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Feb. 12, 2002 — If you’re strong enough to take the sex, you’re strong enough to take Viagra. A new study finds Viagra safe for men with heart disease — if they’re able to exercise without having the symptoms of severe disease.

Men taking nitrate drugs (such as ) to ease the symptoms of heart disease can’t use Viagra. Even when a man isn’t taking nitrates, there’s been concern that Viagra might make his underlying heart disease much worse. There have been reports of men suffering heart attacks or chest pain after taking the popular erectile dysfunction drug.

Adelaide M. Arruda-Olson, MD, PhD, led a team of Mayo Clinic researchers who studied the effects of Viagra on 105 men with coronary artery disease (or heart disease). The men took Viagra or a harmless sugar pill an hour before exercise tests. Then were switched, and the men exercised and were tested again.

The results: Viagra itself didn’t make exercise harder on the heart.

“It seems more likely that the heart attacks and pain reported with Viagra are related more to the performance of sexual activity in a patient with coronary artery disease than the use of the drug,” notes Thomas H. Marwick, MD, PhD. Marwick is a heart disease researcher at the University of Queensland in Brisbane, Australia. The Arruda-Olson study, and Marwick’s accompanying editorial, appear in the Feb. 13 issue of TheJournal of the American Medical Association.

Arruda-Olson and co-workers warn that men with heart disease should see their doctors before taking Viagra. They recommend exercise tests to determine whether patients’ hearts are strong enough for the drug.

The researchers warn that men taking drugs for their heart condition should not take Viagra.

May 29, 2002 — Once again, Viagra comes to the rescue.

A new study shows that Viagra in combination with Paxil helps premature ejaculators who have not improved with standard treatment.

If a man can work up the nerve to talk to his doctor about premature ejaculation, the doctor may refer him to a psychiatrist or a sex therapist, or may prescribe one of several possible medications including Paxil, an antidepressant, or a lidocaine numbing ointment that is rubbed on the head of the penis before sex.

The study, presented this week at the annual meeting of the American Urological in Orlando, Fla., looked at 138 premature ejaculators who started out using a numbing ointment. Thirty-eight were satisfied with that treatment. The remaining 100 started taking Paxil, and 42 of them were satisfied with that, leaving 58 who took Paxil with Viagra.

Over the course of three months, the men took one dose of Paxil seven hours before sex and one dose of Viagra one hour before sex. They noted how long they were able to have sexual intercourse, from the moment they entered a partner’s vagina to the moment they ejaculated. In the beginning, they were able to sustain intercourse for less than one minute to three minutes.

They also rated their on a scale. At first they ejaculated too soon from “half of the time” to “almost always.”

By the end of the study, 56 of the 58 men were able to have intercourse for more than three minutes most of the time.

It’s well known that Paxil has sexual side effects, including delayed ejaculation. But Viagra? There can be several explanations for this, says study author Juza Chen, MD, of the Tel Aviv Sourasky Medical Center in Israel.

One possibility is that Viagra acts on the part of the brain that controls ejaculation. This function involves the chemical nitric oxide. Too much nitric oxide inhibits ejaculation. Viagra increases the amount of nitric oxide in the body, which is how it helps men get erections. Juza says there is some scientific evidence that Viagra increases the amount of nitric oxide in the brain, although that is not certain.

“Another possibility could be a decrease of in the head of the penis,” Juza says.

Arnold Melman, MD, head of the urology department at the Montefiore Medical Center in New York City, says he doubts that has anything to do with it. “What evidence is there?” he says. “Do you think when you have a hard erection you’re less sensitive?”

Viagra may have had a psychological effect, too: With a firmer erection, they had more confidence, so they had more control. Melman says he thinks that is a more likely explanation. “I’m sure that’s true,” he says. “Much of the reason for premature ejaculation is psychological, not physical.”

Juza says more research is needed to learn about using Viagra as a treatment for premature ejaculation. He plans to study the effects of Viagra alone compared with a placebo, and Viagra alone compared with Paxil alone.

“I think it’s a good concept,” Melman says.

Sept. 25, 2001 — We’ve all heard and laughed at Viagra jokes. Poking fun at “the little blue pill” is a favorite of late-night talk show hosts and regular folks alike. But for men with erectile dysfunction and their partners, the hope Viagra offers — of restoring a healthy sex life — is no laughing matter.

There have, however, been worrisome reports of health risks linked to the drug. Now Italian say that taking Viagra can be deadly if users also have chronic heart failure, a condition where the heart is unable to pump healthy amounts of blood through the body.

Their new study, led by Gianfranco Picirillo, MD, of Medical Policlinic Umberto I in Rome, looked at the heart rhythms of 10 healthy men and 10 others with chronic heart failure after they took a standard dose of Viagra. While both groups certain changes to their heart’s normal electrical activity, those changes were more pronounced and were potentially more dangerous in the men with heart failure.

The scientists conclude that for men with heart failure, taking Viagra may result in abnormal heart rhythms, or arrhythmias, that could lead to sudden death. The risk is even more pronounced, they theorize, for patients who also take certain other drugs including certain antibiotics, antihistamines, antifungals, and .

But other heart experts are not convinced there’s anything to worry about.

“What we know about Viagra is clear,” says Gary S. Francis, MD, director of the coronary intensive care unit at The Cleveland Clinic Foundation. “Physicians are well aware of it. The drug should not be taken with nitrates nitroglycerin because there’s a risk of sudden, dangerously low blood pressure,” he says. There has been no evidence, however, that heart failure patients in general should avoid Viagra, he tells WebMD.

