People’s pharmacy: New generic Viagra should help men save money

Q. The last time I filled a prescription for Viagra, they wanted $400 for six pills. That’s insane. I pushed the prescription back across the counter and walked out.

A. Depending upon the pharmacy, Viagra (sildenafil) could cost as much as $65 to $80 per pill. A generic version has just become available because the patent on Viagra has expired. That means substantial savings.

Greenstone, a subsidiary of Viagra maker Pfizer, will sell an authorized generic sildenafil for approximately half the price. That means you are getting the same quality at a reduced price. It’s still not cheap, however.

Brand-name Viagra from Canada costs even less. According to PharmacyChecker.com, the per-pill price ranges from about $14 to $20 from a legitimate Canadian source. Generic sildenafil from Canada is even less expensive, but there is no guarantee you would be buying the authorized generic. Because of its popularity, sildenafil has been widely counterfeited.

In the U.K., men soon will have the opportunity to buy Viagra without a prescription. The drug will be dispensed through a “behind the counter” arrangement that will allow the pharmacist to determine if the medicine is appropriate and whether it interacts with a man’s other medications.

Q. My wife had severe asthma for 35 years, from the time she was a little girl. She has used all sorts of inhalers, and sometimes she needed oral prednisone.

Then, in middle age, she developed nail fungus. The doctor finally prescribed oral itraconazole (Sporanox) to clear it up. She had to take this antifungal medicine for more than a year while the nails grew out.

Several months into the treatment, she realized that her asthma was better. By the end of the treatment, she no longer had asthma. She hasn’t needed any asthma medicine since, and that was decades ago. Have you ever heard of such a thing?

A. Some people with hard-to-manage asthma have an allergic response to a fungus that has colonized their airways (Journal of Asthma, September 2016). This condition can be treated with antifungal medicine (Medical Mycology Case Reports, April 25, 2017). Such drugs are tricky, though, as they often interact with other medicine and carry a range of risks.

Another medication that may help hard-to-treat asthma is the antibiotic azithromycin. A randomized controlled trial (AMAZES) showed that people taking azithromycin along with asthma inhalers had fewer flare-ups and better quality of life (The Lancet, Aug. 12, 2017).

Q. My husband and I got a flu shot in early October. At the end of November, we came down with a terrible case of influenza.

Now I read that the flu shot may be only 10 percent effective. It’s the same faulty flu shot they used in Australia.

My sister-in-law, an emergency room nurse, had to take the shot to keep her job. Now she is as sick as I am with the flu.

A. A recent article in the New England Journal of Medicine (Nov. 29, 2017) described the Australian experience with influenza earlier this year. That is where the 10 percent estimate of vaccine effectiveness against H3N2 originated. The authors make a strong case for a universal influenza vaccine that will be more effective. The flu appears to be spreading fast, and experts believe this could be a bad year.