Small blue diamond-shaped pills were responsible for the last fever of the 20th century: in the first three years of existence, 25 million prescriptions were issued and in 2008 it reached its sales peak: almost 2 billion dollars in the United States alone. Joined. And all to help a very simple molecule, made with an oxygen atom and a nitrogen atom, in its function as a chemical mediator of the erection.
Sildenafil , the active molecule in Viagra, is a drug that enhances the relaxing effect of nitric oxide on the smooth muscles of the penis, allowing blood to enter the corpora cavernosa and thus facilitating erection, provided there is prior erotic stimulation.
The history of Viagra begins, as often happens in science, with a chance discovery . In the 1980s, a team of British scientists began to study the pharmacological properties of sildenafil as a vasodilator. The first tests with hypertensive volunteers showed its limited usefulness in the treatment of heart disease but, surprisingly, some patients insisted on continuing the treatment and refused to return the drug samples .
When the reasons for this behavior were investigated, the volunteers admitted that they had experienced improvements in the quality and number of erections. The finding made the pharmacological possibilities of sildenafil reconsidered and, after a decade of trials, it was marketed in 1998 under the name of Viagra.
Although the manufacturer Pfizer insists that Viagra was a name chosen at random, the most suspicious have wanted to see a play on words that combines the words Niagara and vigor. The explosive force of nature in the most romantic waterfalls in the world (a classic destination for honeymooners in the US) have resulted in a good brand image. However, Viagra’s success has been overshadowed by its link to nearly 500 verified deaths in patients with high blood pressure, where the drug is absolutely and specifically contraindicated.
But the true protagonist of this story is not sildenafil, but a molecule that controls blood pressure, erection and the opening of body orifices , which is capable of fighting bacteria, parasites and tumors, and acting as a messenger between neurons involved in learning, memory, sleep or pain. And most admirable of all, that molecule is a toxic gas with a ridiculously simple structure, one atom of oxygen and one of nitrogen, the two most common elements in the atmosphere. This magical molecule is nitric oxide, whose reign began when in 1987 the journal Nature reported the discovery of its physiological action as an arterial vasodilator .
The other Viagra
Today there are already other drugs intended to treat erectile dysfunction, such as tadalafil (Cialis) – which can cause sudden hearing loss – and vardenafil (Levitra, Staxyn). The most common side effects of all of them are headache and nausea, as well as abdominal pain, back pain, photosensitivity, abnormal vision, eye pain, facial edema or redness, palpitations, tachycardia, myalgia, and rash. Even so, men do not hesitate to take them, which shows that we are capable of putting up with anything in order to have good sex.
Seen what has been seen, the pharmaceutical companies launched themselves in search of a similar medicine for women. And for many years there were no drugs approved to treat sexual desire problems in women. Currently, the well-known US FDA has two drugs approved. On the one hand there is flibanserin (Addyi), originally developed as an antidepressant and whose serious side effects include drop in blood pressure, dizziness and fainting, which are enhanced if mixed with alcohol. The other is bremelanotide (Vyleesi), which should be injected into the abdomen or thigh at least 45 minutes before sexual activity
The Nobel Prize against Dr. NO
But let’s go back to the origin of everything, to nitric oxide. As in any good story there is a dark side, with heroes and villains. In this case the bad guy is the Swedish Committee that awards the Nobel Prizes for Medicine and Physiology . And the hero, the Honduran Salvador Moncada.
Married to Princess María Esmeralda of Belgium , Moncada’s life could inspire a television series. His scientific work is linked to both Viagra and the 20th century drug, aspirin. And in both we find two controversial decisions by the Swedish Academy excluding the Honduran scientist from the Nobel Prize despite widespread protest from the scientific community.
At the beginning of the 70s, a frenetic research production began in the field of cardiovascular physiology. As a result of his first discoveries, aspirin is now used as a fundamental drug in the prevention of thrombosis and in the treatment of acute forms of coronary disease, such as heart attack or angina pectoris, in which it has shown a reduction of the mortality rate.
Only this contribution, from which millions of people around the world have benefited, would be enough for Salvador Moncada to go down in the history of Medicine. When in 1982 the Nobel Prize in this specialty was awarded to the researchers who made the discovery possible, the absence of Moncada among the winners was incomprehensible and, clearly, unfair .
Far from throwing in the towel, our hero began a new line of research that culminated in the discovery of the physiological role of nitric oxide in 1986, a discovery that led him to become one of the most cited scientists of the 20th century.
Despite the enormous weight of his work, another controversial decision by the Swedish Academy removed Moncada from the Nobel Prize in Medicine in 1998, awarded to three scientists whose contributions on nitric oxide were of equal or lesser caliber than those of the Central American.
On this occasion, the entire scientific community criticized the decision of the Nobel committee. Hundreds of letters were published in the most prestigious journals and, for the first time in the history of the awards, the protest did not come from the excluded but from their colleagues, and even from the award-winning scientists, who publicly acknowledged the injustice committed for the second time. with Salvador Moncada.
