Comparison of trimetazidine plusSildenafil Citrate (Viagra) to chronic nitrates in the control of myocardial ischemia during sexual activity in patients with coronary artery disease.

A large proportion of patients who have Erectile Dysfunction also have coronary artery disease (CAD). In these patients, nitrate therapy is a contraindication to the use of sildenafil. To assess whether the metabolic anti-ischemic agent, trimetazidine, is effective in controlling episodes of myocardial ischemia during sexual activity in patients who have CAD and use long-term nitrate therapy, we studied 38 men (57 +/- 6 years of age) who had proved CAD. Patients underwent 24-hour ambulatory electrocardiographic monitoring at baseline, after 1 week of oral nitrate therapy (20 mg 3 times a day), and after 1 week of trimetazidine (20 mg 3 times a day). Patients were asked to engage in >/=1 session of sexual intercourse during each session of ambulatory electrocardiographic monitoring. They were instructed to takeSildenafil Citrate (Viagra) (100 mg) 1 hour before sexual intercourse performed at baseline and during therapy with trimetazidine andSildenafil Citrate (Viagra) or placebo (blinded) during therapy with nitrates. A decrease in total ischemic burden was observed with nitrates and trimetazidine compared with baseline (-3 +/- 1.2 episodes/patient/24 hours vs -5 +/- 1.3 episodes/patient/24 hours and -6 +/- 5 min/patient/24 hours vs -8 +/- 3 min/patient/24 hours, p <0.01 for nitrates and trimetazidine vs baseline). Trimetazidine plusSildenafil Citrate (Viagra) was more effective in controlling episodes of myocardial ischemia during sexual activity than nitrates alone (-45 +/- 11% vs -18 +/- 7%, p <0.04). In conclusion, in patients who have CAD, combination therapy withSildenafil Citrate (Viagra) and trimetazidine is more effective than nitrate therapy in the control of ischemic episodes during sexual activity, suggesting that long-term nitrate therapy may be safely switched to trimetazidine therapy when therapy for Erectile Dysfunction is required

Use ofSildenafil Citrate (Viagra) in the chronic uremic patient

BACKGROUND: Erectile Dysfunction is one of the factors influencing negatively the quality of life of patients in hemodialytic treatment. The international literature shows that Erectile Dysfunction is present in 30% of patients with chronic renal failure and in 50% of patients undergoing dialytic treatment. Fertility, libido and Erectile Dysfunction, suffer progressive worsening with time, in spite of hemodialysis. The availability of a drug likeSildenafil Citrate (Viagra) can improve the quality of life of the patient and give him a normal sexual activity. METHODS: Twenty patients between 29 and 51 years, were selected; 2 of these had been subjected to renal transplant, with a dialytic treatment time varying from 3 to 13 years. Before the treatment all the patients have been subjected to an andrological screening (testosterone, prolactin, penile color Doppler ultrasound) and proposed the IIEF test. Therapeutic strategy included the assumption of the drug in the days in which the patients were not subjected to dialysis, with an interval from 1 to 3 weeks between assumption and another. The dose was 25-50 mg. At the end of three months of therapy the patients were again subjected to the IIEF test. RESULTS: All patients reported an improvement in sexual activity and sexual desire with very good repercussions on general and psychophysical conditions. CONCLUSIONS: The results demonstrate at least thatSildenafil Citrate (Viagra) is also effective in uremic patients in dialytic treatment or after renal transplant and that it can therefore resolve one of the main problems for the normal development of the life of such patients

Sildenafil Citrate (Viagra) does not exacerbate myocardial ischemia in canine models of coronary artery stenosis.

