Viagra: How a Little Blue Pill Changed the World

"It's really about how the colors work together.

Form	Packaging Options	Storage Conditions
Tablets	Blister packs of 10, 20, 30	Store below 25°C, dry place
Sublingual	Small blister packs	Keep away from moisture
Liquid solution	Bottles of 10 mL	Refrigerate if recommended

I'd say you definitely need to work from a palette," Traini said, adding that color

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"Blue also connotes sort of a feeling of calm," Ryan said. "Then their competitor that came out afterwards took advantage of that and said: we don't want to be calm, we're about virility and so we want to be the anti-blue pill." More recently, three similar migraine prevention treatments came to market within the span of a few months. The lettering used for each of their logos employ soothing cool tones of blue and purple, outfitted too with a multi-colored symbol of sorts. "As a company, we typically select a brand’s colors palette and logo years before launch, based on deep customer insights," Lilly, which makes one of those drugs, Emgality (galcanezumab), wrote in an email to BioPharma Dive. "We consider many variables when determining the color palette and logo," the company added.

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"The right combination of brand elements can evoke emotion from customers while helping to differentiate from other brands in the disease state and drug class. While consideration is given to other brands in the therapeutic area, ultimately we made our branding decisions based on customer insights." Lilly's not alone in its rationale, as drugmakers make most commercialization decisions based on what they think will resonate with patients and physicians. Studies have shown color can bring forth strong, wide-ranging reactions from consumers. Though not extensive, research suggests patients are more inclined to take a drug when its color symbolizes the type of effect they're hoping to get. Warm-colored pills appear stimulating, cool-colored capsules imply sedation.

Recreational use

The connotation with darkness or death across multiple cultures explains why black is a rare find among medicines. "If you have a product for, let's just say a dermatology product for psoriasis, you're not going to make the color red because that reminds people of inflammation. You're not going to use the color yellow for something treating an infection because that reminds you of puss," Sentrix's Traini said. The selection process becomes trickier still when a product is hitting multiple geographies or patient groups. In Japan and the U.S., which happen to be two of the biggest pharmaceutical markets in the world, white can symbolize very different things. gradients have been trending across digital marketing, and

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are starting to gain traction specifically in pharma.

MYTH #5: “This pill is only available through the GP”

Store mixed oral liquid in the refrigerator. Throw away any unused mixed Revatio® oral liquid after 60 days. It is important that you tell all of your doctors that you take sildenafil. If you need emergency medical care for a heart problem, it is important that your doctor knows when you last took sildenafil. Do not use this medicine if you are also using a nitrate medicine, often used to treat angina or high blood pressure.

Viagra and herbs and supplements

Some illegal ("street") drugs called "poppers" (such as amyl nitrate, butyl nitrate, or nitrite). Do not use this medicine if you also use riociguat (Adempas®). If you will be taking this medicine for pulmonary arterial hypertension, your doctor will want to check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. If you take sildenafil for pulmonary arterial hypertension, do not take Viagra®, Vibrique™ or other PDE5 inhibitors, including tadalafil (Cialis®) or vardenafil (Levitra®).

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If you take too much sildenafil or take it together with these medicines, the chance for side effects will be higher. It is important to tell your doctor about any heart problems you have now or may have had in the past. This medicine can cause serious side effects in patients with heart problems. If you experience a prolonged or painful erection for 4 hours or more, contact your doctor immediately. This condition may require prompt medical treatment to prevent serious and permanent damage to your penis. Pfizer and AstraZeneca declined requests for comment.

HOW should this medicine be used?

Those success stories have in turn nudged manufacturers and marketers to consider how color, whether in a logo, a campaign, or the drug itself, may best serve a patient's needs and elicit the emotions brand developers want to connect to the product. The most famous blue pill isn't found on the big screen, but rather at local pharmacies. Pfizer's Viagra (sildenafil citrate), first approved in 1998 for erectile dysfunction, quickly achieved blockbuster status and held onto it through 2017. For many pharma marketers, it's a preeminent example of color building a brand. AstraZeneca's stomach medications Nexium (esomeprazole magnesium) and Prilosec (omeprazole magnesium) are also widely recognizable by their purple shades.

Overall Rating

Despite how lucrative these drugs became, some marketers have found that color doesn't come up in many client conversations, but some are trying to change that. Jeanne Ryan, principal at life sciences advertising firm ZS, said this has been especially true when the point-person for a new drug isn't in a commercialization role. In one instance, Ryan noted a client with a clinical asset who was looking into color options. The agency researched patient and pharmacist preferences, potential storage and handling 200mg sildenafil citrate issues, and regulatory and manufacturing requirements before offering a color recommendation, but the client ended up keeping to white. "One of the stated reasons why they stuck with white was that it wasn't their job to commercialize this drug, it wasn't their job to decide how to position it," she told BioPharma Dive.

