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Sildenafil: A 4-year update in the treatment of 20 million erectile dysfunction patients

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Abstract

Sildenafil citrate, the first internationally approved and widely used oral agent for the treatment of erectile dysfunction (ED), has revolutionized the treatment of ED throughout the past 5 years. This phosphodiesterase type-5 (PDE-5) inhibitor is selective for corpus cavernosum smooth muscle tissue and produces excellent erectile function. Its efficacy and safety over a wide variety of etiologies of ED and severities of ED demonstrates its usefulness in the clinical treatment of these patients. More than 20 million men have been treated worldwide with sildenafil with excellent results. ED caused by difficult-to-treat etiologies such as radical prostatectomy, severe diabetes, and spinal cord injury have demonstrated efficacy. Although sildenafil citrate, like all PDE-5 inhibitors, is contraindicated in patients taking nitrate medications for cardiac disease, it is effective and safe for those cardiovascular patients who are not taking nitrate medications. The incidence of adverse cardiovascular events in patients taking sildenafil does not differ from those of the general population. Investigations into the pharmacologic effect of sildenafil on coronary myocardial tissue further supports the safety of this medication. Sildenafil has been safe and effective in patients taking various medications including multiple antihypertensive drugs, selective serotonin reuptake inhibitors, cardiac, and diabetic medications.

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References and Recommended Reading

  1. Carson CC: Long-term use of sildenafil. Expert Opin Pharmacother 2003, 4:397–405. This publication summarizes pharmacologic and clinical data on sildenafil including chemical structure and chemical function.

    Article  PubMed  CAS  Google Scholar 

  2. Shakir SA, Wilton LV, Boshier A, et al.: Cardiovascular events in users of Sildenafil: results first phase of prescription event monitoring in England. BMJ 2001, 322:651–652.

    Article  PubMed  CAS  Google Scholar 

  3. Corbin JD, Francis SH, Webb DJ: Phosphodiesterase type 5 as a pharmacologic target in erectile dysfunction. Urology 2002, 60:4–11. The basic science principles of PDE-5 agents and structures are described in a complete and understandable review by one of the pioneers in PDE-5 chemistry.

    Article  PubMed  Google Scholar 

  4. Carson CC, Burnett AL, Levine LA, Nehra A: The efficacy of Sildenafil citrate (Viagra) in patients with erectile dysfunction. Urology 2002, 60:12–27.

    Article  PubMed  Google Scholar 

  5. Stuckey BG, Jadzinsky MN, Murphy LJ, et al.: Sildenafil citrate for the treatment of erectile dysfunction in men with type I diabetes mellitus a controlled trial. Diabetes Care 2003, 26:279–284.

    Article  PubMed  CAS  Google Scholar 

  6. Vandi Y, Klein L, Nassar S, et al.: Effects of Sildenafil citrate on blood pressure in normotensive and hypertensive men. Urology 2002, 59:747–752. Excellent study evaluating sildenafil in treated and untreated hypertensive men with ED.

    Article  Google Scholar 

  7. Jackson G, Benjamin N, Jackson N, et al.: Effects of sildenafil citrate on human hemodynamics. Am J Cardiol 1999, 83(suppl):13C-20C.

    Article  PubMed  CAS  Google Scholar 

  8. Kloner RA, Brown M, Prisant LM, et al.: Effects of Sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group. Am J Hypertens 2001, 14:70–73.

    Article  PubMed  CAS  Google Scholar 

  9. McVary KT, Cormier S, Wessels H, et al.: Smoking and erectile dysfunction: evidence-based analysis. J Urol 2001, 166:1624–1632.

    Article  PubMed  CAS  Google Scholar 

  10. Kimuna M, Higoshi Y, Hara K, et al.: PDE5 inhibitor Sildenafil citrate augments endothelin dependent vasodilation in smokers. Hypertension 2003, 41:1106–1110.

    Article  Google Scholar 

  11. Feldman AH, Goldstein I, Hatzichristou DG, et al.: Impotence and its medical and psychologic correlates: results of the Massachusetts Male Aging Study. J Urol 1994, 151:54–61.

    PubMed  CAS  Google Scholar 

  12. Benet AE, Melman A: The epidemiology of erectile dysfunction. Urol Clin North Am 1995, 22:699–709.

    PubMed  CAS  Google Scholar 

  13. Nurnberg HG, Seidman SN, Gelenberg AJ, et al.: Depression, antidepressant therapies, and erectile dysfunction: clinical trials of Sildenafil citrate (Viagra) in treated and untreated patients with depression. Urology 2002, 60:58–66. Excellent discussion of ED treatment in depressed men with sildenafil. Reviews reported detail on depression, SSRI effects, ED etiology, and treatment success.

    Article  PubMed  Google Scholar 

  14. Seidman SN, Roose SP, Menza MA, et al.: Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo controlled trial with Sildenafil citrate. Am J Psychiatry 2001, 158:1623–1630.

