Sildenafil citrate in the treatment of erectile dysfunction associated with hypertension

Sildenafil citrate is a potent inhibitor of the electrolytic enzyme type V phosphodiesterase [PDE5] in the corpus cavernosum and therefore increases the penile responses to sexual stimulation associated with erectile dysfunction [ED], which is a common complaint for the patients with hypertension and those taking antihypertensive agents. We evaluated the efficacy of sildenafil citrate compared with placebo in treated and untreated hypertensive subjects with established ED. In this study both the patients taking and those not taking antihypertensive medications treated with 100 mg oral dose of sildenafil showed significant improvement than placebo in the mean scores for the questions of the International Index of Erectile Function [IIEF]. Mean domain of erectile function, orgasmic function, intercourse satisfaction and overall satisfaction showed a significantly positive improvement [p<0.001] in both types of sildenafil treated patients in comparison with the placebo group. However, the sexual-desire domain in sildenafil treated men with respect to their placebo group showed a non- significant difference. The therapeutic response to the sildenafil in these patients with ED was not affected by whether they were taking concomitant antihypertensive medication. Sildenafil citrate is an effective and well-tolerated treatment for ED in patients taking antihypertensive medication and represents an exciting class of drug with plelotropic effect with potential clinical application in a variety of cardiovascular conditions

Effect of sildenafil citrate [Viagra[tm]] on nocturnal release pattern of pituitary-gonadal hormones in diabetic males with and without neuropathy

Effect of 50 mg of oral treatment of sildenafil citrate [Viagra] was studied for nocturnal release pattern of serum total testosterone in relation to the nocturnal release of pituitary-gonadal hormones in 50 diabetic male patients with and without an objective evidence of neuropathy [age span, 20-65 years; duration of diabetes distributed over 1-20 years], and their age-matched non diabetic controls. Diabetic neuropathic patients exhibited a significant increase in low serum level of total testosterone and a significant decrease in the higher serum levels of prolactin [PRL] and luteinizing hormone [LH] [P< 0.001] at the peak hours of the night after the twelve months of therapy. Follicle stimulating hormone [FSH] showed a less significant decrease thus indicating a larger correlation of PRL and LH with testosterone than did FSH in these patients. However non neuropathic patients showed a non significant difference in the nocturnal release pattern in the above mentioned pituitary-gonadal hormones and found to be secreted in normal levels. In addition median level of serum total testosterone and prolactin showed a similar episodic release pattern with a significant increase in their base line levels as the night progressed with the peak levels occurring between 4-6 AM., and 3-6 AM., respectively. FSH and LH also showed an episodic release pattern with slight increase in their base line levels as the night progressed. These results thus suggest a possible neurogenic effect of sildenafil citrate on the nocturnal release pattern of PRL in diabetic neuropathics which in turn participate in the regulation of nocturnal testosterone secretion in these patients restoring the potency. These findings suggest a synergic effect on sleep-related erections of sildenafil citrate and testosterone for diabetic male erectile/gonadal dysfunction with established neuropathic cause and may represent a new class of autonomically acting drug for the treatment of this condition

effect of sildenafil citrate [Viagra[TM]] on the frequency, duration, and degree of nocturnal penile tumescence in diabetic neuropathic men

The present study deals with the effects of sildenafil citrate [Viagra] on the nocturnal sleep related erectile dysfunctions in diabetic neuropathic men. In this investigation 50 type 1 and 50 type 2 diabetic patients with and without an objective evidence of neuropathy, aged between 15 to 60 years with a duration of diabetes distributed over 1-20 years were included along with their age matched non diabetic controls. Subjects were evaluated for nocturnal penile tumescence [NPT] and rigidity testing and the effect of oral administration of 100 mg. of sildenafil citrate [Viagra] was noted on the above-mentioned parameters. Both types of diabetic neuropathic patients exhibited a highly significant decrease in all nocturnal tumescence parameters including frequency, duration, and degree. However, both type 1 and type 2 patients without neuropathy showed a non-significant difference in the above-mentioned parameters than their respective control subjects, thus suggesting that impotence and altered nocturnal erectile responses are likely to be associated with an increased frequency to autonomic neuropathy in these patients irrespective of their type of diabetes. Treatment with oral administration of 100 mg. of sildenafil in both type 1 and type 2 diabetic neuropathic patients indicated significant increase [P<0.0001] in all the parameters of NTP and rigidity testing, however this difference was not significant in both types of diabetic patients without neuropathy before and after oral administration of sildenafil and when compared with their respective control subjects thus suggesting that oral administration of sildenafil citrate improves the quality of nocturnal erection in both type 1 and type 2 neuropathic group of patients. We thus conclude that sildenafil citrate is an effective first-line therapy for erectile dysfunction in diabetic men with impotence of neuropathic etiology. These results will improve our insight into the management of sexual disorders as part of diabetic care, and suggest guidelines for the prescription of Viagra in diabetic neuropathic patients

