Transcript

SACHA PFEIFFER, HOST:

The drug tadalafil, known by its brand name Cialis, is taken by millions of men for erectile dysfunction. Now there’s a movement to repurpose the medication to help people live longer. NPR’s Will Stone reports.

WILL STONE, BYLINE: About a year ago, Kristi Sawicki made a change to her daily wellness routine. She added a low dose of tadalafil.

KRISTI SAWICKI: It seemed very harmless. If anything, it’s going to help blood flow, and that can be beneficial to our brain and our heart.

STONE: It’s true that tadalafil does improve blood flow throughout the body, though, in general, those taking it are only concerned about one region, and Sawicki says she definitely gets questions.

SAWICKI: They’re mostly just like, wait, what? You’re a woman. What are you doing?

STONE: Sawicki has a Ph.D. in molecular oncology. She’s built a following on social media around longevity. Her decision to take a drug intended for erectile dysfunction goes back to her own family history of heart disease.

SAWICKI: That was my main focus of like, well, maybe this is a low-hanging fruit, something that I can do to prevent that.

STONE: In fact, high-profile figures in wellness and biohacking are increasingly talking up tadalafil as a longevity drug. Sawicki herself promotes it for an online clinic called AgelessRx. Dr. Jenell Decker is the medical director there.

JANELL DECKER: I do feel like the observational studies out there are strong enough to warrant offering it as a longevity medication to both men and women.

STONE: This is a big reason drugs like tadalafil are getting more attention. In recent years, research has shown that men who take these medications seem to fare better in a variety of ways. Cardiologist Robert Kloner is at Huntington Medical Research Institutes and the University of Southern California. A study of his looked at more than 8,000 men who took it for erectile dysfunction. They had a 55% lower rate of cardiovascular-related death and a 44% lower rate of death overall during the study period of about three years.

ROBERT KLONER: This to us is a very interesting signal.

STONE: In other words, he says it’s showing an association, not causation.

KLONER: None of these drugs are FDA-approved for longevity or for reducing major adverse cardiovascular events. Having said that, so many of these studies have all been consistent.

STONE: Some have found a decreased risk of dementia and Alzheimer’s when taking these drugs. Tadalafil works by preventing the breakdown of a signaling molecule. This helps smooth muscle cells relax, blood vessels dilate, blood flow increases. It’s already approved to treat a form of high blood pressure affecting arteries in the lungs and is similar to Viagra, which was originally developed as a cardiovascular drug. In fact, earlier this summer, Kloner was part of an expert group known as the Princeton Consensus Panel that concluded it may be appropriate to use low-dose tadalafil for some men at increased risk of cardiovascular disease.

KLONER: It’s not something that cardiologists are routinely recommending, but these drugs, in general, are very safe.

STONE: He acknowledges, though, they’re not as well studied in women. Some experts, including Dr. Steven Nissen, are troubled this is catching on without high-quality data in humans. Nissen is chief academic officer of the Cleveland Clinic Heart, Vascular and Thoracic Institute.

STEVEN NISSEN: Absence of evidence of harm doesn’t mean there isn’t harm. In the absence of randomized controlled trial data, it’s pretty hard to justify.

STONE: Human trials are something Dr. Kloner at USC wants to do.

KLONER: The problem with that is trying to find funding for it.

STONE: He says pharmaceutical companies aren’t incentivized to do these studies because generic versions are already available. So for now, patients and doctors need to decide for themselves if a drug intended for the bedroom should also be used to try to extend life.

Will Stone, NPR News.

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