    Article  PubMed  CAS  Google Scholar 

  15. Tignol JL, Benkert O: Sildenafil citrate effectively treats erectile dysfunction in men who have been successfully treated for depression. Presented at the American Psychiatric Association Meeting New Orleans: May 10, 2001.

  16. Fava M, Rankin MA, Alpert JE: An open trial of oral Sildenafil in antidepressant induced sexual dysfunction. Psychother Psychosom 1998, 67:328–331.

    Article  PubMed  CAS  Google Scholar 

  17. Giuliano F, Hultling C, El Masry WS, et al.: Randomized trial of Sildenafil for the treatment of erectile dysfunction in spinal cord injury. Am Neurol 1999, 46:15–21.

    Article  CAS  Google Scholar 

  18. Hullting C, Guiliano F, Quirla F, et al.: Quality of life in spinal cord injury patients receiving Viagra (Sildenafil citrate) for the treatment of erectile dysfunction. Spinal Cord 2000, 38:363–370.

    Article  Google Scholar 

  19. Fausler C, Miller J, Shariel M: Viagra (Sildenafil citrate) for the treatment of men with multiple sclerosis. Neurology 1999, 46:497.

    Google Scholar 

  20. Dozois RR, Nelson H, Metcalf AM: Sexual function after ileo anal anastomoses. Ann Chir 1993, 47:1009–1013.

    PubMed  CAS  Google Scholar 

  21. Mueleman EJ, Mulders PF: Erectile function after radical prostatectomy: a review. Eur Urol 2003, 43:95–101. Excellent summary of causes of ED in men after radical prostatectomy for prostate cancer and prophylaxis and treatment.

    Article  Google Scholar 

  22. Moul JW, Mooneyham RM, Kao TC, et al.: Preoperative and operative factors predict incontinence, impotence, and stricture after radical prostatectomy. Prostate Cancer Prostatic Dis 1998, 1:242–249.

    Article  PubMed  Google Scholar 

  23. Begg CB, Riedel ER, Bach PB, et al.: Variations in morbidity after radical prostatectomy. N Engl J Med 2002, 346:1138–1144.

    Article  PubMed  Google Scholar 

  24. Raina R, Laken MM, Agarwal A, et al.: Long-term effect of Sildenafil citrate on erectile dysfunction after radical prostatectomy: a 3-year follow-up. Urology 2003, 62:110–115.

    Article  PubMed  Google Scholar 

  25. Hong EK, Lepor H, McCullough AR: Time dependent patient satisfaction with Sildenafil for erectile dysfunction (ED) after nerve sparing radical retropubic prostatectomy (RRP). Int J Impot Res 1999, 11(suppl 1):S15-S22.

    Article  PubMed  Google Scholar 

  26. Montorsi F, Gazzoni G, Strombli LF, et al.: Recovery of spontaneous erectile function after nerve sparing radical retropubic prostatectomy with and without early intracavernous injection of Alprostadil: results of a prospective randomized trial. J Urol 1999, 161:1914–1915.

    Article  Google Scholar 

  27. Padma-Nathan H, McCullough AR, Guiliani F, et al.: Postoperative nightly administration of Sildenafil citrate significantly improves the return of normal spontaneous erectile function after bilateral nerve sparing prostatectomy. J Urol 2003, 169(suppl):375.

    Google Scholar 

  28. McCullough AR, Barada JH, Fawzy A, et al.: Achieving treatment optimization with Sildenafil citrate in patients with erectile function. Urology 2002, 60:28–37. Classic article on the necessity to follow, encourage, and coach men taking sildenafil to achieve the best results.

    Article  PubMed  Google Scholar 

  29. Conti CR, Pepine CJ, Sweeney M: Efficacy and safety of Sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol 1999, 83(suppl):29C-34C.

    Article  PubMed  CAS  Google Scholar 

  30. Zusman RM, Prisant LM, Brown MJ: Effect of Sildenafil citrate on blood pressure and heart rate in men with erectile dysfunction taking concomitant antihypertensive medication. J Hypertens 2000, 18:1865–1869.

    Article  PubMed  CAS  Google Scholar 

  31. Herrmann HC, Chang G, Klugherz BD, et al.: Hemodynamic effects of sildenafil in men with severe coronary artery disease. N Engl J Med 2000, 342:1622–1626.

    Article  PubMed  CAS  Google Scholar 

  32. Padma-Nathan H, Eardley I, Kloner RA, et al.: A 4-year update on the safety of Sildenafil citrate (Viagra). Urology 2002, 60:67.

    Article  PubMed  Google Scholar 

  33. Kloner RA: Cardiovascular risk and Sildenafil. Am J Cardiol 2000, 86:57F-61F.

    Article  PubMed  CAS  Google Scholar 

  34. Carson CC: Sildenafil citrate treatment for erectile dysfunction: rate of adverse events decreases with time. J Urol 2002, 167(suppl):179.

