Drug dysfunction erectile medication daily news.

Nov. 17, 2003 — Start your engines: Of the medications for
erectile dysfunction, more guys say Levitra gives them better performance.

This result — from what the researcher calls the first
head-to-head study of the three drugs — is being presented at the 6th Congress
of the European Society for Sexual Medicine in Istanbul, Turkey this week.

Viagra and Levitra are to treat erectile
dysfunction. Cialis is currently under review by the FDA to treat erectile
dysfunction and a final word is expected later this year. Levitra is
by Bayer Pharmaceuticals and GlaxoSmithKline, a WebMD sponsor.
Cialis is manufactured by Eli Lilly and Company, a WebMD sponsor. Viagra’s
manufacturer is Pfizer.

Even though Cialis’ effects may last longer, nearly 50% of all
patients preferred Levitra at the recommended starting dose at 10 mg,
researcher Frank Sommer, MD, PhD, a urology specialist at the University
Medical Centre in Cologne, Germany, tells WebMD.

“What they really liked was the quick onset of action, it
was very reliable, and it produced satisfactory hardness of the erection,”
Sommer explains.

In Sommer’s study, 47 men received each of the drugs for six
weeks with a one-week drug-free period in between. Sommer also tested different
dosages of the medications. Each drug was taken prior to sexual activity.

All three of the drugs were effective in men with erectile
dysfunction. Compared to the placebo all of these drugs produced a significant
improvement in erections for vaginal penetration and completion of
intercourse.

At the maximum dose — 20 mg of Cialis, 20 mg of Levitra, 100
mg of Viagra — 43% preferred Levitra, 40% liked Cialis best, and 17% preferred
Viagra.

In the half-maximum dose group, 47% preferred Levitra, 34%
preferred Viagra, and 19% rated Cialis best.

Men who preferred Cialis did so because they felt their
erections lasted longer. And the men who preferred Levitra and Viagra listed
their main reasons as ease of getting erections and hardness of erections.

Two men taking Cialis had such severe back pain that they went
to the hospital emergency room, reports Sommer. Since no spinal problems were
evident, the pain was linked with Cialis.

Other studies have shown that between 4% to 6% of all men
taking Cialis complain about back pain, and for some people it’s very severe
back pain, says Sommer.

Another Viewpoint

The study “shows the potency of Levitra,” says Myron
Murdock, MD, who sits on the national medical advisory boards for Cialis and
Levitra.

But there’s one problem that could skew results: “These
patients knew which drug they were taking, and that makes a very big
difference,” he tells WebMD.

Also, all three drugs work through the same mechanism — and
over time, the effect becomes cumulative, he says. “The longer you take any
of these drugs, the more effective the drug becomes.” Therefore, whatever
drug a guy was taking at the study’s end may show the best results.

Another problem: There have been the reports of back pain with
Cialis. “But that typically occurs within the first 24 hours of taking the
pill, and it’s usually mild, and tends to occur in more muscular males.
Physical activity and nonsteroidal anti-inflammatory drugs (NSAIDs, like
ibuprofen) make it go away. For most men, it’s not a serious side affect, but
it can be an annoyance,” says Murdock.

Bottom line on all these erectile dysfunction drugs: “If
Viagra works well for you, and you have one or two sexual episodes a month,
stay on Viagra,” Murdock tells WebMD. If you’ve been disappointed with
Viagra, and don’t have sex frequently, if you’re a diabetic, or have had
prostate surgery — or if you don’t like the lifestyle limitations of Viagra –
then you should be on Levitra, he says.

Cialis is great for very sexually active guys — sex one or
more times a week — and who aren’t in any of the hard-to-treat categories. Of
all the erectile dysfunction drugs, “Cialis will be more
,” Murdock says.

March 9, 2000 (Washington) — A split-second ride fueled by a powerful
Internet search engine reveals the extent of the problem: type in
“Viagra” and nearly 60,000 results come flying back. But those
flashing, dancing, web sites that proclaim, “No prescription? No
problem,” are best avoided, says an Ohio physician who analyzed the risks
of buying the impotence drug via the World Wide Web.

