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Wow, Paul Conley was , which I wrote about on Wednesday. I think maybe we should keep in mind that folks at the Miami Herald may have edited Ed’s piece to suit their own ends — given their boss, Tom Fiedler, sent out.
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Restless Leg Syndrome Linked to Erectile Dysfunction in Older Men
What you need to know about alprostadil (Caverject, Edex, and Prostin VR) injections and MUSE suppositories.
Penile Injection Therapy Backgrounder - Penile injection therapy was discovered fortuitously. In 1980, the French physician Ronald Virag reported that during penile surgery, he inadvertently injected an anesthetized patient in the wrong part of the penis with papaverine - a substance derived from the opium poppy. The resulting relaxation of the smooth muscle of the penile arterial walls created an unexpected two-hour erection. This mistake prompted serious research into the use of injectable medications to relieve ED. Around the same time, Giles Brindley, a British physiologist and research scientist, discovered that injecting the drug phenoxybenzamine into the corpora cavernosa of the penis could produce an erection within minutes. At a meeting in Paris in 1984, New York urologist Dr. Adrian Zorgniotti presented his first case studies of self-injection utilizing a combination of papaverine and phentolamine. The latter drug blocks the action of neurotransmitters that cause vasoconstriction, causing the smooth muscles of the penis to relax. Two years later, Japanese researchers presented evidence that injecting the drug prostaglandin E-1 produced powerful erections. Slowly, news of the favorable results with the injectable medication began to spread within the small international community of urologists who were treating ED. Most began utilizing all three (papaverine, phentolamine, and prostaglandin E-1) in what was referred to as "trimix."
So the shipment of BefarŪ to-and-from the patient and its compulsory storage conditions may be its weak-point. But from the pharmacological and medical viewpoint, BefarŪ is clearly a major improvement over its earlier rivals.
PDE5 inhibitors should be used with caution if you have any of the following conditions:
Men with moderately severe liver disease also should not take more than a 5 mg dose of vardenafil in a 24-hour period.
Hypertension Diabetes Peripheral vascular disease -- This disease particularly affects blood vessels that supply blood to the lower extremities
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Given the relatively high rate of prolonged erection or priapism with this form of alprostadil, prescribing physicians should be aware of appropriate management of these conditions. This includes aspiration of the corpora, followed by intracavernous injection with an alpha-adrenergic agonist such as phenylephrine (Neo-Synephrine). Surgery is occasionally necessary.
No surgery is totally free of possible complications. Complications associated with penile implants include:
Oral sildenafil appears to be safe in the treatment of erectile dysfunction in the real world. It is accepted widely by our patients as first line treatment and is successful in 91% of our patients. At the end of the study period 80% of the patients were willing to continue with sildenafil therapy. In our part of the United Kingdom, there is a large expectation for ED to be treated in the NHS. Of those men eligible for treatment of their ED in the NHS, 30% qualify under the clinical categories and 18% under the 'distress' category. This has implications on the local prescribing policies and resources. Under the current guidelines, only 55% of men with one or more cardiovascular risk factors qualify for treatment in the NHS. The majority of men presenting with ED could be managed in primary care.
Mittleman and colleagues,43 in a review of 53 open-label and double-blind trials of sildenafil representing a total of 6884 patient-years of drug use and 543 patient-years of placebo use, found that the incidence of myocardial infarction was low in both the treatment and placebo groups (0.80 and 1.11 per 100 patient-years respectively) and that the rates did not differ significantly between the 2 groups. Among more than 4000 patients in clinical studies of tadalafil, the incidence of myocardial infarction in the treatment group was 0.39 per 100 patient-years, as compared with 1.1 per 100 patient-years in the placebo group.44
Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence
"These are impressive findings," Fonarow said. "Tadalafil represents a very promising new therapy for patients with pulmonary arterial hypertension, that may be used alone or in combination with other treatments such as bosentan."
Erectile Dysfunction as Warning Sign
Sildenafil is available as oral tablets at doses of 25, 50, and 100 mg. It should be taken approximately one hour before sexual activity. In some men, the onset of action of the drug may be as early as 11-20 minutes. Sildenafil should be taken on an empty stomach for best results since absorption and effectiveness of sildenafil can be diminished if it is taken shortly after a meal, particularly a meal that is high in fat.
Erectile Dysfunction: Treatment Drugs
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