Published: May 22, 2008 12:11 am         

E.D. drugs: Risks and benefits

If you don’t know the risks and benefits of erectile dysfunction drugs, you’re probably not watching enough television.

The smiling faces and dancing bodies portray the obvious benefits of Viagra, Cialis and Levitra. And the voice over somehow manages to make fairly serious risks such as blindness and four-hour erections seem relatively unimportant. The idea is to sell the product, but if you’re suffering from E.D. yourself, you probably want and need more detailed information.

The advertising campaign itself represents a major benefit for the 30 million or more American men who suffer from E.D. The ads accurately portray E.D. as a serious problem, not just for the old and frail but for many young, active, otherwise healthy men who didn’t realize that medical conditions such as high blood pressure, diabetes or high cholesterol could lead to sexual difficulties. Other conditions linked to erectile dysfunction include depression, obesity and hormonal problems, such as underactive thyroid.

The approval of Viagra in 1998 provided the first effective oral medication for the treatment of E.D. Levitra and Cialis followed in 2003. All work in similar ways to relax smooth muscle tissue and allow normal blood flow into the penis. The major difference is the longer (36-hour) window of opportunity for Cialis.

For about 70 percent of men with E.D., these drugs provide a safe, effective solution. The majority of men with E.D. fail to seek treatment and that is a serious mistake, because E.D. is not just a lifestyle matter but very frequently an early sign of heart disease. Nearly all of the disorders linked to E.D., even depression, are risk factors for heart attack or stroke.

In one study, 49 percent of patients diagnosed with acute chest pain and diseased coronary arteries had erectile dysfunction as well. Those with two or three disease.d. arteries were more likely to have difficulty achieving and maintaining an erection.

When Viagra was introduced, there was concern about its safety when used by men with heart disease. Numerous studies conducted since 1993 have found PDE-5 inhibitors are not only safe but probably beneficial for such patients. These drugs work by improving the ability of blood vessels to dilate and contract.

The greatest danger is one presented prominently in the ads: Some men, because of their failing hearts, are not well enough to have sexual activity. Sex elevates the heart rate, and it may not be safe for a heart weakened by heart attack or heart failure.

The connection between E.D. and high blood pressure is strong. More than two thirds of American men with hypertension have erectile dysfunction. And the risk factors for the two are the same: diabetes, smoking, high LDL cholesterol, obesity and physical inactivity. In addition, some blood pressure medications such as diuretics and beta blockers may contribute to erection difficulties.

E.D. drugs have been found to cause moderate decreases in blood pressure and work well with most blood pressure medications.

The major danger is the one mentioned prominently in the ads: taken in conjunction with nitrates, often prescribed to help heart patients cope with heart-related chest pain, any of the PDE-5 inhibitors can cause a precipitous drop in blood pressure. A similar effect can occur when a PDE-5 inhibitor is use.d. in combination with an alpha blocker for blood pressure or prostate problems.

Common side effects of Viagra include blurred vision and/or a change in color vision. The warning about blindness is serious.

NAION is a rare disorder; yet it’s a common reason for sudden vision loss, usually in men or women older than 50. The precise cause is unknown, but it’s believed to be related to a decrease in blood flow to the tiny blood vessels serving the optic nerve. Through 2005, 43 cases of NAION had been reported by men who had recently taken a PDE-5 inhibitor. Clinical data involving large numbers of patients do not reveal an increased incidence of NAION among men taking E.D. drugs.

The warning regarding hearing loss is similar. At least 29 men have reported sudden hearing loss after taking an E.D. drug. Some of these have involved both ears, and in two thirds of cases, the hearing loss was permanent. No causal relationship has been established.

None of these warnings is able to stop the dancing and the singing of “Viva Viagra.” And they shouldn’t. All three of the E.D. drugs have been demonstrated to be effective and safe for most men, as long as they are taken as directed.

In stark contrast, the “all natural” non-prescription remedies are not only ineffective but, in some cases, highly dangerous. When they work, it is usually because they illegally contain PDE-5 inhibitors, but in dangerously high doses or in combination with other substances that could cause serious interactions.

No drug is without safety concerns, but if you’re having trouble getting or maintaining an erection, the safest thing for you to do is see your doctor so you can get back in the dance.



Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.