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Medical Issues for Men Taking Viagra and Cialis

Originally, phosphodiesterase type 5 (PDE 5) inhibitors were investigated as anti-anginal agents for patients with coronary artery disease. However, after the introduction of sildenafil in 1998, significant media attention was paid to its cardiovascular disease effects. The relationship between cardiovascular disease and erectile dysfunction has been well documented in clinical trials.

The PDE 5 inhibitors such as Viagra, Cialis and Levitra have been recognized by expert guidelines as their first-line therapy for erectile dysfunction. This was based on their demonstrated record of efficacy and general safety profile in different men with the condition. That includes those men with comorbidities such as diabetes, hypertension and hyperlipidaemia. The efficacy and safety of PDE 5 inhibitors have been documented in both clinical trials and actual clinical practice scenarios.

Erectile dysfunction is associated with a number of comorbid conditions, including diabetes mellitus, hypogonadism, hypertension, vascular disease, dyslipidaemia and depression. According to a national database of 51 health plans and 28 million people in the US from 1995 to 2002, about 41% of men with erectile dysfunction were reported to suffer from hypertension, 42% hyperlipidaemia, 20% diabetes mellitus and 11% depression. The common denominator for the majority of these men was vascular disease. The pathophysiological and clinical links between erectile dysfunction, cardiovascular disease and endothelial dysfunction have been established.

The Second Princeton Consensus Conference on Sexual Dysfunction and Cardiac Risk Guidelines emphasized the importance of evaluating and managing cardiovascular disease risk factors and comorbidities in patients with erectile dysfunction. These guidelines reinforce and underscore the vital role of primary care doctors in the screening and diagnosis of cardiovascular disease risk in erectile dysfunction patients. The consequences of missed cardiovascular disease risk assessment opportunities in this patient population are substantial.

The Second Princeton Consensus divided patients with erectile dysfunction into three cardiovascular disease risk categories (low risk, intermediate or indeterminate risk and high risk), based on their risk associated with sexual activity. The long-term use or more than 3 years, of PDE 5 inhibitors in the treatment of erectile dysfunction proved to be safe and effective. In a study with a follow up of 1 to 3 years, it was reported that side effects associated with sildenafil treatment were mild and generally tolerable. Likewise, in a study lasting 2 years, it was reported that most of the treatment-emergent side effects reported with vardenafil were mild, with no cardiovascular disease safety concerns.

According to the 2005 American Urological Association guidelines, PDE 5 inhibitors were recommended as first-line therapy for men with erectile dysfunction. Clinical trial and post marketing surveillance data have shown good safety and tolerability profiles for PDE 5 inhibitors, indicating that PDE 5 inhibitors may improve erectile function safely in patients with erectile dysfunction and concomitant cardiovascular disease.

Seeking Medical Advice on Taking Viagra and Cialis

It is normal to experience erectile dysfunction on occasion but if erectile dysfunction lasts longer than two months or is a recurring problem, see your doctor for a physical exam or for a referral to a doctor who specializes in erectile problems. Your doctor can help you determine the underlying cause or causes of erectile dysfunction and then help you find the right type of treatment.

Although you may view erectile dysfunction as a personal or embarrassing problem, it is important to seek treatment. In many cases, erectile dysfunction can be successfully treated. Also, see your doctor if the therapy or medication prescribed to treat erectile dysfunction is not working effectively for you. Do not try to combine medications or therapies on your own or deviate from prescribed doses.

PDE Inhibitors and How They Work

Modern drug therapy for ED was advanced enormously since 1983, when British physiologist Giles Brindley, Ph.D. dropped his trousers and demonstrated to a shocked AUA audience his phentolamin induced erection. The drug Brindley injected into his penis was a nonspecific 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 drug therapies that became known as PDE 5 inhibitors.

Phosphodiesterase (PDE) is an enzyme that causes the breakdown of cyclic GMP, which is the direct intracellular mediator in the nitric oxide (nonadrenergic, noncholinergic) pathway. Discovery of this pathway led to a Nobel Prize in 1998 for the scientists responsible. The nitric oxide system causes relaxation of smooth muscle in blood vessel walls (vasodilatio), in various organ systems.

The direct intracellular mediator of the nitric oxide pathway is cGMP and the PDE catalyzes the degradation of cGMP. This pathway is active in numerous organ systems and a number of different PDEs are known. The various PDEs differ in their physiologic roles and tissue distribution. Type PDE 5 is concentrated in the penile smooth muscle of the corpus cavernosum, where its normal function is to inhibit erection by degradation of cGMP, the mediator of erection.

Viagra and the newer drugs Cialis and Levitra all inhibit PDE 5, which is an inhibitor for corporal smooth muscle relaxation, resulting in increased blood flow in the penis in response to sexual stimulation.

Comparison Between Viagra, Cialis and Levitra

The efficacy of Viagra, Cialis and Levitra is approximately 70%. The side effect profile is similar among the three drugs, except that blue discoloration of vision (overlap with PDE 6 in the retina) is seen only with Viagra and muscle aches only with Cialis. Vasodilatory side effects including headaches, nasal congestion and flushing are common with all three drugs are mild and only rarely caused men to drop out of clinical trials.

All three drugs carry a contra indication in men using organic nitrates. The long halflife of Cialis (17.5 hours) is noteworthy, earning this drug the nickname (The Weekender), as a single dose taken on Friday would still be exerting an effect Sunday.

Conclusion

Alternative PDE 5 inhibitors Cialis and Levitra are in competition with Viagra. Aside from the durability and long performance qualities of Cialis, and the excellent track record of Viagra, the differences between the three drugs are not great. All appear to be effective and safe, provided that concomitant nitrates are avoided. A potential for serious hypotension exists should an organic nitrate be used along with any of these three PDE 5 inhibitors.

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