requested that the FDA reevaluate the entire Viagra advertising campaign and consider asking for its full withdrawal, for the good of the public’s health. A similar letter was sent to Pfizer CEO, Dr. Hank McKinnell. In addition, the Foundation will closely monitor for similar Viagra ads around upcoming holidays, including St. Patrick’s Day, Cinco de Mayo and the Fourth of July.

The FDA previously made Pfizer pull ads from the controversial “Wild Thing” Viagra campaign that featured a male model sporting devil’s horns and a tail, and seemed to suggest that users of the drug could recapture the vigor of their youth.

1. It doesn’t just switch on an erection.

My first ever Viagra-popping patient necked the pill, then sat down to watch Match Of The Day.

By Goal of the Month, he was disappointed that all the action was still on the screen.

It turned out he’d been expecting an automatic erection – after all, the old treatments, including injections, worked that way. The pills are different.

They prime you for action – but you still need foreplay to get you going.

2. You’re only allowed one bonk per week on the NHS.

In fact, most men can’t get treatment on the NHS at all – it is restricted to “special cases” such as blokes with diabetes or multiple sclerosis.

Even then, the pills are rationed – the Department of Health told GPs that “one treatment per week will be appropriate for most patients”.

3. Viagra doesn’t boost your sex drive.

Remember, the pills may help blow up your balloon, but that doesn’t necessarily make you want to party.

So if your sex drive is stuck in the pits, your next stop should be your doc.

4. Viagra might work in women.

It is possible orgasm or arousal problems in the ladies could be helped.

Research continues, and the jury is out for now.

So it can’t be prescribed for this – yet.

5. Viagra shouldn’t be mixed with grapefruit juice.

Because fruit juice is less seductive than champers?

No – it’s just that grapefruit can react with Viagra, increasing the risk of side effects.

Bear in mind that taking it with food may delay its effect too (so much for that romantic candle-lit dinner).

6. The word Viagra doesn’t mean anything.

Many people believe it is a combination of vitality, to suggest vigour, and Niagara, to suggest power and, er, rushing fluid.

In fact, this is an urban myth.

The exact origin of the word is unknown.

7. It can cause blue vision.

Yes, really, in a small number of Viagra-poppers.

It’s temporary and harmless, though.

Much more common side effects are headaches, flushing or indigestion – again, these aren’t serious.

8. Viagra started life as a heart drug.

Because it improves blood flow, it was first tried out as an angina treatment.

Then researchers noticed their cardiac patients had a smile on their face and a bulge in their pants.

And the rest is pharmaceutical history.

9. Online treatments are often counterfeit.

The World Health Organization reckons about half of online sites which conceal their street address supply duff drugs.

No wonder Viagra’s cheaper on the net – avoid.

10. Viagra can help your garden grow.

The magic blue pill is used for problems other than impotence and heart conditions.

For example, it’s sometimes prescribed to treat altitude sickness and high blood pressure in the lungs.

It’s even been shown to stop plants wilting.

The Food and Drug Administration has asked maker Bayer Pharmaceutical Corp. and its marketing partners to pull the 15-second version of the “My Man” television ads that promote the erectile dysfunction drug Levitra.

The ads feature an attractive woman, dubbed “Queen Levitra” by The Wall Street Journal, who describes how the drug provides a “quality experience.”

The FDA said the ad in question failed to include certain safety information and made a misleading assertion about how Levitra compares with other drugs in the same class.

The FDA called on Pfizer Inc. to pull ads for Viagra in September because of similar concerns.

While the short version of the Levitra ad is being pulled, a 45-second version will remain on the air, said Matthew Scampoli, spokesman for the drug company Schering Corp., which handles the U.S. marketing of the drug in conjunction with GlaxoSmithKline. He said the companies will take the FDA’s guidance into consideration when developing future Levitra ads.