OBJECTIVES: Our aim was to determine whether Sildenafil Citrate (Viagra) unfavorably alters coronary perfusion in canine models of coronary artery stenosis. BACKGROUND: Concern has been raised thatSildenafil Citrate (Viagra) may exacerbate ischemia in patients with coronary artery disease. However, the effects ofSildenafil Citrate (Viagra) on coronary perfusion are largely unexplored. METHODS: Using anesthetized dogs, a micromanometer constrictor was applied to either an intact coronary artery (model of stable hypoperfusion: Protocol 1) or a site of arterial injury (model of recurrent platelet-mediated thrombosis: Protocol 2). After monitoring coronary flow for 1 h, dogs received two escalating, clinically relevant doses ofSildenafil Citrate (Viagra) or placebo. Perfusion was assessed during the initial hour pretreatment, for 1 h following dose 1 and 1 h following dose 2 by measuring the area of the flow-time profile, normalized to baseline flow x 60 min. Interaction betweenSildenafil Citrate (Viagra) and adenosine-mediated inhibition of platelet aggregation was evaluated by in vitro platelet aggregometry (Protocol 3). RESULTS: In Protocol 1, flow-time area was maintained at 50% to 60% of baseline in both placebo- and sildenafil-treated groups. In Protocol 2, controls exhibited an expected modest, temporal adenosine-mediated improvement in flow-time area (from 40 +/- 5% to 61 +/- 7%; p < .05) while in contrast, perfusion in sildenafil-treated dogs remained unchanged (37 +/- 6% vs. 33% to 35% before vs. after treatment). In vitro aggregometry confirmed thatSildenafil Citrate (Viagra) rendered platelets refractory to the inhibitory effects of adenosine receptor stimulation. CONCLUSIONS:Sildenafil Citrate (Viagra) did not exacerbate ischemia in canine models of coronary stenosis. However, in the setting of recurrent thrombosis, sildenafil-treated dogs were apparently unresponsive to the platelet inhibitory effects of endogenous adenosine

Sildenafil Citrate (Viagra) and vacuum constriction device combination enhances sexual satisfaction in Erectile Dysfunction after radical prostatectomy.

OBJECTIVES: To assess the effectiveness of combining Sildenafil Citrate (Viagra) with a vacuum constriction device (VCD) in men (after radical prostatectomy) unsatisfied with the results of the VCD alone. METHODS: A total of 31 patients unsatisfied with the early use of VCD alone after radical prostatectomy (mean follow-up of 4.5 months) were instructed to take 100 mg ofSildenafil Citrate (Viagra) 1 to 2 hours before VCD use for sexual intercourse. Patients used combination therapy for a minimum of five attempts before assessment with the abridged International Index of Erectile Function (IIEF) questionnaire and a visual analogue scale to gauge rigidity. The effect of combination therapy on the total IIEF-5 score and penile rigidity score were assessed. RESULTS: Of the 31 patients, 7 (22%) had no improvement with the addition ofSildenafil Citrate (Viagra) with VCD and discontinued the drug, and 24 (77%) reported improved penile rigidity and sexual satisfaction. The IIEF-5 score revealed statistically significant improvement in each domain, and patients reported thatSildenafil Citrate (Viagra) enhanced their erections 100% of the time. The penile rigidity scores on a scale of 0 to 100 with the VCD alone averaged 55% (range 23% to 85%) for the men and 59% (range 26% to 90%) for their partners. With the addition of sildenafil, it increased to 76% for the men and 82% for their partners. Of the 24 men, 7 (30%) reported a return of natural erections at 18 months using combination therapy, with 5 of 7 reporting erections sufficient for vaginal penetration. CONCLUSIONS: In this study, the addition ofSildenafil Citrate (Viagra) with VCD improved sexual satisfaction and penile rigidity in patients unsatisfied with VCD alone after radical prostatectomy

Inhibition of angiotensin converting enzyme and phosphodiesterase type 5 improves endothelial function in heart failure.

