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Viagra & Erectal Dysfunction

Original developed for treatment of myocardial ischemia (angina).  Cells in the corpus cavernosum produce NO [nitrous oxide] during sexual arousal in response to nonadrenergic, noncholinergic neurotransmission.  NO stimulates the formation of cyclic GMP, which leads to relaxation of smooth muscle of the corpus cavernosum and penil arteries, engorgement of the corpus cavernosum, and erection…. Not surprisingly, PDE5 inhibitors have assumed the status of widely used recreational drugs.  Tadalafil (Cialis) and vardenafil (Levitra) share similar therapeutic efficacy and side-effect profiles with sidenafil (Viagra).  [Cialis lasts the longest].—Goodman & Gilman, 11th Ed. 2006, p829   

 

“Most tadalafil clinical trials excluded patients with unsuccessful prior treatment with sildenafil citrate (sildenafil).”  J Sex Med, 2006 Jul;3(4);668-75.  ANOTHER WAY TO MANUFACTURE POSITIVE RESULTS.  Moreover most of the studies are funded by the drug manufactures, thus the testing and reporting of results are slanted.  Of the six studies below, only one seem to maintain a critical prospective.--JK

With sever ED (subtracting placebo effect), only 23% and 40% were satisfied for two questions (below).  For most with sever ED the improvement is none or marginal. 

Curr Med Res Opin, 2005 Nov;21(11):1701-9

Two question: satisfaction with intercourse, and enjoyment of intercourse. RESULTS: At least moderate satisfaction (IIEF overall satisfaction domain) was reported by 55% and 72% of patients with mild ED taking tadalafil 10 mg and 20 mg, respectively, compared with 33% taking placebo (p < 0.002); 60% and 65% vs. 19% of patients with moderate ED (p < 0.001); and 32% and 49% vs. 9% with severe ED (p < 0.001). Satisfactory intercourse during most attempts or almost always/always (IIEF-Q7) was reported by 59% and 79% of patients with mild ED taking tadalafil 10 mg and 20 mg vs. 32% taking placebo (p < 0.001); 52% and 65% vs. 18% with moderate ED (p < 0.001); and 28% and 49% vs. 5% with severe ED (p < 0.001). Highly or very highly enjoyable intercourse (IIEF-Q8) was reported by 45% and 63% of patients with mild ED taking tadalafil 10 mg and 20 mg vs. 21% taking placebo (p < 0.001); 43% and 56% vs. 16% with moderate ED (p < 0.001); and 19% and 44% vs. 5% with severe ED (p < 0.001). CONCLUSIONS: Compared with placebo, tadalafil 10 mg and 20 mg improved overall satisfaction with the sexual experience, intercourse satisfaction, and intercourse enjoyment in men with mild, moderate, and severe ED.

 

 

Urology, 2002 Sep;60(2 Suppl 2):12-27.

The efficacy of sildenafil citrate (Viagra) in clinical populations: an update.

Carson CC., Burnett AL, et al

{a meta study} Efficacy evaluations included the International Index of Erectile Function, a global efficacy question ("Did treatment improve your erections?"), and a patient-recorded event log of sexual activity. Significantly improved erectile function was demonstrated for sildenafil compared with placebo for all efficacy parameters analyzed (P <0.02 to 0.0001), regardless of patient age, race, body mass index, ED etiology, ED severity, ED duration, or the presence of various comorbidities. Long-term effectiveness was assessed in 3 open-label extension studies.  Of those who continued long-term therapy (1 to 3 years) with sildenafil, >95% of patients reported that they were satisfied with the effect of treatment on their erections, and that treatment had improved their ability to engage in sexual activity

 

 

Erectile function and assessments of erection hardness correlate positively with measures of emotional well-being, sexual satisfaction, and treatment satisfaction in men with erectile dysfunction treated with sildenafil citrate (Viagra).
Urology. 2006 Sep;68(3 Suppl):26-37. Review.
PMID: 17011373 [PubMed - indexed for MEDLINE]

 

Curr Med Res Opin 2006 May;22(5):939-48.

Correlation of improved erectile function and rate of successful intercourse with improved emotional well-being assessed with the Self-Esteem And Relationship questionnaire in men treated with sildenafil for erectile dysfunction and stratified by age.  The psychosocial measures of well-being assessed with the SEAR were positively correlated (range 0.60-0.86, P < 0.0001) with erectile function, the frequency of achieving erections that allowed satisfactory sexual intercourse, the percentage of successful sexual intercourse attempts, and global treatment efficacy.

