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The release of Viagra™ (sildenafil) has dramatically changed the options available for men experiencing sexual problems. Huge publicity surrounding this safe and effective therapy has encouraged many men to talk to a doctor about treatment. Two new therapies have recently been approved for the treatment of erectile dysfunction (ED).The new therapies are Cialis™ (tadalafil) and Levitra™ (vardenafil). Like Viagra™, these medications increase blood flow in the penis to help with erections.
These two new therapies differ mostly in their pharmacodynamics, or the way they work in the body. The effect of Levitra™ lasts about the same amount of time as Viagra™. Cialis™ works longer and is effective up to 36 hours after being taken. Evidence suggests that Levitra™ works well for those who are difficult to treat, including men who had the prostate removed due to cancer or who have diabetes. Both Viagra™ and Cialis™ have been shown to work in these situations.
Food, particularly high-fat meals, delays the absorption of Viagra™. The absorption of Cialis™ is not affected by food. The absorption of Levitra™ is delayed only with high-fat meals – the kind that men with erectile dysfunction shouldn’t eat anyway! None of these medications interact with alcohol.
Side effects are similar for all three medications. They include headache, nasal congestion, flushing of the face and dyspepsia (indigestion). However, these side effects are infrequent, temporary and rarely mean a man must stop taking the medication.
Early evidence on Cialis™ and Levitra™ shows that these drugs are very safe for men with stable cardiovascular disease. There were no increased cardiovascular side effects or deaths amongst men with coronary artery disease treated with Cialis™ or Levitra™ as compared to those receiving placebos. Considering that Viagra™ has proved very safe since its release, this data strongly suggests these medications are safe for men with existing cardiovascular disease.
No. Nitroglycerine in any form must not be taken with any of these drugs. When the two are combined, a possibility of significant low blood pressure is created. Nitrates must not be taken for 24 hours after taking Viagra™ or Levitra™. Since Cialis™ is active in the body longer, men should not take nitroglycerine for 48 hours afterwards.
It appears that they work in very similar ways. Since no studies for all three drugs have been identical, it is impossible to precisely compare them. Still, individuals may show a different response to different drugs. As with other medications, people often report differences and unique side effects in how each drug works. These results cannot be predicted based on studies. Talk to your doctor about the similarities, differences and effectiveness of each of the three medications.
First, your doctor will assess whether you have a problem with erectile dysfunction. A thorough sexual history, physical exam and a general health check are often part of this process. Although blood may be drawn, there are not usually other tests involved. If erectile dysfunction is diagnosed, consider involving your sexual partner in discussing treatment and the implications of taking these drugs. Your doctor will probably suggest scheduling an appointment where all of you can discuss treatment options together.
If medication is recommended, your doctor can explain the key differences between the three drugs. You and your partner should discuss which medication best suits your lifestyle. Once you begin using a medication, schedule a follow-up with your doctor to check on your progress. There are many reasons why a medication may not work as well as expected (see sidebar).
The release of the two new medications is good news for men and couples affected by erectile dysfunction. Three effective oral therapies allow more choice for those with a common and distressing condition.
No. An aphrodisiac is a substance that increases sexual desire (libido). These drugs enhance the effect of a naturally-occurring substance in the penis to develop an erection. Desire is related to the complex interaction of hormones, emotions, experience and expectations – all of which are unaffected by these medications.
No. These medications will not create erections that are not appropriate for a man’s age. The medication simply restores a man’s ability to have erections similar to those of other men in his age group. They will not change the fact that erections take longer to happen and are less firm as a natural result of aging. The drug can, however, help men who have difficulty due to common health problems to have natural erections for their age.
No. The new ED drugs only help men who have poor or inadequate firmness in their erections. They do not help men who experience rapid ejaculation, low sexual interest or pain when having an erection. Rapid ejaculation one of the most common of male sexual problems – can be treated with other medications and with sexual counselling.
No. Although clinical trials are in progress, there is no current evidence that supports the use of any of the new ED drugs by women.
No. Erectile dysfunction is a medical disorder that can have profound effects on the lives of men and their partners. This problem can disrupt relationships, cause emotional problems and shatter self-esteem.
Yes. Family doctors have learned a great deal about erectile dysfunction over the past year. Most feel comfortable in deciding whether this medication is appropriate for you. You will need a thorough examination to identify existing health problems. If necessary, you may be referred to a urologist or sexual medicine specialist for some of your treatment.
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