    Google Scholar 

  35. Barada J: Successful salvage of Sildenafil (Viagra) failures: benefits of patient education and rechallenge with Sildenafil. Int J Impot Res 2001, 13(suppl 4):S49.

    Google Scholar 

  36. McMahon CG, Samoli R, Johnson H: Efficacy safety and patient acceptance of Sildenafil citrate as treatment of erectile dysfunction. J Urol 2000, 164:1192–1196.

    Article  PubMed  CAS  Google Scholar 

  37. Montorsi F, McDermott TE, Morgan R, et al.: Efficacy and safety of fixed dose oral Sildenafil in the treatment of erectile dysfunction of various etiologies. Urology 1999, 53:1011–1018.

    Article  PubMed  CAS  Google Scholar 

  38. El-Galley R, Rutland H, Talic R, et al.: Long-term efficacy of Sildenafil and tachyphylaxis effect. J Urol 2001, 166:927–931.

    Article  PubMed  CAS  Google Scholar 

  39. Steers WD: Tachyphylaxis and phosphodiesterase type 5 inhibitors. J Urol 2002, 168:207.

    Article  PubMed  Google Scholar 

  40. Boolell M, Allen MJ, Ballard SA, et al.: Sildenafil: an orally active type 5 cyclic GMP specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impot Res 1996, 8:47–52.

    PubMed  CAS  Google Scholar 

  41. O’Leary MP: LUTS, ED, QOL: alphabet soup or real concerns in aging men? Urology 2000, 56(suppl):7–11.

    Article  PubMed  CAS  Google Scholar 

  42. Sariam K, Kulinsbaya E, McNicholas TA, et al.: Sildenafil influences lower urinary tract symptoms. BJU Int 2002, 90:836–891. Early data linking benign prostatic hyperplasia, lower urinary tract symptoms, and ED with treatment results for sildenafil and its effect on both problems.

    Article  Google Scholar 

  43. Ghofrani HA, Rose F, Schermuly RT, et al.: Oral Sildenafil as long-term adjunct therapy to inhaled iloprost in severe pulmonary arterial hypertension. J Am Coll Cardiol 2003, 42:158–164.

    Article  PubMed  CAS  Google Scholar 

  44. Alaeddini J, Uber P, Park MH, et al.: Sildenafil and assessment of pulmonary arterial reactivity in heart failure. Congest Heart Fail 2003, 9:176–178.

    Article  PubMed  Google Scholar 

  45. Sebkhi A, Strange JW, Phillips SC, et al.: Phosphodiesterase type 5 as a target for the treatment of hypoxia-induced pulmonary hypertension. Circulation 2003, 107:32320–32325.

    Article  Google Scholar 

  46. Bharani A, Mathew V, Sahu A, Lunia B: The efficacy and tolerability of Sildenafil in patients with moderate-to-severe pulmonary hypertension. Indian Heart J 2003, 55:55–59.

    PubMed  Google Scholar 

  47. Cubillos-Garzon LA, Casas JP, Morillo CA: Sildenafil in secondary pulmonary hypertension. Int J Cardiol 2003, 89:101–102.

    Article  PubMed  Google Scholar 

  48. Laupland KB, Helmersen D, Zygun DA, Viner SM: Sildenafil treatment of primary pulmonary hypertension. Can Respir J 2003, 1:48–50.

    Google Scholar 

  49. Rosen RC, McKenna KE: PDE-5 inhibition and sexual response: pharmacological mechanisms and clinical outcomes. Annu Rev Sex Res 2002, 13:36–88.

    PubMed  Google Scholar 

  50. Modelska K, Cummings S: Female sexual dysfunction in postmenopausal women: systematic review of placebo-controlled trials. Am J Obstet Gynecol 2003, 188:286–293.

    Article  PubMed  CAS  Google Scholar 

  51. Rosen RC: Sexual function assessment and the role of vasoactive drugs in female sexual dysfunction. Arch Sex Behav 2002, 31:439–443.

    Article  PubMed  Google Scholar 

  52. Basson R, McInnes R, Smith MD, et al.: Efficacy and safety of Sildenafil citrate in women with sexual dysfunction associated with female sexual arousal disorder. J Womens Health Gend Based Med 2002, 11:367–377. Excellent discussion of controversies and results for women with female sexual arousal disorder who have been treated with sildenafil. This review highlights what is known and what direction research must proceed to solve the female sexual arousal disorder problem.

    Article  PubMed  Google Scholar 

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Carson, C.C. Sildenafil: A 4-year update in the treatment of 20 million erectile dysfunction patients. Curr Urol Rep 4, 488–496 (2003). https://doi.org/10.1007/s11934-003-0031-1

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