Sildenafil for selective serotonin reuptake inhibitor-induced Erectile Dysfunction in elderly male depressed patients.

Treatment with antidepressants, especially agents with potent serotonergic effects, is frequently associated with sexual side effects. In the present study, we examined the efficacy of sildenafil, a potent phosphodiesterase inhibitor, in the treatment of elderly men (n = 10; 70-81 years) with Erectile Dysfunction induced by antidepressant treatment for major depressive disorder. Eligible subjects were instructed to addSildenafil Citrate (Viagra) (25-50 mg/day) to their current drug treatment. Clinical assessment of erectile function was performed at beginning of treatment withSildenafil Citrate (Viagra) and at follow up, 4 weeks later. All patients reported an improvement of their erectile capacity, and in 7 out of 10 subjects, erectile function returned to a normal level.Sildenafil Citrate (Viagra) appears to be a safe and well-tolerated agent in elderly subjects. We noted side effects in 2 patients (flashes), but the side-effects were bothersome only to one patient (headache). It appears thatSildenafil Citrate (Viagra) coadministration improves Erectile Dysfunction associated with selective serotonin reuptake inhibitor ongoing treatment in elderly patients

Efficacy, safety and patient acceptance of Sildenafil Citrate (Viagra) as treatment for Erectile Dysfunction.

PURPOSE: We assessed the efficacy and safety of Sildenafil Citrate (Viagra) as treatment for Erectile Dysfunction. MATERIALS AND METHODS: A total of 433 completely evaluated men with chronic Erectile Dysfunction were treated with Sildenafil Citrate (Viagra). Response was assessed prospectively by baseline and followup physician interviews, and by a patient self-administered 15-item questionnaire on the domains of patient treatment response and satisfaction, partner treatment satisfaction, comparative previous treatment satisfaction, adverse effects, and patient and partner quality of life. RESULTS: Of the 304 men (70.2%) who completed the questionnaire 278 received sildenafil, including 186 who previously had undergone treatment for Erectile Dysfunction, principally involving intracavernous injection therapy. A response was elicited by a median dose of 100 mg. in 188 patients (67.6%) who achieved erection suitable for sexual intercourse. Those with psychogenic Erectile Dysfunction responded significantly better than those with organic dysfunction (p <0.001). erection suitable for intercourse was attained by 30.8% of patients with Erectile Dysfunction after radical prostatectomy and 80% with cavernous veno-occlusive dysfunction. Of previous intracavernous injection responders 29.9% were refractory to sildenafil, while 33. 3% of previous intracavernous injection nonresponders responded to sildenafil. TheSildenafil Citrate (Viagra) response was considered inferior to the intracavernous injection response by 43.6% of the men who previously responded to intracavernous injection, of whom 51.5% continued to receive intracavernous injection as the only treatment (19.5%) or as an alternative toSildenafil Citrate (Viagra) (32%). Adverse effects in 53.6% of cases were assessed as mild in 56.4%, moderate in 38.3% and severe in 5.3%. Multiple adverse effects were reported by 62.4% of patients, while 17 (6.1%) discontinuedSildenafil Citrate (Viagra) as a direct result of intolerable adverse effects. The most common adverse effects were facial flushing in 33.5% of cases, headaches in 23.4%, nasal congestion in 12.6%, dyspepsia in 10.1% and dizziness in 10.8%. Baseline patient and partner quality of life scores significantly improved afterSildenafil Citrate (Viagra) treatment (p <0.001), while significantly improved quality of life was noticed by 51.5% and 43.1%, respectively. CONCLUSIONS: Sildenafil Citrate (Viagra) is effective oral first line treatment for Erectile Dysfunction. Although more than 50% of men reported adverse effects, most were considered mild and rarely resulted in treatment cessation. There was a trend in those on intracavernous injection who responded toSildenafil Citrate (Viagra) to continue intracavernous injection as the only therapy or as an alternative to sildenafil. Also, we noted that some cases refractory toSildenafil Citrate (Viagra) responded to intracavernous injection. These findings imply that intracavernous injection remains an effective Erectile Dysfunction treatment option

Sildenafil does not change coronary flow reserve in diabetics with Erectile Dysfunction

