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Sildenafil can cause hypotension (abnormally low blood pressure that can lead to fainting and even shock) when given to patients who are taking nitrates. Therefore, patients taking nitrates daily, even patients taking nitrates only once a day, should not take sildenafil. Nitrates are used most commonly to relieve angina (chest pain due to insufficient blood supply to the heart muscle because of narrowing of the coronary arteries); these include nitroglycerine tablets, patches, ointments, sprays, and pastes, as well as isosorbide dinitrate, and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate also are found in some recreational drugs called "poppers".
The cardiac effects associated with sildenafil have been studied extensively. Sildenafil is absolutely contraindicated in patients taking nitrates such as nitroglycerin or isosorbide. This is because sildenafil, like the other PDE-5 inhibitor medications, can potentiate the vasodilatory effects of the nitrate-based medication, resulting in an exaggerated vasodilatory effect that is potentially dangerous. Patients with serious cardiac disease, with exertional angina, or taking multiple antihypertensive medications are advised to seek the advice of a cardiologist before beginning therapy with sildenafil. A number of studies examining the cardiac effects of sildenafil have conclusively shown that no adverse consequences exist under normal circumstances.
Penile biothesiometry–This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glands and shaft of the penis. A decreased perception of vibration may indicate nerve damage in the pelvic area, which can lead to impotence.
Do you recommend a medical specialist, such as a urologist, an endocrinologist, a psychiatrist, or a sex therapist? Why or why not?
Several medical treatments may help men who have premature ejaculation. Some antidepressants seem to help delay ejaculation, including antidepressants called selective serotonin reuptake inhibitors (SSRIs). These antidepressants are available with your doctor’s prescription. However, the U.S. Food and Drug Administration (FDA) has not approved the use of these medicines to treat premature ejaculation. Also, antidepressants may cause side effects such as nausea, dry mouth and drowsiness. Antidepressants may also decrease your desire to have sex. Your family doctor can help you decide if an antidepressant is right for you.
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Sometimes the cause of male infertility cannot be identified. In these cases, there may be an underlying genetic problem.
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Tadalafil can cause hypotension (abnormally low blood pressure, which can lead to fainting and even shock) when given to patients who are taking nitrates. Patients taking nitrates daily, even patients taking nitrates only once a day, should not take tadalafil. Most commonly used nitrates are medications to relieve angina (chest pain due to insufficient blood supply to heart muscle because of narrowing of the coronary arteries). These include nitroglycerine tablets, patches, ointments, sprays, pastes, and isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate are found in some recreational drugs called "poppers".
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But the potential impact on humans isn't clear, and Golombek said people shouldn't rush out to prevent jet lag with doses of Viagra. For one thing, Viagra can cause side effects such as low blood pressure.
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Conclusion Dramatic advances in the management of erectile dysfunction have occurred over the past decade. Most patients with the condition are now managed by primary care physicians and specialists other than urologists. A thorough clinical examination can help to differentiate from the numerous causes of erectile dysfunction. Oral therapy with a PDE-5 inhibitor (sildenafil, vardenafil or tadalafil) should be considered for first-line treatment of erectile dysfunction. Although PDE-5 inhibitors should not be given to patients taking nitrates, because of the risk of hypotension, in general they are well tolerated by the majority of patients. Those who do not respond to this first-line therapy should be referred to a urologist for further evaluation and consideration of alternative treatments.
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