Losing the 15-second “reminder ad” is less of a blow because those ads are aimed at doctors who are already familiar with the product and the ailment, said Julie Donohue, a researcher who studies pharmaceutical advertising at the University of Pittsburgh’s Graduate School of Public Health.

Longer ads are geared toward general consumers with a goal of encouraging them to discuss erectile dysfunction with their doctors, Donohue said.

Physicians tend to be reluctant to spontaneously raise the topic during an office visit, she added.

The impact of FDA’s action likely will be blunted by another factor: The “My Man” campaign wasn’t long for this world, anyway.

A Glaxo official said in January that the campaign would be “refreshed” this spring, and Marie Silvia, the actress who stars in the ad, said last month she wouldn’t appear in new Levitra ads.

Direct-to-consumer advertising has been very important to the erectile dysfunction market. Between January and October 2004, drug companies spent $343 million in advertising for Viagra, Levitra and Cialis, an erectile dysfunction drug made by Eli Lilly and Icos.

Industry observers say the abundance of advertising in the United States explains why so many drugs sell here compared with the relatively weak erectile dysfunction market in Europe, where direct-to-consumer ads aren’t allowed.

Even so, growth in sales for erectile dysfunction drugs in the United States has disappointed companies.

Total sales for the five drugs in the class during 2004 was $1.36 billion, according to IMS Health, up only $100 million from 2003 despite the introduction of Levitra and Cialis. Bayer’s Levitra generated about $128 million in sales last year, third in its class.

Glaxo, whose consumer health care division is based in Moon, collaborated with Robinson-based Bayer Corp.’s German parent on Levitra.

In a press release, Pfizer stated the Canadian Federal Court in Toronto agreed that generic Viagra developed by Apotex would infringe on the American drug maker’s patent. Apotex spokesman Elie Betito said his company plans to appeal.

“We’re definitely moving to the next level,” he said. Taking the case to Canada’s Federal Court of Appeal will be pursued in line with the company’s goal of providing “affordable medication to patients.” He added that the appeal will probably take a year.

This is not the first time that Pfizer has had to fight to protect the patent for their erectile dysfunction medication. In a 2000 judgment in the U.K., Pfizer lost its first patent on Viagra as a PDE-5 inhibitor. The company retains the patent to sildenafil citrate, the active ingredient in Viagra.

In 2004, the China State Intellectual Property Office (SIPO) declared the patent for Viagra as invalid in China because it did not conform with China’s Patent Law. Pfizer appealed that decision, however, and in 2006 a Beijing court sided with the drug maker.

Pfizer now competes in the U.S. market with the erectile dysfunction treatments Cialis from Eli Lilly, and Levitra, manufactured by Bayer-AG. All three drugs treat male impotence by acting as PDE-5 inhibitors, but each offers slightly different results. For most men, Cialis tends to be the fastest working and lasts longer period of effectiveness than either Viagra or Levitra.

Even with it’s increased competition, Viagra continues to be the top selling impotence treatment. The phrase “little blue pill,” part of Pfizer’s branding, has become virtually synonymous with male sexual enhancement.

Introduced in 1998, Viagra was originally tested as a treatment for angina. While it proved to be ineffective in treating that disorder, the male participants in the clinical trials reported an interesting side effect — a noticeable improvement in erection quality. The drug was subsequently approved and marketed as a treatment for erectile dysfunction. The discovery was a tremendous success for Pfizer, with Viagra sales bringing in over a billion dollars in its first three years.

Today’s ruling prevents Apotex from introducing a copy of Viagra for seven years. Pfizer is attempting to revive sales of Viagra, which have fallen 11 percent since 2003 to $1.7 billion a year, with a new advertising campaign.

Viagra use among men 18 to 45 increased more than 300 percent between 1998 and 2002, according to a study by Express Scripts, one of the biggest pharmacy benefit management companies in North America. The number of men using the drug for legitimate medical reasons declined during that same time period.

Young men are increasingly using Viagra as a recreational or enhancement drug, according to the study.