BACKGROUND AND AIM OF STUDY: Disturbance of the microvascular coronary circuit is common in diabetics with Erectile Dysfunction. We investigated effects ofSildenafil Citrate (Viagra) on coronary flow reserve (CFR) of the left anterior descending branch. PATIENTS AND METHODS: 43 diabetics (aged 59 +/- 7 years) with Erectile Dysfunction and without symptoms of coronary artery disease were selected. Cardiac diagnosis, including stress ECG and echocardiography was performed in all. Because of the clinical suspicion of coronary artery disease coronary angiography was performed in 16 of them. Severe coronary artery disease was confirmed in 12 patients who were excluded from further analyses as well as 10 diabetics in whom coronary flow measurements were not possible. In the other 21 diabetics, adenosine-mediated CFR was calculated at baseline and 1 hour after ingestion of 50 mgSildenafil Citrate (Viagra) by transthoracic Doppler echocardiography. RESULTS: CFR at baseline was at the lower level of the normal range in 17/21 diabetics (median 245 %, range 210 - 490 %). CFR decreased insignificantly in 12/21 patients afterSildenafil Citrate (Viagra) administration (Delta CFR -10 %, p = 0.3). Patients with a body mass index > 25 kg/m(2), and left ventricular hypertrophy had the highest reduction of CFR after sildenafil, but a drop of the CFR below 200 % was not observed in any patient. Systemic blood pressure dropped significantly from 130/80 mmHg to 120/72 mmHg (p < 0.002). CONCLUSION: Diabetics with Erectile Dysfunction often have a CFR in the lower range of normal.Sildenafil Citrate (Viagra) did not further reduce CFR. Asymptomatic, severe coronary artery disease often can be found in diabetics with Erectile Dysfunction. Cardiological screening for contraindications forSildenafil Citrate (Viagra) seems mandatory in diabetics with a high cardiovascular risk profile

Effect of sildenafil, a phosphodiesterase-5 inhibitor, on oesophageal peristalsis and lower oesophageal sphincter function in cats.

The propagation of oesophageal peristaltic contractions and lower oesophageal sphincter (LOS) relaxation depends on neural release of nitric oxide (NO) which acts to increase intracellular cGMP. Sildenafil, a phosphodiesterase-5 inhibitor that increases cGMP, reduces basal LOS pressure in patients with achalasia. We investigated the effect ofSildenafil Citrate (Viagra) on the propagation of oesophageal contractions and LOS relaxation in the cat. Oesophageal manometry was performed in five cats under light sedation. Peristaltic contractions were monitored at 1, 2, 3, 4 and 8 cm proximal to the LOS, at the LOS using a Dent sleeve, and at 3 cm distal to the upper oesophageal sphincter. Swallow-induced oesophageal contractions and LOS relaxation were recorded during 30 min before and 30 min after intravenous administration of sildenafil.Sildenafil Citrate (Viagra) reduced the amplitude of oesophageal contractions only in the smooth muscle oesophagus. The latency from swallow to distal oesophageal contractions was significantly delayed. LOS pressure was significantly reduced but the relaxation nadir was not modified by sildenafil.Sildenafil Citrate (Viagra) has profound effects on oesophageal motility: it modifies propagation and amplitude of oesophageal contractions and reduces LOS pressure. Slowing down the propagation of contractions in the transitional zone between the striated and smooth muscle can be a useful tool in patients with segmental aperistalsis or intermittent simultaneous contractions, while the effect on the LOS can benefit patients with achalasia

Inhibition of neuroeffector transmission in human vas deferens by sildenafil.

Sildenafil (0.1 - 30 microM), a cyclic GMP phosphodiesterase 5 (PDE 5) inhibitor, induced inhibition of electrically evoked contractions of ring segments of human vas deferens from 34 vasectomies. Zaprinast (0.1 - 100 microM), another PDE 5 inhibitor, and the nitric oxide (NO) donor sodium nitroprusside (SNP) (0.1 - 100 microM) had no effect on neurogenic contractions. The inhibition induced bySildenafil Citrate (Viagra) was not modified by the inhibitor of guanylate cyclase 1H-[1,2,4]oxadiazolo[4,3-a]quinoxaline-1-one (ODQ) (1 - 30 microM) but it was abolished by the K(+) channel blockers tetraethylammonium (TEA, 1 mM), iberiotoxin (0.1 microM) and charybdotoxin (0.1 microM). Sildenafil, zaprinast and SNP did not affect the contractions induced by noradrenaline. SNP (10 microM) caused elevation of cyclic GMP levels that was potentiated bySildenafil Citrate (Viagra) (10 microM) and zaprinast (100 microM). ODQ (10 microM) inhibited the increase in cyclic GMP.Sildenafil Citrate (Viagra) inhibits adrenergic neurotransmission in human vas deferens. The inhibition is not related to accumulation of cyclic GMP but is probably due to activation of prejunctional large-conductance Ca(2+)-activated K(+) channels

Central effects of Sildenafil Citrate (Viagra) on auditory selective attention and verbal recognition memory in humans: a study with event-related brain potentials.

