Archive for the ‘PDE5 selective inhibitors’ Category
Viagra: what every physician and patient shouid know
Viagra, an oral drug taken one hour prior to sexual activity, improves erectile function in the majority of men with erectile dysfunction who receive it. It is not an aphrodisiac and therefore will not work without sexual stimulation. The drug is absolutely contraindicated in patients on organic nitrates, as this combination can lead to severe drops in blood pressure. Patients with heart disease, suspected heart disease and riskfactors for heart disease should discuss with their physicians the safety of resuming sexual activity. A cardiac work-up, including exercise treadmill testing, should be considered in appropriate patients.
Introduction
On March 27,1998, the FDA approved sildenafil (Viagra) as the first oral agent for the treatment of male erectile dysfunction. This new drug has received wide coverage in the media and on talk shows and has spurred an entire generation of new jokes; most importantly, however, it has awakened the public consciousness to the problem of erectile dysfunction (ED). This issue is now being discussed openly by patients, spouses and healthcare providers. The purpose of this article is to describe ED, and to discuss the various treatment options and the efficacy and warnings regarding this remarkable new drug.
What to do if Viagra won’t do
Erectile dysfunction (ED) — impotence — is an extremely common problem that affects up to 22% of American men, mostly in the older age groups. Once considered primarily a psychological disorder, it is now clear that most cases of impotence have a physical basis. The leading causes are the chronic diseases that damage blood vessels and nerves vital for normal erectile function; diabetes, atherosclerosis, and hypertension head the list (see last month’s Harvard Men’s Health Watch). The medications used to treat these problems and other ailments can also contribute to impotence. Hormonal abnormalities are less common, but they are particularly important to detect since they can be corrected. That’s also true of the psychological problems that cause up to 15% of impotence; table 1 summarizes some of the differences between psychological and physical impotence.
A questionnaire for ED
Each question has several possible responses. Circle the number of the response that best describes your own
situation. Please be sure that you select only one response for each question. Over the past six months:
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Viagra, sex, and the heart
If your wife is worried about your heart, she can be reassured about Viagra (sildenafil). The medication is not safe for men who use nitrates in any form, including nitroglycerin tablets and spray, long-acting nitrate tablets, nitrate patches, and amyl nitrate. But the drug is quite safe for men who do not take these medications, even if they have stable coronary artery disease or well-controlled hypertension (see Harvard Men’s Health Watch, April 2005). For example, a study from the Mayo Clinic agrees with lots of earlier research and demonstrates that Viagra is safe. More than 100 men with coronary artery disease participated in the trial. Each man underwent two detailed stress tests that used a bike for exercise and used echocardiograms as well as EKGs to monitor the result. Before one of their tests, the volunteers took Viagra (50 or 100 mg, the top dose), and before the other they took a placebo. Compared to the placebo, Viagra did produce a slight drop in systolic blood pressure (the higher number, recorded while the heart is pumping blood), but there were no changes in diastolic blood pressure (the lower number, recorded when the heart is refilling between beats), exercise capacity, symptoms, or echo-cardiograms and EKGs.