“There are no regulations now, and the government is moving very slowly
to corral the practice of online prescribing,” says Steven E. Kahan, MD,
the lead author of the article in the March issue of the Journal of
Urology. “This is obviously something that is very tough to get your
arms around. Then, after everything is said and done, you have the
international sites, and I don’t know who is going to regulate them.” Kahan
is an attorney and urologist-in-training at Case Western Reserve University in
Cleveland.

However, in a letter published in the March 8 issue of TheJournal
of the American Medical Association, Jane Henney, MD, commissioner of the
FDA, acknowledges that laws need to be updated and writes that the agency is
working with state pharmacy and medicine boards to “investigate illegal
online selling and prescribing.”

Viagra (sildenafil) has been available since March 1998 for the treatment of
impotence, or erectile dysfunction (ED). It has been hawked in television
commercials by Bob Dole, the former senator and presidential candidate. The
most common side effects of Viagra are facial flushing, nausea, dizziness and
blue-tinged vision, but it can also cause a potentially deadly drop in blood
pressure, when combined with certain medications, including
nitroglycerin.

In the article, Kahan and two colleagues trace the advent of Viagra’s
through the Internet and focus on the ethical, legal, and
regulatory issues that surround online prescribing in general. The authors
write that the physician-patient relationship was under stress before the
popularity of the Internet. The increasingly common practice of phone calls to
patients altered this arrangement, with patients expecting “attention to
medical needs” and a guarantee of privacy during such calls.

At first, physicians turned to the Internet primarily as a means to
communicate with colleagues and conduct research, but now more realize it can
“permit easier patient access to health care and lower transaction costs
with arguably continued consistent health care delivery,” the authors say.
Improved patient compliance may also be achieved.

The authors argue that regulations should recognize a distinction between
Internet pharmacies and online prescribing and point out that a variety of
governmental agencies have a limited hand in such regulation today. While the
FDA ostensibly has oversight of prescription medications, it does not regulate
the actual writing of such medications, but only the “development,
distribution, and promotion” of .

There is little harm in people filling prescriptions written by their
physician through reputable Internet pharmacies. But that’s where the sites’
involvement should begin and end, Kahan says.

“I think Internet pharmacies should not initiate a prescription, and the
prescription that is filled should be based on a doctor-patient relationship,
and that usually involves a physical exam,” says Kahan. In his own
practice, Kahan says he found it “strange” that patients had access to
medications he deemed inappropriate for them and “all I could do was warn
them about what might happen and discourage them for getting it from the
Internet. Hopefully, they would have the sense not to get it.”

State governments have cracked down on physicians who have prescribed
medications online to people who don’t reside in the states where the
physicians are licensed, holding that it constitutes practicing medicine
without a license. The Federal Trade Commission is charged with ensuring that
drug advertising is not false or misleading, although monitoring Internet
claims specifically seems to have gotten little emphasis, Kahan says.

Irwin Goldstein, MD, a professor of urology at Boston University, points out
that patients should have a thorough examination before they are given Viagra
to rule out any possible interaction with other medical conditions they have.
He tells WebMD that a “doctor’s visit” by an online physician could
miss the possible reasons for erectile dysfunction and other medical conditions
that could make Viagra a bad idea, including diabetes, hypertension, high
cholesterol, kidney failure, anemia, prostate and testicular infections, and
depression.

For Robert Sher, MD, a urologist in Maryland, the article reinforces his
belief that prescribing and obtaining Viagra over the Internet are just
wrong.

“Viagra has side effects,” says Sher, who reviewed the article for
WebMD. “People need to be monitored on it. If they aren’t monitored they
can die. You need to see the patient. ED is a medical problem and patients need
to have a thorough evaluation prior to prescribing it. Viagra is not for
patients who are using nitroglycerin products and may be abused by someone who
just wants it as a sex enhancer.”

Though none of his patients have discussed obtaining Viagra through the
Internet, the possibility certainly exists that they could get it this way,
Sher says. “You see these sites everywhere. They advertise in the
newspaper, and I think Viagra is probably the tip of the iceberg of what other
drugs you can get on the Internet.”