 

 

Urol, 2006 Mar;175(3 Pt 1):1058-62.

Erectile Function domain scores (r range 0.34 to 0.69, p < 0.0001), other IIEF domain scores (p < 0.0001), percentage of successful intercourse attempts (p < 0.0001) and frequency of erection that allowed satisfactory intercourse (p < 0.0001).

 

Urology, 2006 Sep;68(3 Suppl):17-25

Pooled data from 6549 men with ED provided strong proof and improved characterization of the response to sildenafil. Almost half of men with ED and a baseline IIEF EF domain score classified as "severe ED" (< or = 10) shifted to a score classified as "no ED" (> or = 26). Sildenafil recipients showed greater mean improvement from baseline to end point in IIEF Q2 scores versus placebo, regardless of baseline ED severity, and a higher mean percentage of successful sexual intercourse attempts occurred during the last 4 weeks of treatment versus placebo (5.4-fold vs 2.0-fold increase from baseline). At end point, 95% of men who scored "no ED" on the IIEF EF domain and 92% of men who reported "almost always/always" achieving an erection hard enough for penetration (IIEF Q2) had graded their erections hard (rigid) enough for penetration (grade 3) or completely hard and fully rigid (grade 4) during the last 4 weeks of treatment,

 

 

With sever ED (subtracting placebo effect), only 23% and 40% were satisfied for two questions (below).  For most with sever ED the improvement is none or marginal. 

Curr Med Res Opin, 2005 Nov;21(11):1701-9

Two question: satisfaction with intercourse, and enjoyment of intercourse. RESULTS: At least moderate satisfaction (IIEF overall satisfaction domain) was reported by 55% and 72% of patients with mild ED taking tadalafil 10 mg and 20 mg, respectively, compared with 33% taking placebo (p < 0.002); 60% and 65% vs. 19% of patients with moderate ED (p < 0.001); and 32% and 49% vs. 9% with severe ED (p < 0.001). Satisfactory intercourse during most attempts or almost always/always (IIEF-Q7) was reported by 59% and 79% of patients with mild ED taking tadalafil 10 mg and 20 mg vs. 32% taking placebo (p < 0.001); 52% and 65% vs. 18% with moderate ED (p < 0.001); and 28% and 49% vs. 5% with severe ED (p < 0.001). Highly or very highly enjoyable intercourse (IIEF-Q8) was reported by 45% and 63% of patients with mild ED taking tadalafil 10 mg and 20 mg vs. 21% taking placebo (p < 0.001); 43% and 56% vs. 16% with moderate ED (p < 0.001); and 19% and 44% vs. 5% with severe ED (p < 0.001). CONCLUSIONS: Compared with placebo, tadalafil 10 mg and 20 mg improved overall satisfaction with the sexual experience, intercourse satisfaction, and intercourse enjoyment in men with mild, moderate, and severe ED.

 

 

 

85% satisfied compared to 46% for placebo

Eur Urol, 2004 Sep;46(3):362-9; discussion 369

RESULTS: Of the 443 men who entered the trial, 409 (mean age, 52 years) formed the intent-to-treat population. Mean baseline demographics and ED severity measures were balanced between treatment groups except for a higher percentage of patients naive to sildenafil in the tadalafil group compared to placebo (50% versus 36%). EDITS score of 84 (95%CI 80, 86), which was significantly higher than the median score for placebo-treated patients of 41 (95%CI 32, 59; p < 0.001; Wilcoxon test). The proportion of patients satisfied with treatment (defined as final EDITS score greater than 50) was 87% for the tadalafil-treated group and 46% for the placebo-treated group (p < 0.001; exact test).

Some scare misinformation has been circulating about Viagra and adverse visual effects including blindness. One sources is www.worstpills.org.  I have failed to substantiate this in an internet search.  “The drug also mildly inhibits PDE6, which controls the levels of cyclic GMP in the retina.  Visually, this can result in seeing a bluish haze or experiencing light sensitivity.  Although no retinal damage has been reported, no long-term studies have been reported—Goodman & Gilman, 11 ED. 2006, p. 1728.