Effectiveness and safety

"They literally said they didn't want to take away any of the degrees of freedom from the ultimate brand team that would be responsible for those things." For drugmakers who do pursue color, the decision-making process is far more complicated than throwing a dart at a color wheel — as Ryan's anecdote suggests. Competition alone can greatly shape the selection. "If you have a big competitor in your category that is the orange brand, you're not going to go out and have orange be your primary color," Dave Traini, creative director at healthcare advertising agency Sentrix Health, said in an interview with BioPharma Dive. "So you do want to be mindful of what else has already been taken in that therapeutic category." With Viagra, Pfizer's adoption of blue pushed other erectile dysfunction brands to use a different color, such as the orange branding seen with Eli Lilly's Cialis (tadalafil). Lilly declined request for comment about Cialis branding. Contrary to marketers, Nicolas Madit, business development manager at Lonza Pharma & Biotech,

• Blue sildenafil has revolutionized ED treatment, providing quick and effective relief.
• It is sometimes used in combination with other therapies for better results.
• Awareness of potential drug interactions is crucial when using sildenafil.
• Some users combine sildenafil with nitric oxide donors, increasing risks.
• Reports of headache, facial flushing, and nasal congestion are common side effects.
• Sildenafil may cause visual disturbances, including light sensitivity.
• Certain health conditions may disqualify a person from using sildenafil.
• Regular users should follow medical advice for safe and effective use.
• The drug should be used responsibly to prevent dependence and misuse.
• Scientific research continues to explore new applications for sildenafil.

said he has conversations about color with pretty much every client he deals with.

Medical uses

Offering a unique color is also advantageous when the target population, such as elderly patients, is likely to be taking multiple medications and at risk of accidentally taking the wrong pill. Traini notes, however, that in his work the color of the actual pharmaceutical is less a point of conversation than the promotional materials which go along with it. That's partially because many of the drugs hitting the market right now are large-molecule biologics that come as injections rather than pills. But it's also because color decisions need to be made early on in drug development, sometimes before an advertising agency is even tapped to help commercialization. Ryan's noticed a similar trend, in that color conversations tend to happen in advance, "when a company is able to connect that pill color to their advertising and to their DTC campaign." "You know, the 'little purple pill.' I mean that was the entire sort of crux of that product when it came out," she said of Nexium, "and they really leveraged it." Yet even with Nexium and Viagra, their advertisements aren't just a single color, but rather a small assortment of complementary hues. If the client wants color, it's a decision needed to

Panel 1: Mechanism of action

If you experience a sudden loss of vision in one or both eyes, contact your doctor immediately. Check with your doctor right away if you have a sudden decrease in hearing or loss of hearing, which may be accompanied by dizziness and ringing in the ears. If you already use medicine for high blood pressure (hypertension), sildenafil could make your blood pressure go too low. Call your doctor right away if you have blurred vision, confusion, dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly, sweating, or unusual tiredness or weakness. This medicine does not protect you against sexually transmitted diseases (including HIV or AIDS).

Raynaud's phenomenon

Use protective measures and ask your doctor if you have any questions about this. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Along with its needed effects, a medicine may cause some unwanted effects. Perhaps the most iconic scene from sci-fi thriller "The Matrix" comes when Neo is told to pick one of two pills: the blue would return him to the illusionary comforts of the dream world he's always known, while the red would release him into the harsh but freeing real world.

Take it on an empty stomach

If Neo was a pharmaceutical marketer he may have appreciated just how much thought likely went into those color choices. In the U.S., blue is associated with peace and trustworthiness, red with action and stimulation. Both colors align with the effect of their respective pill. In a pharma world, the commercial team behind Neo's choice would have correctly identified their target customer. The industry has seen that color can help propel a tiny pill into a billion-dollar franchise. be made early on, Madit said, because validating a new color

• The cost of blue sildenafil varies based on pharmacy, location, and insurance.
• It can cause gastrointestinal upset, such as diarrhea or constipation.
• The medication is contraindicated in patients with recent heart attack or stroke.
• It is not recommended for men with aortic stenosis or hypertrophic cardiomyopathy.
• The pill's coating may contain ingredients like lactose or talc.
• It is important to follow the prescribed dosage and not self-adjust.
• A lack of effect may indicate the need for a different treatment approach.

takes between nine months and a year, due to a

• The effects of sildenafil can be enhanced by drugs like ketoconazole.
• It is one of the most counterfeited drugs, leading to health risks.
• Can cause dry mouth or increased thirst as minor side effects.
• The medication is not recommended for men with severe liver disease.
• It is often used off-label for other conditions, but under medical supervision.
• The blue dye is generally inert but can cause allergic reactions in sensitive individuals.
• A gradual increase in dose may be recommended if the initial dose is ineffective.

long list of production and regulatory tests that must be redone. Regulatory requirements sometimes also force a drugmaker's hand to choose a new pigment.

Reaction	Frequency	Severity	Management Tips
Visual disturbances	Rare	Mild	Stop use and consult doctor
Gastrointestinal upset	Occasional	Mild	Take with food if tolerated
Muscle aches	Rare	Mild	Usually self-limiting
Rash or allergic reaction	Very rare	Severe	Seek immediate medical help