'Bandol', the 'Liquid Viagra' that facilitates dose self-adjustment by the patient

This new galenic form of sildefanil in oral suspension from Laboratorios Rubió, marketed as Bandol , facilitates the patient with dose escalation and self-management of his treatment for erectile dysfunction in dialogue with his doctor

More than twenty years after the arrival of Viagra , the Spanish Laboratorios Rubió announces the launch in Spain, and the first in the world, of a new Galenic presentation of the same active ingredient - sildenafil - in oral suspension, under the trade name from Bandol . The company states that two decades later, sildenafil accounts for 75% of the sales of its group's medications for erectile dysfunction.

This liquid Viagra facilitates dose adjustment, involves the patient in his treatment and in his self-care in dialogue with his doctor, according to the specialists gathered in his presentation in Madrid.

"The appearance of Viagra in 98 was a sexual revolution equivalent to the pill for women," said Ignacio Moncada, head of Urology at the Sanitas La Zarzuela Hospital (Madrid) and general secretary of the Spanish Association of Andrology. "This advance allows dosing sildenafil more efficiently and freely, because not all patients have the same severity and depending on whether they are nervous or calm, with one or another partner, the same individual may need a larger or smaller dose."

Dose issue

The original Viagra , from Pfizer, is sold in oral tablets of 25, 50 and 100 mg. The 50 mg presentation is also available in orodispersible tablets. Bandol comes in a 30 ml container, equivalent to 15 doses of 500 mg or 7 doses of 100 mg. With each pulse 12.5 mg of sildenafil are administered.

In the treatment of erectile dysfunction three doses of sildenafil, 25, 50 and 100 mg are used, although the majority of patients are told at least the 50 mg dose, says Juan Ignacio Martínez Salamanca, urologist at Puerta de Hierro Hospital -Majadahonda and Medical Director of Lyx Institute of Urology (both in Madrid). "Personally, in most cases I prefer to ensure efficacy with a dose of 100 mg and if necessary, try lower doses later."

The efficacy and safety characteristics are similar to other sildenafil presentations, says Javier Romero-Otero, head of the Urology Service at the HM Montepríncipe and HM Puerta Sur hospitals and Andrology coordinator of the Spanish Association of Urology. Remember that it is advised that the medicine not be taken with food or alcohol. "The latency time of sildefanil is about 30 minutes. They are drugs that promote or enhance an erection, do not cause it; a stimulus, a minimum dose and taking conditions are necessary."

Phosphodiesterase 5 inhibitors for erectile dysfunction, such as sildenafil vardenafil, tadalafil and avanafil, do not have public funding in Spain, "although strangely, the mutual funds do finance it," says Moncada. In the United Kingdom, where there is an over-the-counter presentation, and in the United States its reimbursement is contemplated in certain situations. "One of the big problems of these drugs is that since they have a high price they lead to discontinuation and abandonment of treatment. The fact that the patient can play with different doses can facilitate the treatment to be better," Romero-Otero says.

In addition, specialists remember that they are subject to medical prescription. "The main argument of the European Medicines Agency for not considering them over-the-counter drugs was that there could be a major health problem behind erectile dysfunction," Martínez Salamanca recalls. "Sildenafil allowed us to change the paradigm and understand that its origin is mostly organic and non-psychological; it taught us that hypertension, diabetes, cholesterol, bad life habits damage small blood vessels and where Cardiovascular disease begins to manifest itself in the penis, "Romero-Otero adds.

Specialists point out that in Spain between 1.2 and 2 million men suffer from erectile dysfunction , and their frequency increases with their age. But much of sildenafil consumption is attributed to recreational use, in combination with alcohol and other drugs. The specialists do not declare themselves worried about whether liquid Viagra can increase a use outside the medical context. "Recreational use has been around for a long time and the drug has been shown to be extraordinarily safe," Moncada defends.

Moreover, Martínez Salamanca adds, "the doses that are managed are far from being toxic, and it must be remembered that it is used in all types of patients, including heart transplants." Its only contraindication is the concomitant use of nitrates, "which on the other hand, are less and less prescribed drugs in Cardiology."

The "paradox of non-financing"

Specialists consider paradoxical the non-financing of drugs for erectile dysfunction, "when intracavernous injections with prostaglandins and penile prostheses for the same indication are," says Javier Romero, head of the Urology Service at HM Montepríncipe hospitals and HM South Gate of Madrid. Juan Ignacio Martínez Salamanca, urologist at the Puerta de Hierro-Majadahonda Hospital, understands that reimbursement would be considered in certain groups of patients, such as cancer patients or diabetics. "It makes no sense that diabetes medications are funded and not for erectile dysfunction that may be secondary to the disease."

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