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Erectile dysfunction (ED) is a disease with high prevalence among men associated with ageing as well as heart disease, hypertension, dyslipidemia, diabetes, obesity, hypogonadism, drug-related risk factors.
Sildenafil has been studied in numerous large studies in the broad population of men with erectile dysfunction. The efficacy, tolerability, and cardiovascular safety of sildenafil has been included in these studies even with several co-morbid conditions and it showed significant efficacy even with men difficult-to-treat such as men with diabetes mellitus and after radical prostatectomy.
Sildenafil has a rapid onset of action (14 minutes) and a prolonged duration of action of 12 hours. Men who used Sildenafil reported that it improved quality of life and satisfaction with minimum side effects.
Sildenafil approved also for the treatment of idiopathic pulmonary hypertension. Some studies stated that it improves the blood supply and has a possible role in premature ejaculation and also could help in the treatment of lower urinary tract symptoms.
The approval of sildenafil for the treatment of erectile dysfunction dramatically changed the management of erectile dysfunction and the number of men seeking medical help increased as treatment become easier and cheaper. Sildenafila has a wide acceptance between men as
more than 30 million men worldwide use sildenafil and more than 2600 papers have been published in Medline about sildenafil and its beneficial roles, not only for erectile dysfunction but also for pulmonary hypertension and pulmonary oedema.
Efficacy in broad populations of men with ED
Sildenafil first data published by Goldstein and colleagues (1998), the result was amazing, Sexual intercourse was successful in 69% of men receiving sildenafil. The mean numbers of successful attempts per month were 5.9 for men receiving sildenafil.
In 6 trials, Patients were stratified into subgroups in terms of race, age, smoking, body mass index (BMI), duration of ED, ED aetiology, and concomitant conditions/Medications, after 12 weeks of treatment 46.5% to 87% of patients receiving sildenafil indicated that treatment had improved their erections compared with 11.3% to 41.3% of patients in subgroups receiving no drug.
In these 6 trials, significantly greater percentages of successful attempts at intercourse were reported by patient subgroups receiving sildenafil (52.6% to 80.1%) compared with patient subgroups receiving no drug (14.0% to 34.5%).
- Long-term effectiveness of sildenafil was assessed in 3 studies, flexible-dose (25 mg to 100 mg) used. After 12 months of treatment (3 years in one study) or at the time of discontinuation, Satisfaction and improvement inability to engage in sexual activity reported in 96% and 99% of patients respectively. 11% of patients discontinued treatment, 2% discontinued for reasons (related to sildenafil (1.6% for unsatisfactory response, 0.4% for adverse events)).
- In the 3 years, one study 32% of patients stopped sildenafil but only 6.7% were for reasons related to sildenafil itself like an insufficient response (5.7%) or for adverse events (1%). The remaining patients discontinued sildenafil for reasons not related to treatment.
- Similar efficacy rates for sildenafil were reported in the clinical practice setting. An improvement inability to achieve erections was reported by 68% and 71% of patients with ED. Success with sildenafil, defined as 75% successful intercourse, was reported by 82% of patients with 77% being successful at every attempt.
How sildenafil work and how to take it?
Sildenafil prevents the breakdown of a molecule called nitric oxide (NO) which is responsible for increasing blood supply to the penis.
sildenafil takes about one hour to reach maximum blood concentration when taken orally as needed in 25 mg, 50 mg, and 100 mg doses.
It’s recommended to start with a dose of 50 mg and increase or decrease it according to efficacy and tolerability.
It is advisable to take sildenafil 1 hour before intercourse, not more than once daily.
The therapeutic window of sildenafil is from 30 min to 4:5 hours so you can freely engage in sexual intercourse during this period and efficacy may be maintained for up to 12 h.
Don’t take sildenafil with a heavy meal as this reduces sildenafil absorption and action, alcohol does not alert the absorption of sildenafil.
Contraindications and dose adjustments for sildenafil
Do not never take sildenafil with any drug contains nitrates
Drugs requiring a decreased dose of sildenafil
- Ketoconazole
- Itraconazole
- Erythromycin
- Clarithromycin
- Severe hepatic disease
- Severe renal disease
- Ritonavir
Drugs requiring an increased dose of sildenafil
- Rifampin
- Phenobarbital
- Phenytoin
- Carbamazepine
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