CAN VIAGRA HELP DISABLED MEN–IS IT SAFE?
Title: CAN VIAGRA HELP DISABLED MEN–IS IT SAFE? , Accent on Living, 00014508, Winter98, Vol. 43, Issue 3
Now that an impotence pill has been approved, the above question is being asked. The best information we have seen appeared in the July issue of Paraplegia News, who has given ACCENT permission to reprint it. The author is PVA’s Associate Director of Research Melinda Kelley, Ph.D. We have seen no data on the benefit of Viagra to those with disabilities other than SCI, such as polio, muscular dystrophy, multiple sclerosis, etc. Physiatrist Julie Silver, M.D., told ACCENT it should be used very cautiously and only under the close supervision of the personal physician. She warned that in addition to a disability, other conditions may be present that could cause severe complications.
On March 27, the Food and Drug Administration (FDA) approved a new pill that can be used by men to treat erectile dysfunction (impotence). Viagra ( Sildenafil citrate) is the first drug for impotence that can be taken orally; it is now available by prescription nationwide.
Although Viagra is approved to treat impotence, the drug Sildenafil has an interesting history. It was originally tested in the early 1990s as a potential treatment for angina (heart pain). Although Sildenafil is not very useful in treating this condition, it did produce a surprising side effect in subjects involved in clinical testing: It improved erections. Further investigation by the company revealed how the chemical action of Sildenafil (or Viagra) might be causing erections in these subjects and suggested that this drug might be an effective treatment for erectile dysfunction.
Unlike many other impotence treatments (see “Impotence Update,” February 1998), Viagra works by enhancing the normal function of the male reproductive system when it receives sexual stimulation. Under normal conditions, stimulation releases a chemical called nitric oxide (NO) inside the penis. NO in turn increases levels of a chemical signal called cGMP that relaxes the penis’s smooth muscles and allows blood to flow into the organ. The flow of blood causes an erection. As long as cGMP is present, the erection continues.
Viagra helps maintain erections by preventing cGMP from being broken down too quickly so that even small amounts of the signaling chemical are sufficient to cause a prolonged effect. It is important to note that Viagra works with sexual stimulation to maintain penile erections, but it will not produce erections directly. In addition, although the drug may lead to greater self-confidence in the user, it does not improve libido directly. Viagra is currently available in several different doses. Users take it once per day, approximately one hour before intercourse.
In clinical trials, Viagra reduced impotence resulting from many different causes. Specifically, men with erectile dysfunction resulting from spinal-cord injuries (SCIs) are believed to be one of the groups that may benefit from taking Viagra. News reports and the manufacturer’s web site suggest that 70-80% of men with SCI who have taken Viagra report improvement in sexual function (as opposed to 12% of the men on placebos, or “dummy pills”). However, many details of this study have not been provided, such as the levels and severity of SCI present in the subject population. It is not clear if all individuals with SCI/D can benefit from using Viagra.
Dr. Stanley Ducharme, a clinical psychologist at Boston University, agrees. He says, “The jury is still out as to Viagra and SCI. Not enough men with SCI have tried the drug to really know what we can expect. Viagra improves blood flow to the pelvic/genital region and, as we know, this is not the primary issue for men with SCI.” Although problems with nerve function are the cause of impotence in many men with SCI, Dr. Ducharme believes Viagra may help some men who have incomplete injuries and reflex erections. Although Viagra is a promising therapy, it has a number of side effects that may affect some of the men who take the drug. These side effects include the following symptoms:
- Headaches
- Flushing
- Upset stomach
- Stuffy nose
- Urinary-tract infection
- Changes in color vision, particularly in blue-green vision
- Diarrhea, and
- Dizziness
Although these side effects may be mild and temporary in able-bodied men, those with SCI/D should be extremely cautious when considering the use of Viagra. For example, the drug can also produce a decrease in blood pressure (particularly in combination with medications that contain nitrates, such as nitroglycerin either skin patches or tablets). This side effect can be especially problematic for individuals with SCI/D who may also experience lowered blood pressure as a complication of their spinal-cord condition.
In addition, two of the milder side effects, headache and flushing, are also similar to symptoms of autonomic dysreflexia, a condition characterized by dangerous increases in blood pressure in response to number of stimuli in the environment. It is possible for a person to mistake the warning signs of autonomic dysreflexia for the milder side effects of Viagra.
Overall, the FDA’s approval of Viagra is a promising development in the treatment of erectile problems in men with SCI/D. However, more research is necessary to determine the drug’s safety and efficiency in men with different levels and types of spinal-cord conditions.
In addition, Viagra has not been tested in combination with other-treatments for impotence, so the use of this drug with other impotence therapies is not recommended. Some medications may also interact with Viagra so all interested individuals should discuss their medical histories with their healthcare providers to determine whether Viagra will help.
Copyright 1998, Paralyzed Veterans of America, by permission of PN/Paraplegia News
TO LEARN MORE
For more general information about Viagra, contact:
Pfizer, Inc. (Viagra’s manufacturer) (800) 879-3477 www.viagra.com/
Food and Drug Administration (800) 532-4440 www.fda.gov/cder/news/viagra.htm For specific information about whether Viagra is right for you, consult your personal healthcare provider.
Copyright 1998, Paralyzed of America, by permission of PN/Paraplegia News
Copyright of Accent on Living is the property of Cheever Publishing, Inc. and its content may not be copied or e-mailed to multiple sites or posted to a listserv without the copyright holder`s express written permission. However, users may print, download, or e-mail articles for individual use.
Source: Accent on Living, Winter98, Vol. 43 Issue 3, p44, 3p
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