How many Indians have heard of sildenafil citrate? Chances are, very few. But on the other hand, if one were to conduct a quick poll on familiarity with the word Viagra, one would probably get a cent per cent result. For the benefit of those who don't belong to the medical fraternity or the pharma industry, sildenafil citrate is a molecule invented by Pfizer and introduced in the world market some four years ago with the brand tag Viagra. And in a year, this impotency buster became a billion-dollar product, prescribed 25 million times in that one year.
The most hyped drug launch ever, Viagra came to India via the grey market and sold for above of Rs 400 a pill. And market research agencies threw up startling revelations of how large the potential market was: 10 per cent of the Indian male population is impotent or is afflicted with erectile dysfunction; 30 per cent of Indians suffer from diabetes and hypertension and such patients are most susceptible to erectile dysfunction; plus more than 50 per cent of the target group (men in the 30-40 age group) are willing to pay Rs 100 or more to pop a pill for impotency. So here was a great opportunity, and loudmouth predictions put the market size for the first year anywhere between Rs 100 and 200 crore.
In January 2001, three years after Viagra was launched internationally and the Drug Controller General of India cleared it for sale in the Indian market, seven pharma companies launched desi variations of Viagra and today there are more than a dozen brands which claim to treat erectile dysfunction in the market. But for Penegra, Caverta, Silagra, Edegra and their ilk, the market hasn't exactly been stimulating. The pharma industry informs us that there are four sildenafil brands in the top 10 new launches for the year 2001, but it's an undeniable fact that after the initial hype, the market turned flaccid.
Viagra is a household name, but it didn't become a household product. Today the total sales of the Indian clones stands at around Rs 27 crore a year, a far cry from even the most conservative estimate that had put a figure of Rs 50 crore for first year's sales.
Pfizer hasn't launched Viagra in India, and one of the reasons could be that the Indian varieties all have Viagra-sounding names, which could confuse the consumer. And unfortunately for Pfizer, last week the Delhi High Court rejected its application seeking a stay on Zydus Cadila using the brand name Penegra because it was deceptively similar to Viagra.
The pricing of the Indian me-too pills, feel market analysts, may also be holding back Pfizer from launching Viagra in the local market. The Indian versions are priced between Rs 12 and Rs 27, depending on whether you buy a 25, 50 or 100 mg tablet. But these prices, low compared to what Viagra sells for, don't seem to have seduced too many customers. Says a south Delhi chemist: "We're not selling much. Last year, we had thought that line lag jayegi (there will be long queues) but nothing of the sort has happened." Says Chennai-based sexual medicine consultant Dr Narayana Reddy: "Sales can never match the initial hype."
One of the main reasons for this slow take-off is the limited access to the drug. It is not an over-the-counter product that you can buy without a prescription. Add to this the fact that the drug can be prescribed only by endocrinologists, urologists and psychiatrists. General physicians (GPs) are not in the list of eligible prescribers. "People feel most comfortable with their family doctor and in India if someone goes to a psychiatrist, he is considered a madman. So, it is very important that GPs come into this list too," feels Reddy.
Sexologists are also not allowed to prescribe the drug because in India you can't get a degree in sexology.It can be studied under the categories of psychiatry, endocrinology and urology. Says an industry analyst: "The fact that only three classes of doctors can prescribe the drug is a crucial reason for its low acceptability. And when companies didn't see the kind of returns they were expecting, they re-focused on newer products with better prospects."
But Ganesh Nayak, executive director, Zydus Cadila, which manufactures the leading brand Penegra, feels that "given the social compulsions and sensitive nature of the malaise, we believe that a market size of Rs 27 crore is not a bad starting point". Says Sanjiv Kaul, regional director, Ranbaxy Laboratories, manufacturer of the Caverta brand: "In India, allopathy medicines have just one-fourth coverage and if the market for erectile dysfunction products stands at around Rs 30 crore, it shows a successful acceptance of a new molecule."
But while the sildenafil citrate manufacturers continue to be hopeful, there are a lot of lessons to be learnt from the mistakes of the first year. To begin with, many of the companies miscalculated the market in terms of the target group. They blindly aped the West where erectile dysfunction is largely an older man's ailment. The older man presumably has less qualms about going to a doctor and saying that he has an erection problem. But in India, the elderly man is expected to be asexual and the only avenue that remains open to him is the quack. So, now the strategy has changed to target the younger Indian male who is in his thirties and is prone to the malady because of lifestyle disorders and is not diffident in seeking medical help either.
Some companies like Ranbaxy are also trying to promote the pill via the wife. "It is actually one's ailment but two's problem and the wife can be an influential decision-maker," says Kaul.
Another myth that led to wrong marketing was that only diabetics suffer from erectile dysfunction. Besides, one particular company had to stop manufacturing a particular dosage of its pill since it was not working well for diabetics, because they needed a stronger dose to maintain an erection.
Again, the drug works only if there is sexual stimulation and desire. It relaxes the muscles of the penis and the walls of the arteries that supply blood to the penis. As a result, more blood flows into the penis and an erection can occur more easily. Until sildenafil citrate hit the market, sufferers had to use vacuum devices, intra-cavernosal injections and other inconvenient methods. But in spite of the fact that it has proved to be a wonder drug, its growth has been stymied because of the fear of side-effects. One myth is that it causes heart attacks. But the truth, if doctors are to be believed, is different—the drug should never be taken together with the cardiac pill sorbitrate, because the combination can be deadly. "Viagra has no major side-effects. There is a difference between death caused by Viagra and Viagra-related deaths. What happens is that people outdo themselves. Those who have not had a proper erection after taking the pill try and push for a second and third erection. Here lies the problem," feels a sexologist.
Doctors generally recommend one pill a day, one hour before the act, and it's important to assess the risk factors and take preventive counselling before popping the pill.
The pharma industry is trying hard to break myths and to establish the fact that sildenafil is not a fun pill, not an aphrodisiac, but an effective treatment for a physical disorder. And over the next one year, they are pushing for a 30 to 40 per cent growth. "I am more concerned with the growth of the category than with brand marketshare alone," says Kaul. Clearly, the Indian Viagras (the industry hates this name even though it took them just weeks to perfect what took Pfizer 13 years and billions of dollars in research to invent) need to look for more penetrative strategies.