Author Archives: Dr. Pullen

Generic Sildenafil: A Little Not-Blue Pill for ED

Sldenafil 20 mg- Little not-blue Pill

On sports radio this morning I heard two consecutive advertisements for mail order pharmacies selling generic sildenafil 20 mg to treat erectile dysfunction (ED) as a substitute for Viagra.  This is an issue because of the odd patent law in the U.S and the high cost of brand name ED medications.  The generic name for the ingredient in Viagra is sildenafil.  It has two FDA approved indications.  One is for idiopathic pulmonary hypertension, for which a dose of 5-20 mg dose three times daily is recommended. The patent on sildenafil (Branded as Revario for pulmonary hypertension) has expired and generic versions of sildenafil 20 mg are available and FDA approved to treat pulmonary hypertension.  Viagra, another brand name for sildenafil,  is marketed and FDA approved for treatment of male erectile dysfunction (ED) at doses of 25, 50 and 100 mg to be used 30-60 minutes before erection is desired.  Sildenafil is not available as a generic in the U.S. at 25, 50 or 100 mg doses.

$$$:  The big issue with use of Viagra is cost.  Viagra 100 mg. per GoodRx.com at the least expensive pharmacy option (a membership plan) costs $299.99 for 6 tablets.  This is essentially $50./ 100mg dose.  Even broken in half and used at 50 mg dose this is $25./ dose.  Generic sildenafil 20 mg per GoodRx.com can be purchased #30 tablets for $19.25 (with free coupon, usual cash prices as low as $2-3.00 / tablet)

Physicians are allowed legally to prescribe FDA available medications for “off label” indications as long as they feel that the off label indication treatment is reasonable, a better option than FDA approved options, and that the patient is informed and agrees to the treatment. In the case of sildenafli this is just an issue with available dose options, and a common practice is to prescribe generic sildenafil 20 mg 1-5 tablets in place of Viagra 100 mg 1/2 -1 tablet.  If a patient uses 5 of the 20 mg pills at a cost of $3-15 the savings over a 100 mg Viagra tablet that costs $50 is significant.

Use of generic sildenafil in doses from 1-5 tablets in place of brand name Viagra is a very viable option that I have recommended to patients in need of an ED medication.

Top 20 Research Studies of 2015- AFP Article

I read the American Family Physician fairly regularly and sometimes I come across an article good enough to summarize here.  In the May 1, 2016 issue is an article titled, “Top 20 Research Studies of 2015 for Primary Care Physicians.”  In each AFP is a section called POEMs, for “Patient Oriented Evidence that Matters,” and… Continue Reading

A Better Approach to Diet for Type 2 Diabetes

For years I’ve sent my newly diagnosed and poorly controlled patients with type 2 diabetes to diabetes education classes.  There they are taught many helpful skills, including how to test their blood sugars at home, how to watch for complications of diabetes like foot ulcers and infections, and a big focus is on how to… Continue Reading

Overoutrage: The Right Way to Determine Healthcare Policy?

I came across a very interesting article today in The Health Care Blog by Saurabh Jah, MD titled Overoutrage and the Assymetric Skepticism of Healthcare Journalists. This addresses a concept I’d not heard of until now. Here is a quote from the above linked article: “Overoutrage is excessive moral outrage. Outrage is excessive anger. Anger is… Continue Reading

Blood Pressure: How Low is Low Enough

A new clinical trial published in the New England Journal of Medicine called the SPRINT Trial ( Systolic Blood Pressure Intervention Trial ) which compares standard treatment of hypertension to a goal of a systolic BP < 140 compared to more aggressive treatment to a goal of systolic BP <120 was published on Nov. 9,… Continue Reading

Editorial on PSA Screening for Prostate Cancer

If you’ve been following this blog for a while you may have noted a number of posts on the dilemma of overdiagnosis and PSA screening for prostate cancer.  We used to thing that all cancers has a common characteristic that once established they inexorably progressed, eventually becoming symptomatic and often lethal.  We now know that… Continue Reading

WHO: Red Meat, especially Processed Meat Causes Cancer

Although I believe the findings in the WHO report the conclusion of the WHO that eating processed meat, and even eating meat at all, causes cancer this information adds very little to my reasons not to eat meat. Some of you may recall from a prior post that I chose to eat a plant based diet… Continue Reading