Erectile dysfunction, whether caused by blood vessel (vascular), hormonal, nervous system, or psychological problems, can be treated with a range of prescription drug therapies.
Oral medication (by mouth medication):
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Increase of blood flow into the penis (erection-producing medications)
Reduction of performance anxiety by ensuring successful erections
Adjustment or replacement of medication taken for other conditions. If such drugs affect your erections, your doctor may review them in an attempt to reduce side effects. Never adjust your dosage without consulting your doctor.
Correction of abnormal hormone levels through testosterone replacement therapy. Abnormal hormone levels, however, are a rare cause of erection problems.
Sildenafil (Viagra)
The oral drug sildenafil, sold under the trade name Viagra, has been a media sensation. Since its introduction in America in April 1998 there has been unprecedented demand and it earned its manufacturers, Pfizer, global revenues of about $800 million in 1998. The diamond-shaped blue tablet, is taken about 60 minutes before sexual activity. Sildenafil works by inhibiting an enzyme called 5-phosphodiesterase, thus increasing the levels a substance called cyclic GMP. Cyclic GMP is a powerful dilator of blood vessels in the penis, leading to inflow of blood and an erection under stimulating circumstances.
There have been reports of Viagra users dying from heart attacks, but these attacks were not thought to be related to the drug. A certain percentage of heart attacks will occur during strenuous activity. Nevertheless, the manufacturers have issued warnings to individuals with cardiovascular disease. Caution is specifically advised for groups for which the drug has not yet been studied, such as men who've had a heart attack, stroke or life-threatening arrhythmia in the past six months, those with significant hypotension (low blood pressure) or hypertension (high blood pressure), those with unstable angina and those with retinitis pigmentosa, a disease that causes retina deterioration. The only current absolute contraindication is the concomitant use of nitrate containing cardiovascular medication.
Nitrates such as Glyceryl tri nitrate (GTN) or isosorbide mononitrate are usually prescribed for ischaemic heart disease and angina.
Viagra has also become popular for recreational use, for example in night-clubs. However, it is a prescription drug that should only be taken under medical supervision. Experts say that it does not have benefits for men who have normal erections. It can be lethal when used in conjunction with inhaled amyl nitrate (“poppers”), a recreational drug particularly popular among gay men. It is used to create a “rush” of sexual stimulation, but in the process also causes blood pressure to plummet to levels that may be dangerously low. This also applies to Viagra use in conjunction with heart medications that contain nitrate.
Because of the potential misuse of the drug, the Medicines Control Council, which delayed approval of the drug after reports of possible Viagra-related deaths in the US and Europe, warned that it would withdraw the drug if evidence of misuse emerged.
Viagra costs between R60 and R80 a tablet, depending on its strength. Following the phenomenal success of Viagra, several other drug companies launched similar type of drugs in the last year. Two such therapies are Vardenafil (Levitra) and Tadalafil (Cialis).
Vardenafil (Levitra)
Vardenafil or Levitra like Viagra is a phosphodiesterase type-5 inhibitor and was developed specifically for erectile dysfunction as an oral agent. Multiple trials have shown that Levitra (Bayer Pharmaceuticals) is effective in improving the rate of achieving and maintaining an erection during sexual intercourse. Improvement also was noted in other aspects of sexual function, including confidence, orgasmic function and overall satisfaction.
Vardenafil produces significant improvements in erectile dysfunction regardless of age, baseline severity and cause of erectile dysfunction. It is also effective in patients with diabetes and after radical prostatectomy surgery for prostate cancer. Levitra has a rapid onset of action and sexual intercourse is possible as early as 16 minutes after its administration by mouth in some patients.
Twenty milligrams of Levitra has sustained longterm efficacy by providing up to 92% of patients with improved erections during more than two years of treatment.
Levitra is well tolerated with side effects very similar to that of Viagra. The most common side effects are headache, flushing, rhinitis (stuffy nose) and indigestion (heartburn), which are mild or moderate and generally decreased with continued treatment.
Levitra comes in two dosages namely ten and twenty milligrams. Ten milligrams is more than adequate for mild to moderate erectile dysfunction.
Tadalafil (Cialis)
Cialis is one of the new PDE-5 inhibitors for the treatment of erectile dysfunction. Also dubbed the weekend drug for its long duration of working, up to 36 hours in some patients. This is because the chemical structure is completely unrelated to the other two PDE-5 inhibitors.
It has been demonstrated to be effective in all severities of erectile dysfunction and for different causes of erectile dysfunction.
Side effects although similar to the other two PDE-5 inhibitors, have the addition of back pain that appear to be self limiting, mild and benign.
Cialis is also contra-indicated with nitroglycerine or any nitrate medications because of a drop in blood pressure.
More on medication
Some drugs are claimed to be effective, but have not been proven to be so in scientific studies. These include yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone.
Medications may be used in conjunction with counselling, psychotherapy or psychiatric medication if your erectile problems have psychological causes.
Reviewed by Dr Werner Botha Specialist Urologist, Cape Town Medi-clinic.
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