In her letter to JAMA, Henney also counsels that patients not obtain
first-time prescriptions from online doctors, and she urges physicians and
pharmacies to “educate their patients about dangerous online
practices.” The agency “also encourages health care professionals and
patients to report any suspicious web sites to the FDA or the National Boards
of Pharmacy. Until fully effective safeguards are in place, patients and health
care providers should be cautious when using or the use of the
Internet for purchase of prescription medications,” she writes.

Vital Information:

• Experts are concerned about the ease with which the erectile dysfunction
  drug Viagra is obtained over the Internet without a prescription or a visit to
  a doctor.
• One problem is that regulation of prescribing over the Internet is
  fragmented among government agencies, although governing practices may be
  changing in the future.
• Getting a prescription filled by an online pharmacy should not be a problem
  for consumers, as long as the prescription was written based on a sound
  doctor-patient relationship that involves a physical exam.

April 1, 2001 — Move over, Viagra: A team of researchers has found that an form of gene therapy can restore over-the-hill male rats to the sexual potency — as measured by their ability to have erections — of studly young rats just a third their age. The therapy was described at the annual Biology meeting in Orlando, Fla.

Although the therapy is far from being ready for prime time in humans, it has potential as a long-acting treatment that could help to restore youthful vigor to men with erectile dysfunction, report Trinity Bivalacqua and colleagues from Tulane University in New Orleans and Johns Hopkins University in Baltimore.

In their study, the researchers injected into the penises of aged rats a cold virus modified to carry a gene that helps blood vessels in the penis to expand and fill with blood, one of the key steps necessary to creating and sustaining an erection.

“We looked at the physiology, asking is this going to help these animals get better erections, which it did,” Bivalacqua, a medical student at Tulane University, tells WebMD.

Erections are controlled by a complex series of events involving nerves and the signals they carry, as well as hormones and other substances that control the expansion of blood vessels, so it’s not surprising that any one of several defects or disruptions of one of the mechanisms involved in sexual performance in men can result in erectile dysfunction.

One method for treating erectile dysfunction has been through direct injection into the penis of substances that stimulate the release of chemicals within the penis that control the relaxation of smooth muscle. When smooth muscles surrounding the blood vessels in the penis relax, they allow more blood to enter, thereby causing an erection. Drugs like Viagra work by interfering with an enzyme that would otherwise prevent relaxation of smooth muscle.

Unfortunately, penile injections and Viagra are one-shot deals and need to be repeated every time a man with erectile dysfunction wishes to have sexual intercourse.

To see whether they could create a longer-lasting treatment for erectile dysfunction, Bivalacqua and colleagues injected into the penises of aged male rats a harmless cold virus, called an adenovirus, that had been modified to carry a gene for an important , or chemical messenger, involved in erections.

Five days after the injections, the rats underwent nerve stimulation to simulate a normal erection, and their responses were compared with those of other rats one-third their age. The researchers found that older animals that received the adenovirus had erectile responses comparable to those of young rats. In contrast, older rats injected with a different gene not associated with erectile function had no significant improvements in function.

The researchers also found evidence that the virus continued to be present in penile tissue for up to 30 days, suggesting that the therapy, if found to be safe and effective in humans, could be delivered once a month rather than before every episode of sexual intercourse — no doubt a welcome prospect to men who are squeamish about the idea of penile injections.

But a urologist who studies gene therapy for erectile dysfunction tells WebMD that there are several drawbacks to using adenoviruses as carriers for genes.

“As a strategy in humans, I think adenovirus has some drawbacks in that it’s inflammatory, and usually repeated doses will cause an immune system reaction. I think we need to keep trying different genes, and we also need to start looking at long-term strategies for gene expression, because these are temporary and won’t be permanently incorporated into the penis,” says Hunter Wessells, MD, associate professor of urology at the University of Washington School of Medicine in Seattle.

Craig F. Donatucci, MD, a urologist who specializes in research and treatment of erectile dysfunction at Duke University Medical Center in Chapel Hill, N.C., tells WebMD that ” it makes sense, because you fix the problem, but then you have the issue about the dangers of adenoviruses.”

