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PDE-5 selective inhibitor. Inhibition of PDE-5 increases cGMP activity, which increases vasodilatory effects of NO. Effective in men with mild-to-moderate ED. Take on an empty stomach approximately 1 h before sexual activity. Sexual stimulation is necessary to activate response. The increased sensitivity for erections may last 24 h. Available as 25-, 50-, and 100-mg tablets. Onset of action varies from 15-60 min, with a duration of action of 4-6 h. Half-life is 4-5 h.
ED can affect intimate relationships and cause low self-esteem in men, as well as in their sexual partners. Smoking, alcohol abuse, and psychological factors, such as depression, stress, and anxiety, may increase the risk for erectile dysfunction. Common treatments for impotence include oral medications (e.g., sildenafil [Viagra®], tadalafil [Cialis®], vardenafil [Levitra®]), sex therapy, self-injections, vacuum devices, and in some cases, surgery.
Might lifestyle changes, such as eating a healthier diet, avoiding alcohol, quitting smoking, exercising regularly, and getting enough sleep, be beneficial? Why or why not?
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A. I then recommend trimix. I also recommend trimix when a patient experiences pain from Caverject. However, if a patient has a painful reaction with Caverject, he will frequently have a similar reaction with trimix. In that situation, a combination of papaverine and phentolamine (bimix) can be tried.
Modern drug therapy for ED was advanced enormously in 1983 when British physiologist Giles Brindley, Ph.D. dropped his trousers and demonstrated to a shocked American Urological Association audience his phentolamine-induced erection. The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered, established the fundamentals for the later development of specific, safe, orally-effective drug therapies.[9]
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No. When a man tries to pull out before ejaculating ("coming"), he usually leaves behind a small amount of fluid that leaks from the penis during sex. This fluid has enough sperm in it to cause pregnancy.
Men taking PDE5 inhibitors have reported mild and temporary blurred vision, altered light perception, and blue-tinged vision.
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The risk of developing heart attacks or abnormal heart rhythms during sex is low in men with well controlled hypertension, mild disease of the heart's valves, well controlled heart failure, mild and stable angina (with a favorable treadmill stress test), successful coronary stenting or bypass surgery, and a remote history of heart attack (more than 8 weeks previously). Sildenafil can be used safely in men in these low risk groups.
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What are my “numbers”? Work with your doctor to measure and control:
With the introduction of effective pharmacologic therapies for erectile dysfunction, more men are seeking treatment. The underlying cause of erectile dysfunction is usually a chronic medical illness or a side effect of certain drugs. Less commonly, the problem is psychogenic. Even after optimal treatment of common medical disorders such as diabetes mellitus and hypertension, erectile dysfunction may persist. Pharmacologic treatments, such as the intracavernosal or transurethral administration of alprostadil or the use of the new oral medication sildenafil, may offer patients substantial benefit. Before any of these drugs are prescribed, consideration should be given to existing medical illnesses and medications, partner satisfaction, comfort with the method of administration and the side effect profile. (Am Fam Physician 1999;60:1159-72.)
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Telephone number to call if severe drug side effects or complications develop:
Adult 10 mg PO 1 h before sexual activity; may increase to maximum recommended dose of 20 mg or decrease to 5 mg based on efficacy and adverse effects
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