Updated

The makers of long-lasting impotence treatment Cialis have added a new twist to the old free-sample gambit — they are offering dissatisfied patients the chance to try rival drugs for free.

Eli Lilly & Co. (LLY) and Icos Corp. (ICOS) on Monday kicked off the rare promotion for a prescription medicine with full-page ads in USA Today and the Wall Street Journal.

Billed as "The Cialis Promise," the drugmakers are offering patients who have never tried Cialis (search) free trial samples of the erectile dysfunction (ED) treatment. If they were not satisfied, Lilly and Icos would pay for a trial sample of Viagra (search) or its other relatively new rival, Levitra (search), which is sold by Britain's GlaxoSmithKline Plc (GSK) and Germany's Bayer AG.

"We are so confident that men with ED will appreciate the benefits of Cialis that we're willing to go as far as offering to pay for our competitors' products if they are not satisfied," Paul Clark, Icos chief executive, said in a statement.

Pfizer Inc. (PFE), seeking to hold onto the market dominance that made Viagra a household name and spawned sales of $1.9 billion last year, in April initiated a promotion offering a free refill to patients after six paid prescriptions.

The new Cialis promotion will also feature a suggestive sequel to its now-ubiquitous television ads showing a man and woman relaxing in side-by-side bathtubs on a sunset-lit bluff. In the new TV spot the bathtubs sit empty, accompanied by the tagline: "Looks like someone discovered the Cialis promise."

The battle for the multibillion dollar erectile dysfunction market has become one of the advertising industry's highest profile clashes since Levitra and Cialis were introduced last year, ending Viagra's five-year virtual monopoly.

In February, Cialis and Levitra blitzed Super Bowl viewers with erectile dysfunction ads during television's most expensive commercial air-time event.

The Cialis ads boasted of the drug's ability to work for up to 36 hours. Viagra and Levitra work for about four hours.

Although fast-acting Levitra had a head start of several months into the marketplace, Cialis has surpassed Levitra in new prescriptions and market share, and it is starting to make inroads on Viagra — especially in Europe, where its 36-hour window of opportunity has earned it the nickname "le weekend."

Cialis's market share was approaching 40 percent in France and 30 percent in Germany and Italy, according to data released by Lilly and Icos in March.

For the week ended July 2, Cialis garnered 19.6 percent of new U.S. prescriptions, compared with 15.6 percent for Levitra and 64.8 percent for Viagra, according to data collected by prescription drug tracking company IMS Health.

In April, Levitra's makers altered their advertising tack, replacing gruff former football coach "Iron" Mike Ditka as pitchman with an attractive, young woman sharing the secret of her satisfaction.

Pfizer also recently shifted advertising gears, switching from virile professional athletes touting the drug to scenes of overweight, middle-aged men jumping for joy while the song "We Are the Champions" plays.

Last month, Pfizer awarded its estimated $100 million Viagra ad account for consumer marketing to Interpublic Group of Cos. Inc. (IPG) agency McCann-Erickson.

Eli Lilly shares were up 48 cents to $67.48 on the New York Stock Exchange. Shares of tiny Icos, which has seen losses mount as it pays for its share of Cialis's massive advertising and promotion costs, were off 14 cents to $25.01 on Nasdaq.