The purpose of this study was to assess possible central side-effects of Sildenafil Citrate (Viagra) on attention and memory functions.Sildenafil Citrate (Viagra) and placebo were administered in young male subjects in a double-blind balanced cross-over design. Behavioral patterns and event-related brain potentials (ERP) were recorded in a spatial auditory attention and a visual word recognition task. While behavioral patterns did not reveal any overt effects of sildenafil, auditory ERPs were indicative of an enhanced ability to focus attention (amplitude enhancement of Nd-effect) and to select relevant target stimuli in theSildenafil Citrate (Viagra) condition (P3 component). In the memory task, CNS-effects ofSildenafil Citrate (Viagra) were evident in a reduction of a negativity in the 150-250 ms range. No overt effects on behavior were observed. Nevertheless, the data reveal CNS-effects ofSildenafil Citrate (Viagra) necessitating further studies

Effect of Sildenafil Citrate (Viagra) on an orthotopic prostate cancer growth and metastasis model.

PURPOSE: We characterized the effects of Sildenafil Citrate (Viagra) on the growth and metastasis of human prostate cancer cells in nude mice. MATERIALS AND METHODS: The androgen independent human prostate cancer cell line PC-3 was inoculated into the prostate of nude mice to produce orthotopic primary prostate cancers and metastases. Sildenafil Citrate (Viagra) gavage was started on day 31 after tumor cell inoculation and given every other day 15 times (30 days). The 7 mice in the low dose group received 25 mg/kg body weight Sildenafil Citrate (Viagra) per gavage, while the 7 in the high dose group received 50 mg/kg body weight Sildenafil Citrate (Viagra) and the 9 in the control group received water. Autopsy was performed on day 75 to evaluate primary tumor growth and metastasis. Plasma cyclic guanosine monophosphate concentrations were measured after the single dose of 50 mg/kg Sildenafil Citrate (Viagra) in the mice. RESULTS: Plasma cyclic guanosine monophosphate concentration increased 4-fold 1 hour after Sildenafil Citrate (Viagra) administration. The plasma concentration decreased rapidly and returned to normal after 8 hours. There was no significant difference in tumor weight between any of the 3 groups. The number of metastatic lymph nodes correlated significantly with primary tumor weight (p = 0.03) with a correlation coefficient of 0.454 but there was no significant correlation between the number of involved lymph nodes andSildenafil Citrate (Viagra) administration. Distant metastases were not significantly promoted bySildenafil Citrate (Viagra) administration. CONCLUSIONS: Incontinuous oral administration of Sildenafil Citrate (Viagra) did not promote primary tumor growth and metastasis in an orthotopic prostate cancer model

Cost-sharing for prescriptions ofSildenafil Citrate (Viagra) and finasteride: a case study in veteran patients.

OBJECTIVE: To evaluate patients willingness to share the costs of 2 medications (often described as "lifestyle medications"):Sildenafil Citrate (Viagra) for Erectile Dysfunction and finasteride for hair loss, which are not routinely covered by the Department of Veterans Affairs (VA) healthcare system. STUDY DESIGN: Self-administered, anonymous survey. PATIENTS AND METHODS: Adult men (n = 339) were recruited from waiting rooms for primary care or Erectile Dysfunction clinic appointments at 2 Los Angeles VA facilities. RESULTS: Participants with self-reported need were analyzed separately for finasteride (primary care patients only) andSildenafil Citrate (Viagra) (both primary care and Erectile Dysfunction clinic patients). The mean age of the participants was 56 and 60 years for the finasteride andSildenafil Citrate (Viagra) groups, respectively. Mean annual household income for both groups was under $10,000. Respondents reported a mean willingness to cost-share $4.20 for a 30-day prescription of daily finasteride (VA wholesale cost = $27) and $5.40 for 4Sildenafil Citrate (Viagra) pills (VA wholesale cost = $20). In the multivariate analysis, higher income (P = .002) and increasing self-reported need for medication (P = .04) were associated with increased willingness to cost-share for finasteride after controlling for age, race/ethnicity, insured status, comorbid conditions, and type of clinic. In addition, younger age (P = .01) was associated with greater willingness to cost-share for sildenafil. CONCLUSIONS: In this low-income veteran population, patients with a self-reported need forSildenafil Citrate (Viagra) and finasteride would be willing to make a higher copayment than the current VA maximum copayment of $2.00 per 30-day prescription, if these medicines were made available