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Consider the case of Mr. Jones, a new patient I was helping in an ambulatory cardiac clinic. Most of my patients are on multiple medications for their heart conditions and other complicated issues, so I often review their medications to make sure everything is all right. This includes screening labs, checking vitals, reviewing past reports, and conducting drug interaction checks related to therapy.

At his last visit, Mr. Jones was prescribed Imdur isosorbide mononitrate to help with his heart condition. Reading through the notes, it looks like the Imdur worked. He was feeling better, so much better that he wanted to start having sex with his wife again. And here was the problem: Quickly, I went from a moment of elation to consternation.

The answer, as we learned after Viagra came out, is this reaction could lead to heart attack in patients and potentially cause death, leading to a black box warning for the whole class of drugs like Viagra.

Jones is on a nitrate, specifically Imdur. Fortunately for him, he had not yet used the Cialis. I advised him to avoid the combination, based on his significant cardiac history. But what can patients with ED and taking nitrates do to engage in an active sex life? There is another drug that came out before Viagra, namely alprostadil, available under two brand names: This drug works by relaxing the penile tissue allowing for easier blood flow leading to an erection.

The plus side is it works relatively quickly; the downside is that is not available as a pill. Caverject must be directly injected into the base of the penis to work. For many patients, when I mention there is an another option to Viagra and other PDE-5 Inhibitors, their eyes light up, quickly followed by a nervous look as they find that it requires an injection to their penis or inserting something directly into their urethra.

At this point, to not completely turn off the patient, I do try to get some information in to help them make a decision. While both Caverject and Muse share the same active ingredient, there are some pros and cons each. The draw back though is that it is an injection that needs to be applied to the base of the penis, and can cause irritation to the surrounding tissue.

It has a higher risk of causing priapism basically an erection lasting for more than 4 hours, which incidentally is name after a Greek God called Priapus. I generally recommend starting with Muse prior to moving onto Caverject because of this.

A study conducted in in patients using a topical formulation did demonstrate some efficacy though less than Caverject or Muse. Common side effects were burning sensation for both men and women though this was relatively low, with only 2. Currently, drug manufacturer Apricus Biosciences is looking to bring this formulation, named Vitaros , to market in the US it is available in Europe at this time but progress with regulatory approval has been slow.

When and if this formulation makes it to the US market, it may be preferred by men who cannot take PDE-5 inhibitors. Some men wonder about testosterone as an alternative for ED. The other issue is that men with a cardiac history, adding testosterone to their therapy could prove highly risk to their health. If a patient does have low testosterone levels, it is possible to use testosterone supplements which come different formulation such as a topical ointment.

Bringing this all together, talking to Mr. Jones and those like him about these options takes some time and often requires some trial and error to find what works. Some men are fine starting with Caverject right away and find it non-bothersome, but I would say it comes down to personal preference on what side effects are manageable for the patient. I do hope to see some advancements in other medications aside from PDE-5 inhibitors and expansion on the use of topical Alprostadil in the near future, which I feel more men would prefer.

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Viagra for men

Erectile dysfunction is when a man has difficulty getting an erection. Or keeping it long enough for sex. It's also known as ED or impotence. It happens when not. Nov 26, Man on the tube checking how long Viagra lasts on his smartphone For most men Viagra starts to wear off hours after you first take it. To get the whole picture of Viagra treatment you need to know the situation men are in before they seek treatment and the results they get after starting their.

Viagra for men

One-third to one-half of the subjects in these studies reported successful intercourse at least once during a 4-week, treatment-free run-in period, viagra for men. While there were no severe adverse events potentially related to blood pressure reported in this study, one subject reported moderate vasodilatation after both Viagra 50 mg and mg. Stronger CYP3A4 inhibitors such as ketoconazole or itraconazole could be expected to have greater effects than seen with saquinavir. Drug Interactions in more detail. Most active discussions votes comments.

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