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ISLAMABAD, March 12: Shuja Ahmed (not his real name) spoke cautiously as he lay in the cardiac unit of the Pakistan Institute of Medical Sciences (Pims), an ECG monitor beeping behind him at intervals. "I just took Viagra to improve my performance at night," the 62-year-old said meekly. "I never thought about consulting a doctor for prescription and certainly never imagined that I'll land here."
The weary looking man now deeply regrets his oversight. "The first six months I took the pills, it helped me. I did not experience any side effects. But then I started getting light-headed and dizzy, and went to the doctor who told me my blood pressure is haywire due to the pills," he said.Mr Ahmed is one of many Pakistani men who buy Viagra (generic name sildenafil) from stores to self-treat sexual dysfunction, without knowing that sale of the brand is not regularised and that it can have adverse effects if it interacts with common anti-hypertensive medications.
Doctors in the capital city told this scribe that they regularly see patients suffering from side effects from either excess consumption or because of the spurious raw materials used to manufacture them.
"Long term use of Viagra has severe negative symptoms, and we've had patients come in with life-threateningly low blood pressures," said an assistant professor at Pims. "Other common symptoms are headaches, irregular heartbeat and upset stomach." "Now we tell all our cardiac patients in advance that they should desist from using such medications for sexual dysfunction as they can interact with their current medications and make matters worse," he added.
He opines that all medications with sildenafil should be removed from the market as the health authorities have not registered the product.
On the other hand, many doctors also feel that this all-or-nothing attitude is not helpful as internationally Viagra is the prime treatment for sexual dysfunction and is legal in nearly all markets.
"Sexual dysfunction is a common problem in all age groups across the world," one of them said on the request of anonymity. "Why make it so taboo? We need to regularise such medications, and make sure only checked and authorised brands are available."
Indeed, the outlook of health authorities has done little to help solve a natural problem frequently encountered. A couple of years back, it was reported that the health authorities had decided not to regularise the sale of Viagra as "it was not in public interest". The last time this issue was picked up was in 2010 when 16 companies, including Pfizer, applied for licence but details about the progress are not known.
In this environment, sale of drugs to treat impotency and other libido related issues has boomed. A regular user of male anti-impotency drugs in Islamabad told this scribe that for the last six months a drug imported from India has taken over the market. "It was initially being sold as Vegah but is now available under other brand names as well," said Asif Niaz (not his real name). "I am okay with it – but I haven't asked any physician for it," he replied when enquired about any side effects he had experienced lately.
Meanwhile, Fayyaz Asif, a local drugs store owner, said that on an average he sells 40 tablets a day. Another medical store owner said: "Several medical stores in the city sell the medicine and because of a high demand our supply is intact."
"They can be easily obtained from all stores. Two pills of the Indian brands are sold for Rs50, but the American pills are far more expensive and are sold from anywhere between Rs800 and Rs1,000," Mr Asif added.
Mr Asif had some more interesting revelations: "Nowadays even hakeems use powdered Viagra pills and claim that it is a herbal medicine which enhances male libido."
When Dawn contacted an official of the newly established Drug Regulatory Agency of Pakistan to enquire why Viagra was not registered and tested by the Drug Testing Laboratories of the government, he replied: "Unregistered drugs are available in the market mainly because there were no regulations available in this regard however a comprehensive rule making process is in progress. Once rules are formed regarding the sale of unregistered drugs, since it's already a violation of Drug Act 1976, strict action will be taken by our drug inspectors in a few weeks' time."
The official said that it was the job of the provincial drug officials at the district level to lift such drugs from the market and impose fines. "Districts across Pakistan have their own health officers and they have the legal powers to manage such issues," suggested the official as an alternative for immediate action against the sale of unregistered drugs.
However, no comments were available that if Viagra is used to treat sexual dysfunctions the world over, why not simply regularise its sale so that counterfeit sale and side effects could be avoided.