Effectiveness of sildenafil citrate [viagra[TM] and tadalafil [Cialis[TM] on sexual responses in Saudi men with erectile dysfunction in routine clinical practice

Satisfaction with the sexual experience is considered important when evaluating the impact of treatments for erectile dysfunction, yet enhanced satisfaction has been infrequently assessed in the sexual trials. We evaluated the efficacy of sildenafil verse tadalafil, in Saudi men with erectile dysfunction and determined the self-based rating of medicinal preference. Sildenafil citrate [ViagraTM] is a potent inhibitor of the electrolytic enzyme type V phosphodiesterase [PDE5], in the corpus cavernosum and therefore increases the penile response to sexual stimulation. Tadalafil [CialisTM] is also a PDE5 inhibitor that increases the level of cyclic guanosine monophosphate [cGMP] in cavernous smooth muscle cells. Whereas cGMP is a second messenger for the vasodilator effects of nitric oxide causing smooth muscle relaxation, which in turn leads to penile erection; however the mechanism by which cGMP stimulates relaxation of the smooth muscles remains to be elucidated Both sildenafil and tadalafil have a rapid onset with the effectiveness up to 4 hours and 36 hours respectively. In this study subjects treated with 100 mg oral dose of sildenafil / 20 mg tadalafil were found to be associated with higher mean scores for the questions of the International Index of Erectile Function [IIEF]. Frequency of penetration and maintenance of erection after sexual penetration and/or during masturbation were found to be enhanced significantly [p < 0.001] in both sildenafil/tadalafil treated men. Similarly mean domain of erectile function, orgasmic function, and intercourse satisfaction also showed a significantly positive improvement [p < 0.001] in both the treated groups in comparison with their age matched untreated controls. Interestingly in all the cases, tadalafil group showed considerably greater positive responses than the sildenafil group but within the same significant levels. Strikingly the sexual-desire domain in sildenafil treated men with respect to their aged matched controls showed a non-significant difference, where as this difference was found to be highly significant in tadalafil tre ated group. Similarly mean scores for the overall satisfaction domains of the IIEF in comparison with the untreated subjects showed a significant positive response in the sildenafil treated group [p < 0.001], where as tadalafil treated group showed a highly significant positive response [p < 0.005]. These findings suggest that both sildenafil and tadalafil may assist an individual in extending/enhancing the excitement phase or prolonging the sexual interaction. These studies further conclude that there is a major point of difference between the short-acting agent sildenafil and the longer acting tadalafil. This probably allows more choice about the onset of sexual responses with tadalafil than with sildenafil

Possible neurogenic role of sildenafil citrate [viagra] on the regulatory pattern of pituitary-testis axis in diabetic males with and without neuropathy

Sexual dysfunctions due to neurogenic impotence decrease the testosterone levels through a central effect on the hypothalamic-pituitary axis. The present study deals with the effect of sildenafil citrate [Viagra] treatment for these neurogenic sexual disturbances on the reversibility of this neuro-endocrine pattern of the serum levels of pituitary-gonadal hormones. In this investigation 50 insulin dependent [IDDM] and 50 non insulin dependent [NIDDM] diabetic male patients with and without an objective evidence of neuropathy and 50 age matched non diabetic male controls were selected. Every male had age between 20 to 65 years with duration of diabetes distributed over 1 to 20 years. During treatment with sildenafil citrate [50 mg. oral dose] serum total testosterone, free testosterone, serum PRL, FSH and LH were measured. Treatment with 50 mg. of oral sildenafil citrate reversed this neuro-endocrine release pattern in both IDDM/ NIDDM neuropathic men by exhibiting a significant increase in serum total and serum free [urinary] testosterone levels [p<0.001] and a significant decrease in the levels of serum prolactin [PRL] and follicle stimulating hormone [FSH]. Decrease in luteinizing hormone [LH] was found to be less significant [p<0.01]. However both types of non neuropathic diabetics treated with sildenafil citrate showed a non significant difference in the in the serum levels of the above mentioned pituitary-gonadal hormones when compared with the untreated groups and their respective control subjects. These findings conclude that sildenafil citrate has a direct effect on the pituitary-testicular axis and is a well tolerated and highly effective oral therapy for restoring the potency with established neuropathic cause [irrespective of the type of diabetes] and may represent a new class of autonomically acting drug for the treatment of this condition. In other words it is worth trying sildenafil citrate for erectile dysfunctions of neuropathic etiology

Post ejaculatory effects of sildenafil citrate [viagra] on sexual responses in diabetic neuropathic men

