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In 1998, the FDA approved Pfizer's drug Viagra for the treatment of ED. There has been over one billion pills sold world wide to over 23 million men, over 600,000 physicians have prescribed the drug and one prescription is written every 4 seconds. As a result the drug has become the second most common trade name in the world just behind Coke but ahead of General Motors, IBM, and Microsoft. This is also one of the most widely tested drugs with more than 130 studies in more than 13,000 experimental patients. There have been more than 2000 articles written on the safety of the drug in heart patients and in men with hypertension making it one of the scrutinized drugs every brought to market. The drug is also a financial success for Pfizer with sales of over $1 billion annually for this pill that sells for about $9 in local pharmacies. Now there are two new drugs that are available for the 30 million American men who suffer from ED. Levitra (Bayer-Glaxo, Smith, Klein) and Cialis (Lilly-ICOS). Each drug maker is touting the benefits and features of their drug leading to potential confusion for men who suffer from ED. How to select a drug for ED?
The onset of action is another area of comparison. Most of other drugs work in 10-30 minutes, although Levitra reports a faster onset of action than Viagra or Cialis. With or without food? Viagra appears to work best if not taken with a heavy meal, especially a meal high in fat content. Levitra's onset of action is slightly delayed with high fat meals and Cialis does not seem to be affected by food consumption. All three drugs are effective with minimal to moderate amounts of alcohol. All three drugs have decreased performance with excessive alcohol consumption. Who wants to have sex when you are passed out from imbibing too many "ritas" or more vodka than tonic? All three drugs are absolutely contraindicated in men using nitrates for angina and chest pain. The nitrates and the ED drugs can reduce the blood pressure to such a low level that the blood supply to the heart is also affected and result in serious heart complications. However, if a man is able to walk up two flights of stairs without shortness of breath or without chest pain, then it is perfectly safe for him to engage in sexual intimacy. (Just ask Jack Nicholson in "Something Got To Give" when he asked his doctor about returning to sex after suffering from a heart attack.) ED drugs and alpha blockers. Levitra is contraindicated in men using any alpha blocker, i.e., Cardura, Hytrin, and Flomax, for the treatment of benign prostate enlargement. Cialis is to be avoided with the use of Cardura and Hytrin but not with the lowest dose of Flomax, or 0.4mg. Viagra is not to be used within four hours of using any of the alpha-blockers. So, if you have sex in the morning and use Viagra, take the alpha blockers in the evening and visa verse for those who prefer their sex when the sun goes down. Duration
The side effect profiles of the three drugs are also similar. They all cause mild nasal congestion, flushing or redness of the face, and occasional headaches. Cialis can cause temporary low back pain in a small number of men which subsides in a few hours. It is of interest that only 2-3% of men will stop using the three ED drugs because of these adverse events. So what's my advice.
Finally, check with your doctor who will also check your medications to be certain there are no contraindications to adding ED drugs to your existing medications. The doctor will also check for conditions like high blood pressure, heart disease, and diabetes before prescribing these drugs. Finally, your doctor will also instruct you in the proper use of the medication in order to achieve the best results. Wishing you good sex until next month. Dr. Neil Baum is a urologist in New Orleans and can be reached at 504.891.8454 and through his website, www.neilbaum.com. |
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Dr. Neil Baum |