Ashton Kutcher, the popular 27-year-old actor, admitted dabbling with the drug in a recent interview with Glamour Magazine. “I tried it, but I’m not addicted,” he told the magazine. “I took it a few times recreationally. When I was a bit more sexually recreational – when you’re involved with multiple people – it helps.”

Some use it to ward off the effects of alcohol on sexual performance after a night out.

It’s easy to buy without a prescription over the Internet, according to Dr. Abraham Morgantaler, an associate clinical professor at Harvard Medical School and author of “The Viagra Myth.”

Chino Ingram, a counselor at Vera House in Syracuse who works with young men, said he’s seen Viagra being sold on the street in Syracuse for as little as $5 a pill.

Doctors say taking potency pills you don’t need can have negative consequences.

What’s the downside?
Using Viagra or similar drugs such as Levitra or Cialis with large amounts of alcohol can lead to a drop in blood pressure, according to Dr. Richard Kronhaus, a Syracuse urologist. “That’s not a good thing,” he said. “Using any prescription drug without the supervision of a physician is not a good thing. Using one drug to counteract the deleterious effect of another is not a good thing. It could be like a truck driver using speed.”

On a purely medical basis, Viagra, Levitra and Cialis are benign drugs, according to Morgantaler. “These are very safe medicines that have been prescribed to millions of men,” he said.

The greatest danger of taking Viagra recreationally may be psychological, Morgantaler said. Some young men become psychologically dependent on the drug.

“Once they’ve taken this they may feel they need to take a pill in order to function adequately sexually. They are taking it for the emotional or psychological edge,” he said. “At what point do you say, “I don’t need these pills anymore.”‘

Morgantaler said many young men who use Viagra don’t tell their sexual partners about it. That can make it difficult to establish trust in a relationship. “If the partner finds out she may get angry,” he said. “Her response is going to be, “Why does he need a pill to have sex with me? How can I trust you?”‘

It’s not your father’s little blue pill anymore.

“A result of ecstasy is kids feel sexy but they can’t have an erection,” said Chris Haynes, 32, who gets the skinny on nightlife trends through his job as a Boston publicist. “So they take a Viagra and call it `Sextasy.’ ”

In the past two years, Kevin Kapila, mental-health medical director at Boston’s Fenway Community Health, has become all too familiar with the use of Viagra among young gay men to counteract the effects of methamphetamine use.

“The rise in crystal use is huge in the gay community here,” said Kapila. “It’s used in sex parties and sex clubs, and dance clubs, too.”

Indeed, a recent study by Express Scripts research director Tom Delate found that use of Pfizer’s Viagra by men ages 18 to 45 grew by 312 percent between 1998 and 2002. About 5 percent of the patient data surveyed came from Massachusetts Blue Cross/Blue Shield alone.

The revelers themselves wax rhapsodic about the drug’s expansive effects – though some add that newcomers to the class, such as Eli Lilly’s Cialis, pack a perkier punch.

“Cialis lasts for 36 hours,” said a man in his 30s who’s taken Viagra or its competitors six times in the past year. But that has a downside. “You can’t go to a gym,” he said. “If you ride a bike, you can forget about it.”

The man, who asked that his name not be used, popped the pills when he knew he’d be partying with two to four women at once. Intercourse is possible “with three women in a row easily,” he said, “like I was 15 again.”

Men straight and gay alike generally get their recreational supplies over the Internet, from friends with prescriptions or dealers, and even from Dad’s medicine cabinet.

The stuff doesn’t come cheap: Each pill retails for $12 – $15. But because 100-milligram pills cost the same as 50s, purchasing the higher dose and cracking it in two is the popular way to go.

Medical experts, however, sound a cautionary note – and not just because the drugs can have dangerous or even lethal reactions with other chemicals, such as nitrates. While doctors have become more comfortable prescribing the pills for performance anxiety to those well under Viagra pitchman Bob Dole’s advanced age, they’re worried that young men will see them as a panacea.

