Sildenafil citrate for treatment of...

Sildenafil citrate for treatment of erectile dysfunction has minor side purports caused by vasodilation, including headache, facial flushing, and nasal congestion. Although skilled hand consensus guidelines advise against the use of sildenafil in men with active coronary ischemia, conclusion monitoring data have not shown any increase in adverse cardiac circumstances in randomized trials using sildenafil and placebo.

DeBusk and associates manner of lifeed a randomized, double-blind, prospective, multi-center, placebo-controlled consideration to evaluate the efficacy and safety of sildenafil citrate when used to treat erectile dysfunction. Men in stable sexual relationships with confirmed erectile dysfunction who had stable coronary artery disease (CAD) were included. No nitrates could have been used in the four weeks before the investigation and men were required to be at gentle or intermediate risk for adverse cardiovascular ends during sexual activity as determined through the Prince-ton guidelines. Patients were randomized to receive sildenafil or placebo.

The studious mood drug was started at 50 mg and could be adjusted to 25 or 100 mg depending forward efficacy and tolerability. Outcomes measured for efficacy included questions 3 (frequency of penetration) and 4 (frequency of maintained erections after penetration) of the International Index of Erectile Function. Other lifestyle and efficacy measurements were used with sum of two units questionnaires to measure the rejoinder of the partners to the intervention.

Among the 142 patients randomized and included in the intent-to-treat analysis of efficacy, patients in the sildenafil form into groups had significantly higher improvement in erections and intercourse rate than those who received placebo. Partner satisfaction also was higher in the treatment dispose but the number of respondent was too small to determine significance.

Adverse affairs were slightly higher in the sildenafil cluster as shown by previous trials. no other than one patient taking sildenafil unraveled a cardiac adverse event; this patient had moderate chest press and vasodilation on day 9 The reflection medication was halted for several days and then resum This same patient later disentangleed moderate edema of the right forearm and moderate hypertension. No further adverse consequences were noted when the dosage was reduc to 25 mg Five patients had increases in angina scores, still these increases occurred almost equally in the couple groups.

The authors close that sildenafil is effective and well tolerated in patients with stable CAD. Although the sildenafil collection had a higher rate of adverse occurrences the rate of events related to cardiovascular weights was low.

DeBusk RF et al. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease. Am J Cardiol January 15 2004;93:147-53

EDITOR'S NOTE: The use of phosphodiesterase impressed sign 5 inhibitors in the treatment of erectile dysfunction caused early disquiets about patients with cardiovascular disease. Many of these touchs have been unfounded. Sexual activity is not associated with a significant absolute increase in morbidity or mortality, and guidelines have been perform the operations indicated ined to identify the men who may be harmed according to resuming an active sex life. (1) Among all patients who participated in placebo-controlled trials of sildenafil, the incidence of myocardial infarction was slightly lower among those taking the consideration medication.

Among all patients chronicleed in open-label studies of sildenafil, the incidence of death attributed to cardiovascular disease was the same in the treatment and the placebo clusters Even in patients with stable CAD, previous studies confirm the safety of sildenafil use that was noted by the agency of DeBusk and colleagues in this cogitation In studies examining physiologic measurements in patients with coronary ischemia who were given sildenafil, vardenafil, or tadalafil, total exercise duration increased in men with stable angina. The arrhythmogenic potential of all of the phosphodiesterase mark 5 inhibitors is currently determined to be minimal, although vardenafil is specifically contraindicated for concomitant use with class IA and class III antiarrhythmic agents. It appears that with near attention to patient selection, phosphodiesterase token 5 inhibitors can be used safely in the majority of men plane in the presence of stable cardiovascular disease.--R.S.

REFERENCE

(1) DeBusk R Drory Y Goldstein I, Jackson G Kaul s Kimmel SE, et al. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Am J Cardiol 2000;86:175-81

COPYRIGHT 2004 American Academy of Family Physicians

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