A New “Super-Viagra” (Simenafil) and Its Consequences for the Generic Sildenafil Market

Markups for brand-name drugs facing generic pressure aren't a new phenomenon.

Other Options for the Treatment of Erectile Dysfunction

And herein lies a tale about the bizarro world of drug pricing. Generic versions of sildenafil cost as little as 44 cents per typical 50-mg dose in the U.S. when 30 pills are purchased, according to GoodRx.com. At that price, the doses needed to power a month's worth of daily intimate encounters add up to just $13.20, less than a Chipotle steak burrito with guacamole and a drink. But equivalent brand-name Viagra pills cost at least $67.12 each, or $2,013.70 for 30.

Choosing the Best Option

That's a remarkable markup of over 150 times the generic price, even though the pills share the same active ingredient and work the exact same way. A MedPage Today investigation found that Viagra is perhaps the most extraordinary example of a curious phenomenon in the world of drug pricing -- brand-name medications whose prices go up despite the arrival of stiff competition from much-cheaper generics. This isn't the way competition in capitalism is supposed to work, and it's hardly healthy for consumers. But some pharmaceutical companies are banking big-time on brand-name loyalty and ignorance about generics, and no one is going to tell viagra alternative uk them to knock it off. "Companies can decide the price of drugs in the U.S.

What is Viagra (sildenafil)?

private sector without any constraints," Enrique Seoane-Vazquez, PhD, a professor of pharmacy who studies drug pricing at Chapman University in Irvine, California, said in an interview with MedPage Today. "We may need public health campaigns explaining the value of generic drugs so patients have information and can decide if they want to expend thousands of dollars out-of-pocket to get the brand drug instead of the low-cost generic." Viagra: Still the ED Leader After All These Years Sildenafil entered the U.S. market as Viagra in 1998 and instantly revolutionized impotence care by giving men a convenient alternative to less-than-appealing erectile dysfunction (ED) treatments like penis pumps, injections, and implants. The little blue pill became a household name thanks to celebrity endorsements, TV commercials, and the world's most famous side effect. (Sorry, gentlemen, a four-hour erection isn't all it's cracked up to be.) Nearly a quarter-century later, sildenafil has spawned a handful of competitors, notably tadalafil (Cialis) and vardenafil (Levitra), but it remains the undisputed king of ED care in the U.S., according to 2018 to 2019 numbers. "The idea is that once a generic enters the market, the prices of the generic go so low in comparison with the brand that it doesn't make sense for the brand to compete based on price," Seoane-Vazquez said. This is why shelves are filled with competing over-the-counter products that are essentially the same except one costs more and has a familiar name attached -- Bayer, Tylenol, Afrin, Metamucil.

Product	Dosage	Quantity + Bonus	Price
Viagra Professional	100mg	90 + 2 Pills	207.09€ 197.23€	Buy
Viagra Oral Jelly	100mg	90 + 8 Sachets	258.02€ 245.73€	Buy
Viagra Generic	200mg	60 + 4 Pills	125.19€ 119.23€	Buy
Viagra Original	100mg	64 + 4 Pills	264.15€ 251.57€	Buy
Viagra Soft Tabs	100mg	270 + 10 Pills	419.95€ 399.95€	Buy
Viagra Oral Jelly	100mg	220 + 18 Sachets	562.28€ 535.50€	Buy
Viagra Soft Tabs	100mg	60 + 6 Pills	152.94€ 145.66€	Buy
Viagra Generic	50mg	360 + 10 Pills	225.33€ 214.60€	Buy
Viagra Generic	100mg	360 + 10 Pills	330.21€ 314.49€	Buy
Viagra Generic	200mg	180 + 10 Pills	277.56€ 264.34€	Buy
Viagra Generic	25mg	360 + 10 Pills	213.68€ 203.50€	Buy
Viagra Generic	100mg	120 + 6 Pills	149.50€ 142.38€	Buy
Viagra Professional	100mg	60 + 2 Pills	146.74€ 139.75€	Buy
Viagra Professional	100mg	10 Pills	44.09€ 41.99€	Buy
Viagra Generic	100mg	180 + 8 Pills	199.37€ 189.88€	Buy
Viagra Soft Tabs	100mg	20 Pills	62.99€ 59.99€	Buy

On grocery shelves, the big difference from pharmaceuticals is that no one requires low-priced supermarket brands to taste the same as Ragu pasta sauce or Kellogg's Corn Flakes. In contrast, equivalent brand-name and generic drugs are mandated by law to be identical -- mostly. As the FDA puts it, "a generic medicine is the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality, as well as in the way it is taken and should be used." There are some differences: Brand-name drugs may have different inactive ingredients than the equivalent generics, and they typically look different due to trademarks that protect their appearance. Among sildenafil pills, for example, only brand-name Viagra can be both blue and diamond-shaped.