Erectile dysfunctions in diabetes are important signs probably due to pelvic autonomic neuropathy with damage to the parasympathetic nervierignetes. Direct evidence for a neuropathic etiology comes from studies that show structural changes in autonomic nerve fibers supplying the corpora cavernosa. The present study deals with the post ejaculatory effects of sildenafil citrate [Viagra] administration on sexual dysfunctions associated with diabetic neuropathy/ erectile impotence prevailing in the male population. To investigate whether sildenafil citrate administration maintains improved erectile functions in diabetic men with established autonomic neuropathy during post ejaculatory refractory phase [the phase of re-obtaining erection after ejaculation] after psychic and physical sexual stimulation. These findings may be of patho-physiological significance for the use of sildenafil citrate on the management of erectile dysfunctions in diabetic neuropathic men. The study design consisted of a prospective cross-over, two period investigation [Pre and post ejaculation before and after the intake of 50 mg Viagra]. Eectile/sexual functions including libido, erection frquency, masturbation ability, pattern of ejaculation, and pattern of erection lost were noted during audiovisual sexual stimulation in 50 insulin dependent diabetes mellitus [IDDM] and in 50 non insulin dependent diabetes mellitus [NIDDM] patients with and without an objective evidence of neuropathy, having an age span in between 20 and 65 years and a duration of diabetes distributed over 1-25 years with their age matched non diabetic controls. Sildenafil treatment showed a significant improvement [P<0.0005 in some cases] in all the parameters during the first ejaculatory phase in both types of diabetic neuropathics and were found to be maintained [absolute] during post-ejaculatory phase as well. However, this difference was found to be non significant in both types of diabetic patients without neuropathy and when compared with their respective control subjects during the first ejaculatory phase. A complete failure in the pattern of erotic responses in these subjects during the post ejaculatory phase was also observed since no erection/ejaculation could be achieved during this phase. These results suggest that sildenafil citrate is an effective and well-tolerated treatment for erectile/sexual dysfunction in patients with diabetic neuropathy and has a positive influence over the resumption of erections and sexual functions following post ejaculation in the presence of a continuous psycho-sexual stimulus and adds a new aspect of interest in the research area concerning the regulatory mechanism of male copulatory behaviour

Efficacy of sildenafil citrate [Viagra[TM]] on sexual responses in non-dysfunctional younger-aged men

Sildenafil citrate [Viagra [TM]] is a potent inhibitor of the electrolytic enzyme type V phosphodiesterase [PDE5], in the corpus cavernosum and therefore increases the penile response to sexual stimulation. We evaluated the efficacy of sildenafil, in younger men without erectile dysfunction. In this study subjects treated with 25 mg oral dose of sildenafil were found to be associated with higher mean scores for the questions of the International Index of Erectile Function [IIEF]. Frequency of penetration and maintenance of erection after sexual penetration and/or during masturbation were found to be enhanced significantly [p<0.001] in the sildenafil treated men. Similarly mean domain of erectile function, orgasmic function, intercourse satisfaction and over all satisfaction also showed a significantly positive improvement [p<0.001] in the sildenafil group in comparison with their age matched untreated controls. However the sexual-desire domain in sildenafil treated men with respect to their age matched controls showed a non-significant difference. Sildenafil citrate may assist an individual or couple in extending/enhancing the excitement phase or prolonging the sexual interaction and may have other sexual effects not recognized in the clinical studies

Effect of sildenafil citrate [viagra] on penile vasculature and cardiodynamics in diabetic males with and without neuropathy

Erectile and cardiovascular dysfunctions in diabetes are important signs resulting probably due to pelvic autonomic neuropathy with damage to the parasympathetic nerviergnetes. Direct evidence for a neuropathic etiology comes from studies that show structural changes in autonomic nerve fibers supplying the corpora cavernosa. The present study deals with the diabetic neuopathies prevailing in men and the possible role of sildenafil citrate [Viagra] treatment for these neurogenic cardio-sexual disturbances. Penile mid shaft circumference and length, penile pulse amplitude, both systolic and diastolic blood pressures, and heart rate were measured in response to erotic stimulation by film and fantasy and the effect of the treatment of sildenafil citrate [50 mg oral dose] was noted in 50 insulin dependent diabetes mellitus [IDDM] and in 50 non insulin dependent diabetes mellitus [NIDDM] patients with and without an objective evidence of neuropathy, having an age span in between 20 and 65 years and a duration of diabetes distributed over 1-25 years with their age matched non diabetic controls. Sildenafil treatment showed a significant increase [P<0.0005] in penile mid shaft circumference and length, and penile pulse amplitude, where as both systolic and diastolic blood pressures and heart rate exhibited a significant decrease [P<0.025 and P<0.005 respectively] in both IDDM and NIDDM diabetic neuropathic patients. However this difference was found to be non-significant in both types of diabetic patients without neuropathy and when compared with their respective control subjects. Oral administration of sildenafil citrate is an effective first line therapy for erectile dysfunctions in diabetic impotent men with neuropathic etiology [irrespective of their type of diabetes] with out much altering the cardiodynamic profile. These results further explain how to manage sexual disorders as part of diabetic care, and suggest rules for sildenafil prescription in diabetic neuropathic patients