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Sildenafil in clinical practice

 

Clinical bottom line

In clinical practice in a British general hospital sildenafil treatment was successful in 9 out of 10 men, and 8 out of 10 were willing to continue. Adverse events of headache, dyspepsia, flushing and abnormal vision.


Reference

K Sairam et al. Oral sildenafil (viagra) in male erectile dysfunction: use, efficacy and safety profile in an unselected cohort presenting to a British district general hospital. BMC Urology 2002 2 ( http://www.biomedcentral.com/1471-2490/2/4 )

Study

This was a prospective observational study on patients referred to a urology clinic with erectile dysfunction as their main complaint. Use of the IIEF and consultation with medical history and examination determined eligibility. Men with known contraindications or who had previously had unsuccessful experience of sildenafil were excluded. Sildenafil was started in a dose-escalation manner, usually on 50 mg, but with 25 mg with elderly men or those with a cardiovascular history.

Follow up was at 4, 12 and 52 weeks.

Results

Of the 147 men seen over six months to April 2000, 113 were enrolled, and 99 entered the study. The median follow up period was 11 months. After sildenafil, 82/99 (83%) had improved erections suitable for intercourse. Seventeen (17%) failed treatment. At the one-year visit, 59/74 (80%) wanted to continue using sildenafil, and three reported return of spontaneous erections and had stopped using it.

The optimal dose for achieving erection satisfactory for sexual intercourse was 25 mg in 6%, 50 mg in 44%, 75 mg in 1% and 100 mg in 38%.

Common adverse effects were headache (24%), flushing (16%), dyspepsia (12%), nasal congestion (10%) and abnormal vision (5%). Penile pain, palpitations and dizziness occurred in one patient each.

Comment

This is a detailed account of the use of sildenafil in clinical practice. The results are similar to those found in a systematic review of randomised trials.