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A third pill to treat impotence was approved by the Food and Drug Administration for sale in the United States on Friday, intensifying competition in a billion-dollar slice of the drug market. The new pill will be sold under the name Cialis. It joins Viagra, the oral drug that went on the market in 1998, and Levitra, which was approved earlier this year by the FDA. All three drugs act on an enzyme that helps prompt and maintain erections by relaxing muscles in the penis and blood vessels. The duration and onset of the drug action is different, however, with each pill. Cialis, manufactured by Eli Lilly, was found in studies to stay longer in the body than Viagra. Studies suggest that a 20-mg dose of Cialis is active for 24 to 36 hours. In France, where the drug has been on the market for some time, Cialis is called "le weekend" pill. The drug is not recommended for patients on some heart medications, such as nitroglycerin tablets or some alpha blockers, or for use in combination with the recreational substances amyl nitrate or nitrite, commonly called poppers. Combining the substances can cause a sharp drop in blood pressure than can cause fainting and even death in some men. Sexual dysfunction is relatively common as men grow older, with studies showing that about 5% of men in their 40s experience some symptoms of erectile dysfunction. The percentage of men experiencing erectile dysfunction increases as men age, with as many as half of men between 40 and 70 experiencing at least occasional symptoms. Stephen E. Goldstone, MD, medical director of the Web site GayHealth.com, has told The Advocate that gay men are typically more likely than straight men to seek erectile dysfunction treatments when experiencing even rare signs of sexual dysfunction. "We go for Botox, we go for plastic surgery," he said. "We don't want to see our erections drop as we grow old either." Medications like Viagra, Levitra, and Cialis--and even injectible erectile dysfunction treatments--also are popular among users of drugs like ecstasy and crystal methamphetamine to counter the erection-inhibiting side effects of the party drugs.
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