'MEN VALUE SEXUALITY OVER GENERAL HEALTH'

WASHINGTON (AP) -- Deaths among men who took the wildly popular impotence
pill Viagra have climbed to 16, including seven men who reportedly died
during or after sex, a reminder that sexual exertion in older men can be
risky with or without a pill.

The Food and Drug Administration said Tuesday there is no evidence that
Viagra itself is dangerous, although the agency did repeat warnings that
heart patients who take nitroglycerin should never take the impotence pill
because the drug mix can be deadly. Two deaths suggest that happened.

Doctors say if there is any risk, some men don't care.

"I've had a lot of patients say, 'If I have to go, that's the way I want to
go out,"' said Dr. Ira Sharlip of San Francisco, an adviser on impotence to
the American Urological Association.

"I've taken prescriptions out of two patients' hands who lied about (using)
nitroglycerin" because they wanted Viagra so badly, said Dr. William Steers,
the University of Virginia's urology chairman. "Men value sexuality over
general health. ... They are going to have this regardless of the consequences."

'No direct link' to Viagra

The FDA repeated that Viagra is safe and effective when used by appropriate
patients. But in response to intense public interest, the FDA posted on its
Internet site 16 deaths reported among Viagra users.

Nine men already had heart disease, including previous heart attacks, atrial
fibrillation, cardiomyopathy or high blood pressure. Because the FDA did not
receive full medical information, there is no information about the medical
history of six others, including four patients discovered through media
reports. Ages ranged from 48 to 80; most were in their 60s and 70s.

A L S O :

Reported deaths among Viagra users

"There's no direct link (to Viagra), but we are going to continue to monitor
these reports" in case a pattern suggesting a problem appears, said FDA
spokeswoman Lorrie McHugh. "The bottom line is, patients need to talk with
their health care provider and read warning labels before taking this."

The FDA will regularly update the Internet list as it learns of more deaths.
That's considered inevitable because so many older men are flocking to the
drug, the very population most at cardiac risk. The American Heart
Association counts 418,000 new or recurrent heart attacks in men over 65
every year; about 116,000 die of a heart attack.

Report 'raises a red flag'

Pfizer has counted 1.7 million new Viagra prescriptions since it was
approved in March, 80 percent of them for men over age 50.

The FDA and Pfizer have warned since Viagra began selling that men who take
nitroglycerine or related nitrate-containing heart drugs should never take
Viagra because the mix can cause large drops in blood pressure. Pfizer just
mailed 750,000 doctors a reminder warning.

But doctors are finding advice for men with heart disease who don't take the
risky nitrate drugs a little tougher.

"I'd be very careful about prescribing it for patients with heart disease
until I really understand what their level of risk might be," said former
American Heart Association president Dr. Sidney Smith of the University of
North Carolina, Chapel Hill. The FDA's death report, while not a link,
"certainly raises a red flag and makes everyone aware of the need for more
information."

Dangers of exertion

But University of Virginia's Steers said reports of possible Viagra problems
have been extraordinarily low considering how many men take it. He considers
the Viagra cautions a good reminder for doctors to more closely examine
impotent men for heart disease and get them treated.

"It's amazing how many men don't come in for health problems," but have
appeared at doctors' doors for Viagra, Steers said. "You need a complete
medical history. ... Ask them about chest pain," because that symptom is so
often treated with nitroglycerin.

Sexual intercourse increases the heart rate about as much as suddenly
running up two flights of stairs, Smith said.

So Sharlip, who has prescribed Viagra almost 700 times, counsels potential
Viagra patients over 60 and anyone with heart disease that there is a small
risk of heart attack during sex.

Checked-by: Melodi Cornett