Dear Dr G,

I am a 60-year-old-man who is just reaching the age of having problems “rising” to the occasion.

On many occasions, I find it hard to “stand up and be counted”, especially I have had a bit too much to drink.

I understand, technically I suffer from erectile dysfunction (ED), and am tempted to take the blue pills to remind myself what it feels like to be in my prime.

I am usually a careful chap and will not consume any medication without considering the risks.

However, because of the embarrassment of seeing a doctor about my condition and worry about cost, I managed to get some blue pills through some friends.

I know Dr G would disapprove of the practice of consuming medications without a doctor, however, I am simply too shy to discuss bedroom matters with anyone.

After taking the pills on several occasion, I felt the heartburn and flushing and I must say most of the side effects are bearable.

The one I am most curious about is “seeing blurred and blue” when I take the blue pills. I begin to wonder whether all these are just in my mind, or are a serious side effect.

I would like to put Dr G on the spot about the risk of taking the blue pills.

What are the common side effects of the blue pills?

Are there medical conditions that prohibit men from taking the pills at all?

Any serious risks such as heart attack and sudden death?

Finally, why am I seeing blue when I take the blue pills?

Kindly let me just let me have the hard facts straight!


Blurred Bob

On the March 27, 1998, sildenafil (commonly known as the blue diamond pills) was approved by the US FDA as the first oral treatment for erectile dysfunction (ED) in United States.

The drug, initially termed compound UK92,480, was synthesised by a group of chemists in England, for use in hypertension and angina.

In the first phase clinical trial, the drug was noted to have minimal impact on the heart, but tremendous response on the hard-on.

Sildenafil and a group of medications called phosphodiesterase 5 inhibitors (PDE5-I) have become the first-line therapy for men with ED.

Before the 1990s, the understanding of the physiology of erection was deficient, and treatments such as penile prosthesis; vacuum pumps and injections directly into the penis were the only options for men with ED.

The emergence of the blue pills did not just transform the treatment modality for ED; it also reduced taboos in sexual medicine, facilitated research and changed the landscape of men’s health.

More importantly, the pills also significantly reduced the taboo and stigma of men suffering from sexual dysfunction.

There are currently five “shades of blue” emerging in the market in recent years. These are sildenafil, vardenafil, tadalafil, udenafil and avanafil.

Five years following the approval of the blue tablets, vardenafil and tadalafil were both introduced in 2003. The next new arrival from South Korea, udenafil and the new kid on the block, avanafil, are also gaining momentum in helping men with ED.

All the medicines work with an identical mechanism, which is the prevention of the degradation of a component (cGMP), which enhances the blood flow to the penis.

This would have the impact of prolonging the erectile rigidity during sex. The only differences the five pills have are the pharmacokinetics for the different timing for onset and side effects.

There are not too many medications that still warrant such scrutiny, induce myth and cause controversy like the blue pills, more than twenty years after its arrival.

It is because sex itself is too “hard” to talk about, and the sense of “guilty pleasure” will always raise questions that too much of a good thing surely is bad for you?

It is now obvious the initial fear of sudden death, stroke and heart attacks following the consumption of the blue pills, is a complete myth and unfounded.

The most common adversity of sildenafil includes headache, flushing, indigestion, and nasal congestion. Other PDE-5 inhibitors such as tadalafil also have the side effects of a transient backache.

Another unique, but common, side effect is cyanopsia or blue vision, which is often a strange experience that users may associate with “punishment” for the over consumption of the “blue materials”.

The reason behind this peculiar side effect of sildenafil is related to the activation of a subtype of enzyme – PDE6, which is found in the retinal cells, the light sensitive cells at the back of the eye.

It is thought the high doses of PDE5-inhibitors would lead to the build-up of the molecules, causing blurring of vision and difficulties in differentiating blue and green.

Most of these side effects are transient and completely harmless.

ED can also be a barometer for a “broken” heart, as the condition is a precursor for many non-communicable diseases, such as diabetes, hypertension, and dyslipidemia.

Therefore, doctor is the best person to judge the fitness for taking the “magic” remedy while at the same time, helping men treat these conditions.

In fact, the assessment is simple, if one is not on nitrite pills for the heart and does not suffer from a rare condition called retinitis pigmentosa, then the pills are generally safe for consumption.

Despite the good efficacy of the medication with minimal side effects, the ugly truth is that a pill for sex still has a moral barrier to be overcome.

The famous scientist Stephen Hawking once said: “Look up at the stars and not down at your feet. Try to make sense of what you see and wonder about what makes the Universe exist. Be curious”.

Many men are lured by the curiosity of a magic pill that can create the sparkles in the bedroom and forget the real health reasons why they ended up with ED.

When Dr G is put on the spot by the curious men lured by access to the blue pills, bypassing the guidance of a doctor, his response is: “Look up in the head and not down in the pants. Try to make sense of sexual health as overall health. Only then can you be safely curious and find out why you are seeing the blues through the pills.”

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