Erectile dysfunction

Drug Store News, Feb 15, 1999 by Carol Dickson McKee

Agents for the treatment of erectile dysfunction should be used with caution in patients with anatomical deformation of the penis or in those with conditions which may predispose them to priapism, including sickle cell anemia, multiple myeloma, leukemia or the use of certain medications [(Table 1).sup.2-5].

Treatment of erectile dysfunction should not be initiated until a thorough medical history, drug history and physical examination have been performed. Potential causes for erectile dysfunction should be determined and treated appropriately. Initiating treatment for erectile dysfunction without first carefully examining the patient may result in missing significant problems, such as prostate cancer.

What consultations are important to tell my patients who use [sildenafil.sup.12-18]?

* Sildenafil is absolutely contraindicated in patients taking any type of nitrates, including "poppers."

* Sildenafil is taken orally approximately one hour prior to sexual intercourse. It can, however, be taken from four hours to 30 minutes prior to expected intercourse.

* Sildenafil should not be taken more often than once a day (e.g., once per a 24-hour period).

* Sildenafil is absorbed more quickly if taken on an empty stomach; fatty food, especially, will slow the rate of sildenafil's absorption.

* Taking sildenafil with grapefruit juice may cause increased sildenafil serum concentrations and adverse effects.

* Sildenafil does not offer any protection from the transmission of the human immunodeficiency virus or other sexually transmitted diseases.

* Contraception should be used, if appropriate.

* Sildenafil is not a hormone or an aphrodisiac. It is important for partners especially to know that sildenafil will not produce an erection unless the man is sexually stimulated and aroused.

* Sildenafil does not cause an erection itself, but rather allows an erection to occur with sexual stimulation and arousal. If circumstances change, and a man is not sexually stimulated or aroused, he will not obtain an erection simply from taking sildenafil. Sildenafil has no effect in the absence of sexual stimulation.

* The safety and efficacy of combinations of sildenafil with other treatments for erectile dysfunction have not yet been studied and are therefore, not recommended.

What else should I especially [remember.sup.12-18]?

The degree of cardiovascular risk associated with sexual activity should be considered for each patient, based upon his cardiovascular status, prior to initiating any treatment for erectile dysfunction. Other conditions in which sildenafil should be used with caution, if at all, include active coronary ischemia, even in patients who are not on nitrates, congestive heart failure and borderline low blood pressure and volume status. Caution should also be used when considering the use of silde-nafli in patients on complicated multi-drug antihypertensive programs and in patients having conditions or taking medications, as discussed previously, which may cause increased serum sildenafil concentrations or prolong sildenafil's half-life.