Simenafil as a New PDE5 Inhibitor: What the Phase III Data Show

"Viagra is still often the first drug prescribed because everyone knows about it, and even primary care docs are comfortable writing it. Also, the evidence in the literature largely supports it being the strongest and most efficacious" of the main ED drugs, University of Utah urologist Alexander Pastuszak, MD, PhD, told MedPage Today. "There are strong considerations for Cialis as well, but it's less popular because fewer physicians and patients really know how to use it." Patent expiration, the perennial scourge of brand-name drug manufacturers, came for Viagra in the late 2010s. Pfizer and Teva Pharmaceuticals began selling generic forms of sildenafil in late 2017, and other companies started offering generic products the following year. That's when the world shifted for patients. There can also be variations in the bioavailability of a drug's active ingredient.

• The effectiveness of the "strongest" Viagra varies with body weight.
• Higher doses are not suitable for everyone; consult a healthcare provider first.
• The strongest Viagra may cause longer-lasting erections.
• Dosage adjustments can optimize strength and minimize side effects.
• New formulations aim to deliver maximum potency reliably.
• Viagra's strength can be enhanced by taking it at the right time.
• Some users report the strongest effects with 100mg tablets.
• The safety of very high doses like 150mg or 200mg is not established.
• Always follow medical advice for using the strongest Viagra safely.
• The "strongest" Viagra is often recommended for severe cases of ED.

It's not easy to understand exactly how much the typical customer pays for brand-name and generic sildenafil.

Pill Type	Onset Time (min)	Peak Effect (min)	Duration (hours)	User Ratings (out of 5)
Standard Viagra	30-60	60	4	4.2
High-Potency Viagra	15-30	45	6	4.5
Ultra Strength Viagra	20-40	50	7	4.0
Fast-Acting Viagra	10-20	40	3-4	4.1

For one thing, list prices don't truly represent the amount that customers pay for drugs. Pharmacies discount the prices of medications, and consumers can get coupons from a variety of sources such as pharmaceutical companies and GoodRx.com. To make things even more complicated, insurers may not cover ED drugs, and even if they do they're not likely to pay for expensive brand names when generics are available. One thing is clear: Viagra's markup is consistently high.

4. Ginseng

The Effect of Oral Vitamin E on Semen Parameters and IVF Outcome: A Double-Blinded Randomised Placebo-Controlled Clinical Trial. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomised, Placebo-controlled Clinical Study. Risk Factors Affecting Decreased Libido Among Middle-Aged to Elderly Men; Nocturnal Voiding is an Independent Risk Factor of Decreased Libido. Flibanserin for Premenopausal Hypoactive Sexual Desire Disorder: Pooled Analysis of Clinical Trials. Journal of Women’s Health (2002), 28(6), 769–777.

Avanafil (Stendra)

Cigarette Smoking and Erectile Dysfunction: Focus on NO Bioavailability and ROS Generation. The Journal of Sexual Medicine, 5(6), 1284–1295. Effects of S-1-propenylcysteine, a sulphur compound in aged garlic extract, on blood pressure and peripheral circulation in spontaneously hypertensive rats. The Journal of Pharmacy and Pharmacology, 70(4), 559–565. Effects of an Aqueous Extract of Withania somnifera on Strength Training Adaptations and Recovery: The STAR Trial.

The Low Dose: 25mg

Chondroitin helps the joints and other elements of the body. Glutathione is one of the most potent antioxidants for supporting the body's health. Find out how it works and where to get it from. See why hip joints hurt and how to treat their ailments. In a weird paradox, it's never been cheaper -- and more expensive -- for men to treat themselves with sildenafil (Viagra), the mainstay of erectile-dysfunction therapy. According to GoodRx.com, the cheapest price in the San Diego area for six tablets of 100 mg generic sildenafil is $9.47 at Ralphs supermarkets with a free coupon.