Rony Shimony, MD, FACC, says that people with heart failure who have a weak heart and irregular heartbeats automatically have a higher death rate than healthy people.

“You’re already in a higher risk group,” says the attending cardiologist at Lenox Hill Hospital and at Cornell Columbia Presbyterian Medical Center, in New York City. He says that these sudden deaths can’t necessarily be linked to Viagra and that the study “is not a reason to panic. Heart failure patients are at higher risk to start with,” he tells WebMD.

What’s more, says Shimony, “cardiac patients are clearly at increased risk from doing any form of exercise or taking any form of medication. You have to use common sense.” No doctor would prescribe Viagra to a very ill patient, he tells WebMD, but if you’re appropriately screened by your heart doctor, even if you have well-controlled heart failure, all evidence indicates that you will not drop dead.

According to Shimony, “the overall experience of the medical community has been that Viagra is a very safe drug” without long-term side effects. But because it is used only to enhance the quality of life, rather than prolong it, “when a doctor prescribes Viagra and something bad happens, that’s when the drug comes under great scrutiny.”

Francis does not completely dismiss the notion that something may be going on here, but significantly more work is needed to determine if the findings are important or not. Results from any test conducted on only 10 people “don’t mean a whole lot,” he says, but this one small study suggests is “that the use of Viagra in patients with heart failure has the potential to alter the electrical stability of the heart.” And that change, he says, “may predispose them to arrhythmias, some of which may be fatal.”

Aug. 30, 2000 –The popular drug Viagra has improved the lives
of millions, but regular exercise could make it obsolete, according to a report
in the journal Urology.

In the first study of its kind, researchers showed that
physically active men have a lower risk of developing erectile dysfunction (ED)
than inactive men, even if they don’t begin exercising until midlife. But
surprisingly, the study found that reducing tobacco and alcohol use and losing
weight in midlife didn’t reduce a man’s risk of developing erectile
dysfunction.

“Our study showed that men who burn 200 calories a day,
often by walking briskly for about two miles, can lower their risk of ED
significantly,” says study co-author Irwin Goldstein, MD, a professor of
urology at Boston University School of Medicine. “And men who burn more
than 200 calories a day can lower their risk even more.”

Defined as the inability to have or maintain an erection,
erectile dysfunction affects over half of all men between 40 and 70 years of
age, but isn’t part of aging.

For their study exploring the effects of lifestyle changes on
ED, Goldstein and colleagues nearly 600 healthy men ranging from
40-70 years of age. After their body mass was calculated, the were
polled about their physical activity, smoking habits, alcohol use, and sexual
function. Eight years later, the process was repeated.

Unlike regular exercise, smoking cessation, alcohol reduction,
and weight loss in midlife didn’t reduce the risk of developing erectile
dysfunction, according to the study. “This suggests that midlife changes
are too late to reverse their effects,” Goldstein cautions, “and
highlights the importance of adopting healthy behaviors early in life.”

One of the major causes of erectile dysfunction is hardening of
the arteries, which reduces the amount of blood that can enter and enlarge the
penis. “That’s why we say that good heart health is needed for good
sexual health,” says William Steers, MD, professor and chairman of urology
at University of Virginia in Charlottesville.

“In fact, ED may be an early warning sign of a future heart
attack or stroke,” Steers tells WebMD. “So think about some other ways
to reduce your risk of heart disease and diabetes,” he urges. For example,
men should:

• Stop smoking cigarettes and cigars
• Get their blood pressure under control
• Reduce dietary fat to lower their
• Lose excess weight for their height
• Limit alcohol to one or two drinks a day

But even men who get started on a healthy lifestyle early in
life may experience impotence occasionally. “Psychological factors like
depression and anxiety can put the brakes on sexual function, but stress is
probably a bigger issue,” says Drogo Montague, MD, director of the Center
for Sexual Function at Ohio’s Cleveland Clinic and chairman of the American
Urological ED Guidelines Panel. “It can even lead to
persistent difficulty, so look for ways to relax and clear your mind.”

He also advises that men looking to avoid ED:

• Get adequate sleep to reduce fatigue
• Plan some time together with their partner, away from the kids
• Avoid alcohol before sex

Also, “a common cause of permanent impotence is physical
trauma like spinal cord injuries and pelvic fractures, so remember to wear your
seat belt,” Montague says.

The study was supported by the National Institutes of
Health.

Jan. 8, 2003 — For men taking Viagra, an unnerving side effect — light , bluish-colored vision — has been a concern. But there’s no evidence that Viagra causes eye damage, even in those who take high doses, according to a new study.

Since Viagra lowers blood pressure overall, there was a suspicion that the drug might decrease blood flow to optic nerves — nerves that control vision — which can cause nerve damage.

However, this study of 13 men at Stanford University found that high doses of Viagra by and large preserved the thickness of the choroid layer of the eye, indicating that blood flow was normal. There were some small variations in thickness, which indicated that some men with an blood vessel condition — such as hardening of the arteries — may indeed have changes in vision.

The study appears in the November-December 2002 issue of Ophthalmologica.

Some of the men did have more difficulties between shades of blue and green. However, those men had trouble seeing the between many colors.

“Viagra can change blood vessel structure as well as general blood pressure, so we needed to answer the question whether the drug could change blood vessels in the eye,” says lead researcher Tim McCulley, MD, assistant professor of ophthalmology at Stanford University, in a news release.

“Our study may have had a small group of , but it showed very little change in blood vessels or blood flow in nearly all the patients,” he says.