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In treating men with erectile dysfunction, doctors worry most about heart disease. "Any form of cardiovascular disease is more likely to occur in men who have erectile dysfunction," says Ira Sharlip, MD, a urologist in San Francisco and past president of the Sexual Medicine Society of North America.
The most important concern is the labeled contraindication for patients taking nitrates of any kind because of the potential for sudden severe hypotension. Patients taking nitrates have high levels of nitric oxide in the bloodstream. Sildenafil potentiates the effect of the nitrates by inhibiting the breakdown of cGMP, causing hypotension due to severe vasodilation.
Numerous factors can disrupt the normal physiologic mechanisms involved in erection (Table 1). Most cases of erectile dysfunction were thought to be psychologically based, but it is now understood that most have an organic cause, especially in older patients. In about 40% of men over 50 years old, the primary cause of erectile dysfunction is related to atherosclerotic disease.20 In this respect, risk factors are similar to those of cardiovascular disease. However, erectile dysfunction may also be related to psychological, neurological, hormonal, pharmacological and end-organ (penile) factors.
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Concurrent administration with ketoconazole (200 mg PO qd), itraconazole (200 mg PO qd), or erythromycin: Not to exceed 5 mg PO q24h
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"I have that conversation a lot with the older gentlemen, particularly those guys over 75 years old," Mason said. "Those are the guys who really have to weigh whether it's worth it."
Suppressive assay. 2 x 105 purified splenic or intratumoral CD11b+ cells were added to 106 clonotypic CFSE-labeled splenocytes. They were then peptide pulsed and cultured for 3 d in 96-well flat-bottom plates. Sildenafil was added where indicated in the figures.
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"If you control your diabetes, and treat existing risk factors and do things to prevent diabetes and control your blood pressure and cholesterol levels, not only will you reduce your risk of cardiovascular disease and diabetes, but you will also improve your sexual function," she said.
Generally, sexual function suffers when you have health problems that damage vascular health and blood flow. So, while Viagra may be a quick fix, it doesn't address the underlying health problems that are plaguing your sex life.
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