Angiotensin converting enzyme (ACE) inhibitors and phosphodiesterase type 5 (PDE5) inhibitors have each been reported to improve endothelial function in cardiovascular disease patients, but the comparative and combined effects of these two classes have not been previously studied. We sought to characterize the acute effects of ramipril alone,Sildenafil Citrate (Viagra) alone, or their combination on endothelial function in patients with chronic heart failure (CHF). 64 CHF subjects were randomized to receive placebo, ramipril 10 mg alone,Sildenafil Citrate (Viagra) 50 mg alone, or the combination of ramipril andSildenafil Citrate (Viagra) in a double-blind manner. Flow-mediated dilation (FMD) of the brachial artery was determined by high-resolution ultrasound imaging before and at 1, 2, and 4 hours after study drug. Ramipril alone increased FMD at 4 hours when compared with placebo (+2.3+/-1.3%, p=0.02).Sildenafil Citrate (Viagra) alone increased FMD at 1, 2 and 4 hours when compared with placebo (+3.9+/-1.4, +4.6+/-1.8, and +3.7+/-1.3% respectively, all p<0.02).Sildenafil Citrate (Viagra) in combination with ramipril increased FMD at 1, 2, and 4 hours when compared with placebo (+3.5+/-1.5, +4.5+/-1.8, and +4.8+/-1.3% respectively, all p< 0.03). Ramipril andSildenafil Citrate (Viagra) both acutely improved FMD in patients with CHF, with additive effects evident at 4 hours during combination therapy. Further work to characterize chronic effects of combined ACE and PDE5 inhibition on endothelial function are warranted

Erectile Dysfunction after kidney transplantation: our 22 years of experience.

AIM: To evaluate the results of treatment of Erectile Dysfunction (ED) in kidney transplant recipients before and after the advent of sildenafil. MATERIALS AND METHODS: From 1981 through 2002, 971 male patients of mean age 53.4 years received a renal graft. Erectile Dysfunction (ED) was investigated in all patients at the first urologic visit posttransplantation. Psycho-sexual support was offered to all patients. BeforeSildenafil Citrate (Viagra) use (1998), our diagnostic approach was complex. From 1998 we tested: serum levels of testosterone, prolactin, and glucose with penile duplex ultrasonography and NPT reserved for selected cases. RESULTS: From 1981 through 1998, 365 male kidney transplant recipients (45%) reported ED. Only 169 patients chose to be treated: 27 responded to psycho-sexual therapy; 3 received testosterone with benefit; 133 had a good results from intracavernosal injection of vasoactive drugs; and 6 received a penile prosthesis. Since 1998, 126 patients reported ED (78.3%). Only 78 chose treatment: 24 patients had a satisfactory response toSildenafil Citrate (Viagra) (65% with 50 mg and 35% with 100 mg). PGE1 alone or in combination with papaverine and phentolamine produced a good response in 37 patients; 17 patients did not respond to pharmacotherapy; and 5 received a tricomponent penile prosthesis without complications. The side effects ofSildenafil Citrate (Viagra) and PGE1 therapy were similar to those reported in the literature. CONCLUSIONS: ED is an important problem in male renal transplant recipients. Cultural resistance to treatment is common. However, treatment with Sildenafil Citrate (Viagra) and intracavernosal self-injection of PGE1 are well accepted, and prosthetic devices may help in resistant cases

Fatal variceal rupture afterSildenafil Citrate (Viagra) use: Report of a case.

Sildenafil may increase the risk of variceal bleeding in portal hyptertension by increasing splanchnic blood flow. We report herein the second case of variceal rupture afterSildenafil Citrate (Viagra) use

Efficacy and safety of oralSildenafil Citrate (Viagra) in men with Erectile Dysfunction and spinal cord injury.

OBJECTIVE: To assess the efficacy ofSildenafil Citrate (Viagra) in men with spinal cord injury (SCI) and Erectile Dysfunction (ED). METHODS: Seventeen men with SCI were selected from February to September 1998 forSildenafil Citrate (Viagra) treatment of ED. The initial dose of 25 mg was increased by 25-mg increments as needed. Patients underwent baseline physical examination and answered questions from the abridged International Index of Erectile Function before and during therapy. RESULTS: Sixteen patients tolerated therapy; 1 developed hypotension and discontinued therapy. There was significant improvement in erectile function (P < .05) after 5.3 +/- 2.2 months when compared with baseline or previous therapies (P < .05). Of the 17 patients, 94% recommendedSildenafil Citrate (Viagra) to others. Six of these 16 patients were available for long-term follow-up. There was further significant improvement in quality of erection (P < .05), but no change in satisfaction. CONCLUSION:Sildenafil Citrate (Viagra) is effective and well tolerated in men with SCI and ED