How Soon Do They Start to Work?

From December 2017 to June 2021, the list price for six tablets of 100 mg of generic sildenafil (the most common prescribed amount) fell by 98% from $265 to $4, according to an analysis provided by GoodRx.com. Over that same time, the average list price for the equivalent doses of Viagra grew by 27% from $369 to $467. "We're still seeing spikes with Viagra every year, while sildenafil has plummeted in price," GoodRx.com director of research Tori Marsh, MPH, told MedPage Today. "I have no idea why there continues to be that large price gap. There is just no good reason," endocrinologist Bradley Anawalt, MD, chief of medicine at the University of Washington Medical Center, told MedPage Today. The least expensive price for the equivalent amount of brand-name Viagra is $404.26 at all 10 pharmacy outlets listed with a free discount -- a markup of 42 times. When It Comes to Humongous Markups, Viagra Stands Tall Viagra isn't alone in boosting its price in response to competition. For nearly 3 decades, researchers have chronicled the "generic competition paradox": Drugmakers actually boost the prices of their brand-name medications when cheaper generics enter the market. The most likely brand-name drugs to do this are those with high name recognition and intense generic competition, Seoane-Vazquez said.

When oral medications might not be safe

American Journal of Men’s Health, 13(2), 1557988319835985. Effects of garlic on brachial endothelial function and capacity of plasma to mediate cholesterol efflux in patients with coronary artery disease. Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation. The Journal of Sexual Medicine, 2(3), 368–375. Selenium–vitamin E supplementation in infertile men: Effects on semen parameters and pregnancy rate.

Dosage for adults over 65 years old

International Journal of General Medicine, 4, 99–104. Indian Journal of Pharmacology, 47(6), 594–599. Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction. (PDF) The Effect of Black Pepper Fruits (Piper nigrum L.) on the Increase of Erection. Biological Activities, Health Benefits, and Therapeutic Properties of Avenanthramides: From Skin Protection to Prevention and Treatment of Cerebrovascular Diseases.

Usual Adult Dose for:

Oxidative Medicine and Cellular Longevity, 2018, 6015351. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systematic Review and Meta-Analysis. The Journal of Sexual Medicine, 16(2), 223–234. Dehydroepiandrosterone treatment in the ageing male—What should the urologist know? European Urology, 48(5), 724–733; discussion 733. (Viagra fits this description.) Other types of drugs are less likely to raise their prices in response to generics. These, he said, include drugs such as biologics with limited competition, drugs used in hospitals and physician offices, and drugs with relatively low name recognition such as some antibiotics.

Country	Legal Status	Prescription Required	Notable Regulations
United States	Prescription-only	Yes	FDA-approved brands
United Kingdom	Prescription-only	Yes	MHRA regulations
Canada	Prescription-only	Yes	Canadian Health Authority
India	Both OTC and Prescription	Varies	Over-the-counter in some states

In a bit of good news for consumers, the generic competition paradox phenomenon appears to be less common than it used to be, according to researchers with StoneTurn, a consulting firm. They examined 78 drugs whose patents expired from 2009 to 2020 and found that their prices tend to stabilize after generic equivalents appear and not go up at a fast clip.

• The strongest Viagra has to be taken responsibly to avoid health risks.
• Advanced formulations seek to maximize bioavailability and strength.
• The strongest Viagra is usually reserved for severe erectile dysfunction.
• Combining Viagra with other supplements can increase perceived strength.
• Biological differences influence individual response to the strongest dose.
• The strongest Viagra is usually stored in a cool, dry place.
• Pharmaceutical companies research the most potent doses for efficacy.
• Some markets offer higher-dose Viagra illegally, with safety concerns.
• The strongest brands use high-quality active ingredients for effect.
• Medical guidelines prioritize safe, effective use over maximum dose.

This marks a significant shift from the past, the researchers argue in a 2021 study published in the International Journal of the Economics of Business.

User Feedback Aspect	Average Rating (out of 5)	Comments
Effectiveness	4.3	Faster onset and stronger effect than generic options
Side Effects	3.8	Mild headaches common, some experience flushing
Duration Satisfaction	4.0	Up to 6-7 hours for high doses
Overall Satisfaction	4.2	Generally positive, recommend for potency seekers