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Senior Citizens & Sex
Erectile Dysfunction Drugs Not Just About Sex
Study says they produce mostly beneficial results,
and not just for ED
June 16, 2006 - Since the Food and Drug
Administration gave Viagra (sildenafil) its approval in 1998, “erectile
dysfunction” has become a household term – probably to the chagrin of
many parents fielding questions from their kids watching TV. But with
sildenafil and the subsequent introduction and marketing of Levitra (vardenafil)
and Cialis (tadalafil), many men have found answers to a
once-unmentionable condition. It is primarily a problem of senior
citizens age 65 and older.
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June 9, 2006 - A new national survey of U.S. men
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high blood pressure (hypertension or HTN) (82%) were not aware of its
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Treating Men with ED Improves Female Partners Sexual
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Aging Does Not End Sex, Relationships, Says Expert
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Bicycle Riding Can Cause Erectile Dysfunction
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Senior Citizens & Sex |
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“As more and more patients seek therapy for sexual
dysfunction, it is increasingly important for clinicians in a wide range
of specialties to become proficient in the mechanisms and systemic
effects of these medications,” said Ernst R. Schwarz, M.D., Ph.D., a
cardiologist at Cedars-Sinai Medical Center who specializes in therapies
for men who suffer from erectile dysfunction (ED) and have heart
problems, diabetes, high blood pressure or other related conditions.
Schwarz and colleagues recently concluded a review
of the medical literature, as well as their own research findings and
clinical data, to determine what actually is known about the effects of
long-term use of this class of drugs on various organ systems. Their
findings appears in the June 8, 2006 issue of the International Journal
of Impotence Research.
Studies so far suggest the drugs, called
phosphodiesterase-5 inhibitors (PDE-5i), produce mostly beneficial
results, and not just for erectile dysfunction. The FDA recently
approved a reformulation of sildenafil for the treatment of primary
pulmonary hypertension, a disease that tends to occur in young women,
causing elevated blood pressures in the lung that can lead to heart
failure and early death.
“When we look at all the different organ systems –
the blood, the heart, the lungs, blood flow in the brain – there are
hardly any negative side effects. In fact, just the opposite is true.
There are beneficial effects for primary pulmonary hypertension, as well
as for conditions such as heart failure and lack of oxygen in the
heart,” said Schwarz.
“The only issue is that the data we have are from
relatively short-term studies. Viagra has been on the market since 1998
and the other two PDE-5 inhibitors were approved by the FDA in 2003.
Therefore, we do not have multi-year follow-up studies. On the other
hand, the drugs have been on the market for several years now and there
have been no reports of negative long-term effects.”
While there are some differences among the three
medications, they have many properties in common and work by limiting
the activity of the enzyme phosphodiesterase-5, which is found in
tissues and vessels of the penis, blood platelets, and smooth muscle of
blood vessels.
For the treatment of erectile dysfunction, the
drugs’ constraint of the enzyme’s action results in increased levels of
cyclic guanosine monophosphate (cGMP) and nitric oxide (NO),
biochemicals that promote smooth muscle relaxation and increased blood
flow in erectile tissue.
According to the article, PDE-5 inhibitors can be
effective in treating erectile dysfunction even for many men who also
have diabetes, those who are older, and those who have co-existing
ischemic heart disease (reduced blood flow to the heart caused by plaque
buildup in the arteries). Furthermore, say the authors, “since PDE-5 is
found in smooth muscles of the systemic arteries and veins throughout
the body, use of PDE-5i has been associated with various cardiovascular
effects.”
“The original intention was to develop PDE-5
inhibitors as a treatment for angina, chest pain that occurs when the
heart is starved for oxygen,” Schwarz said. “As such, their effects on
the heart appear to be all beneficial. Nitrates and other substances
commonly used to improve blood flow and oxygenation to the heart muscle
have a side effect that we call the ‘steal phenomenon,’ in which blood
is taken away from underperfused (flow-restricted) areas to improve
blood flow in normal areas.
In contrast, PDE-5 inhibitors actually improve
blood flow even in areas where there is a blockage of an artery, thereby
having a protective effect on the heart muscle.”
The drugs’ potential impact on visual function
became a matter of controversy when a suspected link between PDE-5
inhibitors and vision loss led to lawsuits filed last year against the
maker of Viagra.
According to the article’s authors, however,
“analysis of clinical trial data in more than 13,000 men and on more
than 35,000 patient-years of observation” found occurrence of the visual
disorder to be similar to that of the general population.
“Even though individual cases have been reported
for all PDE-5i, these recently published data do not suggest an
increased incidence of NAION (non-arteric anterior ischemic optic
neuropathy) in men who took PDE-5i for ED,” the article states.
Among other findings:
● Although the enzyme PDE-5 has been found in
tissue and arteries of the brain, sildenafil does not appear to dilate
cerebral arteries or have an effect on cerebral blood flow or blood flow
velocity, an indication that there is no increased risk of stroke or
hemorrhage.
● PDE-5 exists in blood platelets, cells that
play a major role in the blood clotting process, but sildenafil appears
to have no direct impact on platelet function. However, the drug’s
effects have not been specifically evaluated in patients with bleeding
disorders or in those taking drugs that reduce clotting.
“Experimental and human studies indicate that PDE-5
inhibitors are effective and well tolerated, and there is evidence that
they are not being used to their utmost potential. We suggest that these
drugs may prove beneficial in treating a wide variety of disorders,”
said Schwarz, the article’s first author and a specialist in cardiology,
interventional cardiology, heart failure, and transplantation.
“Some studies are underway to determine the effects
of long-term use of PDE-5 inhibitors, and others are warranted,
especially in patients who are considered at high risk because of
chronic cardiovascular disorders.”
About Cedars-Sinai Medical Center
The first of eight hospitals in California whose
nurses have been honored with the prestigious Magnet designation,
Cedars-Sinai Medical Center is one of the largest nonprofit academic
medical centers in the Western United States. For 18 consecutive years,
it has been named Los Angeles’ most preferred hospital for all health
needs in an independent survey of area residents. Cedars-Sinai is
internationally renowned for its diagnostic and treatment capabilities
and its broad spectrum of programs and services, as well as
breakthroughs in biomedical research and superlative medical education.
It ranks among the top 10 non-university hospitals in the nation for its
research activities and is fully accredited by the Association for the
Accreditation of Human Research Protection Programs, Inc. (AAHRPP).
Additional information is available at
http://www.cedars-sinai.edu.
>>
More about Erectile
Dysfunction by American Academy of Family Physicians
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