Donatucci points to the 1999 death of a patient at the University of who was undergoing experimental gene therapy with an adenovirus for correcting a lifelong metabolic disorder. “If you’re talking just about erectile failure, what’s your safety level? Where do you set that?” he asks. “From a general philosophical viewpoint, it’s very attractive to think of gene therapy in the future, putting in some form of gene therapy, but realistically, it’s a long way from happening.”

First there was the little blue pill. This year it has two
companions: The little orange pill, and the , yellow pill.

Men with erectile dysfunction now have three drugs to choose
from — Viagra, Levitra, and Cialis. If that’s news to you, you must not have
turned on a television set or opened a magazine in the last few months.
Everywhere you look, it seems, there are famous athletes singing the praises of
their drug-restored virility. It’s hard to remember the no-so-long-ago time
when “erectile dysfunction” were words no man dared speak.

Does one drug work better than another? That depends on the
man.

All three drugs work the same way, says urologist Gerald Brock,
MD, associate professor at St. Joseph’s Health Center in London, Ontario,
Canada. Brock is past chair of the Canadian Male Sexual Health Council. He’s
treated many patients with Viagra and, in clinical trials, with Cialis and
Levitra.

“The big difference is length of action,” Brock tells
WebMD. “All are very safe and have proven in tens of thousands of men to be
a valuable treatment for erectile dysfunction.”

Viagra starts working in about half an hour — although an
effect has been seen in as little as 12 minutes — and its effect lasts for
about four hours. Levitra has about the same window of effect at lower doses.
Cialis gets to work a bit faster — one-third of men respond in 15 minutes –
but lasts for 36 to 48 hours in some men.

All of the drugs block an enzyme called PDE-5. PDE-5 is a key
link in the chain of chemical messages that tell a man’s erection to go away.
Brock says that there’s more PDE-5 in the penis than in other muscles, so the
drugs have a pretty specific effect.

Chad Ritenour, MD, teaches urology at Atlanta’s Emory
University. He says lots of patients are trying the newer drugs.

“I tell patients it is going to be like Pepsi versus Coke
– get ready for the blitz,” Ritenour tells WebMD. “But I
don’t think anybody can say one works better than the other. Each drug probably
will work better for some patients than for others.”

More to Sex Than Erections

It’s good to get men talking about their sexuality. But being
sexual is different than having an erection, says Jeanne Shaw, PhD, an
Atlanta-based clinical psychologist and certified sex therapist.

“What I see as a problem is the public has been educated to
believe that good sex requires an erect penis that stays hard through the
entire sexual encounter,” Shaw tells WebMD. “This definition of good
sex changes the basic nature of an encounter from intimacy and pleasure to
achievement and performance.”

This focus on performance, Shaw says, robs men and their
partners of the to deepen their relationships — and their
sexuality. The sexual needs of adolescents, she says, are different that those
of adults. Yet by making erections the be-all and end-all of sex, grown men are
retreating to adolescent sexual values.

“Having an erection does not mean you are being sexual.
Being sexual comes from inside your sense of yourself,” Shaw says. “You
can be sexual, you can feel sexual, you can behave sexually without an
erection. A penis is not the only part of a man’s body that can be used
sexually.”

Shaw makes a distinction between genital behavior and sexual behavior.
Mistaking one for the other, she says, leads to dishonesty and
dissatisfaction.

“You can behave genitally whether you feel sexual or
not,” Shaw notes. “Women and men can fake it. Lots of men get an
erection, penetrate, and lose the erection and pretend they have had an orgasm
because they want to be perfect. They don’t say, ‘Hey, I didn’t have an orgasm
but maybe next time. Being near you is enough.’”

In her practice, Shaw finds that physical problems don’t lie at
the heart of most men’s sexual problems.

“Actually, it is psychological distress associated with not
measuring up rather than physiological problems that causes most sexual
dissatisfaction,” Shaw says. “For many, many men — maybe most –
problems with sex are due to ignorance, anxiety, and inability to communicate
with their partners. I think sexual dysfunction is the inevitable result of the
effort to attain perfection.”