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Erectile dysfunction drugs vary in effectiveness, side effects

(Reuters Health) – Viagra is the most effective treatment for erectile dysfunction, but it also has a higher rate of side effects than other options, according to an analysis of more than 150 trials.

Viagra is known generically as sildenafil. Men concerned about possible side effects of Viagra like headaches, flushing, indigestion and nasal congestion may want to start on Cialis, which is known generically as tadalafil, researchers report in European Urology. If that’s not effective, men in some countries can try Zydena (udenafil).

Many men have trouble getting or keeping an erection, especially as they age, but erectile dysfunction – also known as ED – is not a natural part of aging, according to the U.S. National Institutes of Health.

The new review compares seven common ED therapies, all belonging to a class of medications called phosphodiesterase 5 inhibitors (PDE5i’s). They work by inhibiting an enzyme that may reduce the potency of an erection.

Viagra, Cialis, Levitra (vardenafil) and Stendra (avanafil) all work this way and are approved for use in the U.S. The additional drugs Zydena, Helleva (lodenafil) and Mvix (mirodenafil) are only approved for use in other countries.

PDE5i’s are considered the first-choice therapy for ED, but they’re only effective for 60 to 80 percent of men who try them, and many will stop taking them, according to Dr. Alexander W. Pastuszak of Baylor College of Medicine’s urology department in Houston, Texas. He was not part of the new study.

Researchers at the University of Zurich, the Swiss Federal Institute of Technology, and Maastricht University Medical Center in the Netherlands reviewed 82 studies of the drugs’ effectiveness and 72 studies exploring side effects.

These treatments are all more effective than placebo for treating erectile dysfunction, and are generally safe and well tolerated, the authors note.

A 50- or 100-milligram (mg) dose of Viagra appeared to be the most effective treatment. It performed about 50 percent better than a placebo. Smaller doses were less effective. Stendra, in doses ranging from 50 to 200 mg, was among the least effective – only 20 to 30 percent more effective than a placebo.

The 50-milligram dose of Stendra was associated with the lowest rate of side effects of any medication – 8.5 percent of the time. A 20-mg dose of Levitra had the highest rate of side effects: 25 percent. Higher doses of Viagra and Cialis tended to cause side effects between 21 and 22 percent of the time.

“Viagra has an established efficacy and safety profile and remains an important treatment option for men with erectile dysfunction,” a spokesperson for Pfizer, makers of the drug, told Reuters Health in a statement. “Viagra has been studied for more than 15 years in more than 136 completed and ongoing clinical trials involving more than 23,000 men with ED.”

Side effects depend on which drug is used and what other enzymes the drug is able to inhibit, Pastuszak told Reuters Health by email. One of the main side effects of Viagra is visual changes, whereas Cialis more often causes muscle pain.

More generally, these types of ED drugs can cause a drop in blood pressure, because they are vasodilators, which open blood vessels, he said. He added that they should not be used with nitrate-based heart medications since they can cause a steep drop in blood pressure.

“Other common side effects include facial flushing, congestion, headache, and upset stomach,” Pastuszak said.

“Men complain of side effects, but more often of a lack of complete efficacy,” he said. “The drugs are not for everyone, as they won’t necessarily help a man with severe erectile dysfunction as much as they would someone with mild or moderate ED.”

Urologists will already have an understanding of the effectiveness and side effects of the available ED therapies, so the new results will not be a surprise, he said.

Only Cialis is to be taken daily, the other options are all short-acting, so men have the option of trying several to see which one works well, he said.

Doctors should carefully discuss expectations and treatment effects of the various options with patients before choosing a therapy, the authors write. Some ED patients may want immediate stronger efficacy at the cost of higher side effects, while others may not.

SOURCE: bit.ly/1Dv6EVy European Urology, online March 26, 2015.

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Viagra, para qué…¿Para todos? ¿Qué es la disfunción eréctil?

El primer paso para superarla es recibir información sobre todas las posibles causas y tratamientos.

La gran mayoría de los casos se puede tratar. Aunque algunas dificultades de erección son temporales y ocasionales es importante hablar del problema con tu médico. En la actualidad hay muchos tratamientos y opciones para tratarla satisfactoriamente.

Puede ser un tema difícil del que hablar, pero recuerda que sólo es otro síntoma para su médico; es un tema con el que tu médico trata regularmente, por lo que no deberías sentirte avergonzado de hablar sobre ello.

¿Cómo hablo con mi pareja?

Cuando se producen problemas sexuales muchas parejas encuentran difícil hablar sobre ellos y a menudo, cuanto más lo dejan, más difícil se hace hablarlo. Una vez que reconoces la situación y decides buscar ayuda, juntos puede ser más fácil.

La DE es un problema frecuente. Si crees que tu pareja tiene disfunción eréctil, no está solo y tú le puedes ayudar: Si la pareja se implica en el tratamiento es más fácil que los hombres sigan con el tratamiento. También es importante hacerse una revisión por si hubiera problemas subyacentes como una enfermedad cardiovascular y diabetes.

Nos referimos a parejas tanto hetero como homosexuales, la DE no sabe de condiciones sexuales. Incluso pueden consultar antes los homosexuales masculinos pues para una relación satisfactoria necesitan una buena erección para conseguir vencer la resistencia del esfínter anal.

¿Qué causas la producen?