“My main concern has been among men 18 to 25 who may have no difficulties with erections and sexuality, but who have the impression that if they’re pharmacologically enhanced they’re going to be more adequate in relationships, a better lover, more appealing,” said Abraham Morgentaler, a Harvard Medical School urology professor and author of “The Viagra Myth” (Jossey-Bass, 2003), whose own patients have told him about parties among 20-somethings that feature “bowls of Viagra.” “They lose an opportunity to be accepted and loved for who they are.”

These websites often promote “Viagra” but send the consumer counterfeit drug. Some sites promote “generic Viagra” or “generic sildenafil citrate”.

Pfizer says there is no such things as a generic version of its product, because no other company is licensed to sell sildenafil citrate.

According to a recent study published in Britain, researchers purchased Viagra from several seemingly reputable Internet sources. They received what looked like branded Viagra, identically packaged like the real product. The sources of the pills were worldwide and included places like Thailand, India and Malta. The content of sildenafil was determined using near infrared microscopy.

Nearly half of the pills contained no active ingredient.

Sales of counterfeit Viagra and “generic” erectile dysfunction medications are largely driven through spam that promotes the purchase of these products. The entire profit is split between the online pharmacy and the spammer therefore making it one of the most profitable business opportunities for these so-called affiliates. “When all our relays are working, I make up to $15,000 in one day, ” said one spammer.

An investigative researcher for Impotence Magazine posed as an online pharmacy selling Viagra. By the end of the investigation, over forty prospective affiliates replied who wanted to sell the product via the high traffic generated by spam.

The investigator for Impotence Magazine also posed as a spammer by posting messages on Web sites for affiliate programs and received eight proposals from “bulk-friendly” online pharmacies. Currently, the two online pharmacies generating the most traffic from spam are “Health Suite” and “Human Nature”. They provide affiliates with numerous throw-away domain names owned by the same company that are designed to protect the Web site if a Web host decides to shut down one of the domains. All traffic is then shunted to the remaining domain names, ensuring uninterrupted spamming. In fact, the above mentioned sites have been spamming uninterrupted for over six months.

So-called “affiliate providers” have been paying off Web hosts and abuse administrators in China and other countries for years. One Affiliate Manager even guaranteed that the abuse administrator at their hosting company assures uninterrupted service in spite of complaints made.

Pfizer, in a move to thwart counterfeit Viagra, has included special radio frequency identification tags on all packages of its pill to verify they are the authentic Pfizer product. The world’s biggest drugmaker said the new technology, which is difficult and costly to duplicate, would create barriers “for criminals who might attempt to counterfeit our products.”

According to the FDA, drug counterfeiters defraud consumers by selling products that resemble legitimate drugs but may contain inactive or incorrect ingredients; contain improper doses of active ingredients; or be otherwise contaminated. Other risks and consequences of purchasing ED products online from illegitimate websites may include:

• Fake or “generic” ED drugs may be manufactured in unregulated factories, often in regions of the world that do not share the same rigorous standards for pharmaceutical manufacturing applied in the U.S.
• The drugs may contain dangerous additives
• The illegal drugs may not work as claimed, or at all
• Illegitimate pharmacies may take payment but not ship ordered products, or shipped products may be seized by the U.S. government because they are illegal
• Websites that distribute counterfeit ED pills, including “generic Viagra”, have been found to abuse credit card information

Note: It can be dangerous to get any drug over the Internet without a physical examination from your doctor including Viagra online. Do not use an Internet pharmacy that offers an online diagnosis for erictile dysfunction or any other condition. Pfizer does not sell Viagra over the Internet directly. If your doctor decides to prescribe Viagra for you, there are a handful of reputable online pharmacies. These are major, trustworthy pharmacy operations that sell drugs only if you have a prescription. Only your doctor knows if Viagra is right for you.