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The causes of erectile dysfunction include aging, high blood pressure, diabetes mellitus, cigarette smoking, atherosclerosis, depression, nerve or spinal cord damage, medication side effects, alcoholism or other substance abuse, and low testosterone levels.
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The mean IIEF GS at Visit 1 was 25.7 (median 22, range 5 – 64), at Visit 3, 56.9 (median 62, range 7 – 73) and at Visit 4, 59.3 (median 60, range 18 – 73). The respective mean IIEF EDS was 8.2 (median 6, range 0 – 28), 23.5 (median 27, range 1 – 30) and 25.2 (median 25, range 6 – 30). There was no correlation between age and response to Viagra, although older men had relatively lower IIEF scores.
Attention has recently been focused on the chemical mediators of erection. These include prostaglandin E, acetylcholine, vasoactive intestinal peptide and nitric oxide. The most physiologically important mediator is nitric oxide.2 This substance is released from nerve endings and vascular endothelium and functions by activating guanylate cyclase, which converts guanosine triphosphate to cyclic guanosine monophosphate (cGMP).3 cGMP becomes the secondary messenger that causes smooth muscle relaxation, resulting in venous engorgement and penile tumescence.
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Men with a rare heart condition known as long QT syndrome should not take vardenafil since this may lead to abnormal heart rhythms. The QT interval is the time it takes for the heart's muscle to recover after it has contracted. The QT interval is measured with an electrocardiogram (EKG). Some patients have longer than normal QT intervals, and they may develop potentially life-threatening abnormal heart rhythms, especially when given certain medications. Since long QT syndrome can be inherited, men with a family history of long QT syndrome should not take vardenafil. Furthermore, vardenafil is not recommended for men who are taking medications that can affect the QT interval such as quinidine (Quinaglute, Quinidex), procainamide (Pronestyl; Procan-SR; Procanbid), amiodarone (Cordarone), and sotalol (Betapace).
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