Existen diversas razones por las que un hombre no puede conseguir una erección (envejecimiento, enfermedades vasculares, diabetes, sedentarismo, obesidad, tabaquismo, cirugía de próstata, lesiones de médula espinal e incluso tener origen psicológico), sin embargo es tranquilizador saber que la mayoría de los casos se puede tratar con la ayuda del médico. La DE ocurre cuando el pene no se pone suficientemente duro (erecto) para permitir que un hombre tenga actividad sexual, debido a que no llega suficiente sangre para que se produzca la erección, o la sangre no permanece allí el tiempo necesario.

Una erección es un proceso complejo que implica cambios en los músculos, nervios y vasos sanguíneos en el pene. La sangre se bombea para que este se ponga firme, lo que generalmente empieza cuando pensamos sobre sexo y/o cuando se nos estimula. La estimulación sexual hace que unas señales viajen por los nervios que van desde la médula espinal hasta los genitales. Los vasos sanguíneos que irrigan el pene se dilatan, de manera que la sangre llega y el pene se agranda.

Alrededor del 40% de los hombres mayores de 40 años sufren algún grado de DE. Algunos problemas de erección no duran mucho ni pasan a menudo, pero si ocurren más a menudo, pueden ser una señal de que tienes DE. En muchos casos, la DE está provocada por una combinación de factores físicos y psicológicos por lo que es importante una evaluación médica adecuada (enfermedades asociadas, medicación, etc).

Causas Físicas

Enfermedades vasculares: Diabetes, enfermedades cardiovasculares, tensión alta, fallo renal.

Efectos post-operatorios: Después de una cirugía de próstata o de la parte inferior del intestino (recto).

Otras enfermedades: Cáncer de próstata, enfermedades neurológicas (Esclerosis múltiple y enfermedad de Parkinson), traumatismos.

Efectos secundarios de medicamentos: Uso de tranquilizantes, antidepresivos, betabloqueantes y ciertos antipsicóticos.

Causas Psicológicas: Estrés y problemas emocionales.

¿Cómo están relacionados el estrés y la ansiedad con la disfunción eréctil?

Se piensa que entre el 10-20% de los casos de DE están causados por factores psicológicos como el estrés, la ansiedad y la depresión. Aunque no está claro cómo la provocan, se entiende que un hombre tiene que sentirse relajado para conseguir una erección. El estrés y la ansiedad provocan tensión en el cuerpo que a su vez provoca que los vasos sanguíneos en el pene se contraigan reduciendo el flujo de sangre que se necesita para una erección. Sentirse tenso y ansioso también afecta a los nervios del pene que ayudan a mantener una erección.

El estrés se puede relacionar con varios factores incluyendo problemas de dinero, presión en el trabajo o problemas en las relaciones interpersonales. La DE en sí misma a menudo es una gran fuente de estrés y ansiedad para muchos hombres y puede llevar a provocar ansiedad que hace que el problema sea todavía peor.

Los síntomas de estrés y ansiedad pueden incluir: Problemas de sueño, tensión muscular, Ritmo cardiaco irregular, fatiga, irritabilidad, Mareos y respiración rápida o superficial.

¿Cómo se relacionan las diferentes causas físicas con la disfunción eréctil?

Tanto los factores de riesgo cardiovascular (tabaquismo, exceso de peso, sedentarismo, colesterol elevado) como la hipertensión y la diabetes producen alteraciones vasculares en todo el organismo. Los vasos sanguíneos del pene son aún más finos por lo que la arterioesclerosis les afecta en mayor medida.

¿Los fármacos para tratarla los podemos usar todos sin restricciones?

Un examen médico completo y la revisión de la historia clínica del paciente deben ser realizados para determinar un diagnóstico de la DE y así detectar las causas probables e identificar el tratamiento apropiado.

Es relevante remarcar que se tratan de medicamentos para una condición médica y psicológica específica: la DE. Aunque actualmente hay personas que lo usan para mejorar su rendimiento sexual. En el mercado existen varios: Viagra® (más conocido), Cialis®) y Levitra® En los últimos dos años se ha advertido la facilidad con la que se compran ciertos fármacos a través de Internet y los utilizados para el tratamiento de la DE son los más vendidos por este medio (sobre todo Viagra®). Esto en realidad es un peligro porque se puede vender a pacientes para los que no está indicado, causando problemas de salud o simplemente no dando resultados efectivos. Por eso, el único lugar seguro para obtenerlos son las farmacias.

Este tipo de medicamento ayuda a la mayoría de los hombres con DE a lograr erecciones más rígidas y a mantenerlas durante la actividad sexual.

Tengamos en cuenta que estos productos no son afrodisíacos, no actúan en el cerebro ni en el corazón, sino en los cuerpos cavernosos del pene, siempre en presencia del deseo y del estímulo sexual y como todos los medicamentos tienen contraindicaciones y precauciones. Es importante tener en cuenta que si no hay una estimulación sexual estos fármacos no causarán una erección, como tampoco aumentará el interés sexual (libido), ni mejorará la excitación sexual y no actúan sobre la eyaculación ni el orgasmo. Aunque de manera indirecta, al dar mayor confianza y seguridad puede aumentar los niveles de excitación y deseo sexual. Los efectos secundarios más comunes son: dolor de cabeza, enrojecimiento de la cara y malestar estomacal. Los menos comunes son visión azulada o borrosa, o sensibilidad a la luz. Estos pueden durar poco tiempo.

  • Pacientes que están tomando óxidos nítricos, nitritos y nitratos orgánicos.
  • Pacientes en quienes la relación sexual es desaconsejable debido a factores de riesgo cardiovascular.
  • Insuficiencia hepática o renal severas.
  • Hipotensión arterial.
  • Infarto de miocardio reciente.
  • Patología de retina degenerativa de tipo hereditario.