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All PDE-5 inhibitors are contraindicated in men who use or may need to use nitrates. These drugs potentiate the vasodilatory effect of organic nitrates and nitric oxide donor drugs.45 The effect on systemic blood pressure, however, in both normotensive and hypertensive men tends to be clinically nonsignificant when sildenafil is used alone or in conjunction with other antihypertensive agents.46 Thadani and colleagues47 reported that use of vardenafil did not affect exercise tolerance among men with stable coronary artery disease.47
Article Date: 21 Jan 2010 - 1:00 PST
Obese patients have to exercise regularly and aim at reducing weight.
In fact, the most favorable risk/ benefit ratio is seen with a dose optimization regimen of 3mg, with the 3mg dose providing efficacy comparable to that of 4mg, but with fewer side effects. (15)
Currently, any man who wishes to have erectile function can do so regardless of the etiology of the problem. Many therapeutic options are available, and the task of the physician is to help the patient seek the best solution. Finding a trained and understanding physician who is willing to take the time to understand the patient's problem is the first step in identifying which therapeutic option will ultimately be most appropriate and successful.
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Duplex ultrasound: This is perhaps the best test for evaluating ED. An ultrasound uses high-frequency sound waves to take "pictures" of the body's tissues. For people with ED, an ultrasound may be used to evaluate blood flow and check for signs of a venous leak, artherosclerosis or tissue scarring. This test is performed both while the penis is erect (usually induced by an injection of a drug that stimulates erection) and also while it is soft.
The results suggest it is likely that the two disorders share common mechanisms, said lead author Xiang Gao, MD, PhD, instructor at Harvard Medical School, associate epidemiologist at Brigham and Women's Hospital and research scientist at the Harvard School of public health in Boston, Mass.
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Recommendation 2: The American College of Physicians recommends that clinicians base the choice of a specific PDE-5 inhibitor on the individual preferences of men with erectile dysfunction, including ease of use, cost of medication, and adverse effects profile (Grade: weak recommendation; low-quality evidence).
Cardiovascular disease (CVD) - studies show that erectile dysfunction often occurs two to three years before CVD. Men with ED are also more likely to suffer heart attack and stroke.
Men who present with diminished libido and ED may be found to have low serum testosterone levels. Hormone replacement may be of benefit to those with severe hypogonadism and possibly as adjunctive therapy when other treatments are unsuccessful by themselves. Libido and an overall sense of well-being are likely to improve when serum testosterone levels are restored to the reference range.
These drugs, called selective phodiesterase type 5 (PDE5) inhibitors, treat erectile dysfunction by interfering with the action of the compound PDE5 in the blood vessels of the penis. But there are concerns that PDE5 inhibitors may also act on similar compounds in the retina, the part of the eye that receives and transmits images to the brain, according to background information in the study.
Dr. Andrew McCullough, director of male sexual health, fertility and microsurgery at NYU Langone Medical Center, said the results are promising.
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