Please Heed Warnings on Viagra

[Guest Dr. DG]

After seeing an alarming increase in the number of case reports and mutually treating a number of patients with similar circumstances, my husband (a urologist) and I (an infectious disease specialist) wish to remind everyone of the following cautions and warnings when using Viagra:

 

1. DO NOT USE VIAGRA WITH NITRATES (Nitroglycerin, Poppers, Isosorbide, etc.) SINCE A POTENTIALLY LIFE-THREATENING INCIDENT OF CARDIOVASCULAR COLLAPSE IS POSSIBLE. We cannot emphasize this enough. Exercise extreme caution if you are using Viagra with any type of cardiovascular medication, such as Lanoxin (Digoxin), calcium channel blockers (e.g. Isoptin, Calan, Norvasc, Plendil, etc.), ACE inhibitors (Capoten, Prinivil, Vasotec, Zestril, etc.), beta-blockers (Tenormin, Lopressor, etc.), or diuretics (Lasix, Diuril, etc.). Do not take chances--inform your doctor or pharmacist.

2. If you are on any type of high blood pressure medication, please notify your doctor or pharmacist. Use of Viagra with other antihypertensives (high blood pressure medications) may lower your blood pressure to the point where you health may be threatened. Due to a mechanism known as synergy, even lower dose Viagra when combined with antihypertensives may produce more hypotensive effects than either medication(s) used alone.

3. If you do not need Viagra--do not take it. Viagra is a prescription-only medication due specifically to its side-effects, drug interactions and other factors which the FDA considers to be potentially harmful when this medication is used outside of proper medical supervision.

4. Do NOT use Viagra with any "recreational" drug like Ecstasy, etc. Dangerous drug interactions have been reported.

 

We cannot emphasize the importance of using Viagra and ALL prescription medications safely and appropriately. Talk to your pharmacist or physician if you have any questions.

 

We realize that not every person will listen to our advice, nor is it our intention to practice medicine or practice pharmacy in this venue, but rather to carry forward these warnings in an effort to improve the safety and health of our patients consistent with our professional ethics and moral obligations to promote healthy people. Thank you for listening and please--play safely!

[Guest Starbuck999]

I seem to recall that a new drug with similar purpose was due on the market about August. Can you tell us anything about it?

[Guest Dr. DG]

Second Drug for ED

 

The second drug for erectile dysfunction might be approved shortly by the FDA, but only God knows when they will finally act.

 

The mediction is known chemically as apomorphine, and I believe the trade name will be Uprima--pronounced You-preem-ah. No--you won't get a narcotic buzz on the stuff! From what I have read, the medication is taken as a sublingual tablet (like Nitroglycerin for angina).

 

Apomorphine acts to increase sexual desire or so I am told. My husband has had requests for it, but as yet neither of us have not seen any final product literature. When he does, I will share more information with you. Apomorphine does not work the same way as Viagra, so I am given to understand that BOTH agents might be used for some refractory (e.g. difficult to treat) cases of erectile dysfunction.

 

As I get more information, I will forward it on to you.

 

And thank you for listening!

[adriano46]

RE: Second Drug for ED

 

Dr DG,

 

I am adding a note to thank you for the info here, and to raise this back up front in the Lounge. HOOBOY, you may want to start a thread just on such medical "advice" as it is important.

 

I takean anti-hypertensive pill daily (Procardia), and have been on it for some years now. My physician recently put me on a diuretic following to help reduce some water ... I am under the impression from him that this is only temporary, and once I finish the current "batch", that's it.

 

A few weeks ago, during a wild week with a few escorts, I had some of the erectal dysfunctional problems some of us face - and was sorely tempted to try Viagra, until I say this note... which I think may have saved me some undo medical problems. I don't take poppers, as I am not a bottom, but wanted to experiment and found - from a past experience - they were the only thing which "relaxed me" enough to get anywhere. A simliar warning about the effects of these kept me away from using them.

 

But my problem was not so much the erection, but maintaining it during intercourse... seems my mind overcomes my body; as I start penetration, it goes down on me... The only times (long ago) I was ever able to keep it up was in barebacking, and once I knew of the problems with THAT,, obviously never did it again (and was grateful that my few experiences in the past never caused any medical problems).

 

One escort told me he thought that I used condoms which were too tight. Perhaps... So, what can we people who use anti-hypertension pills do to "keep it up" so to speak?

[Guest Dr. DG]

RE: Second Drug for ED

 

I'll make it clear up front that I am not practicing medicine in this venue, as I do not have a full practitioner:patient relationship with you. Accordingly, I will only give you a few points of advice for you to discuss with your own doctor.

 

Viagra may (and I must stress "MAY"!) be used for men taking antihypertensives (diuretics, beta-blockers, calcium channel blockers, ACE-inhibitors, Angiotensin-receptor II blockers and many other drugs) successfully when the patient's medication regimen is very well established, e.g. you have been taking the same thing for more than 6 months and your blood pressure is well controlled on that dosing. Usually, lower doses of Viagra (e.g. 25 mg) do much better for stable patients on antihypertensives than larger doses. The problem with antihypertensives is an effect known as synergy--lower doses of two (or more) antihypertensive medications often produce lower blood pressure than could be achieved with higher dosing of any single medication in the combination selected. To add misery to this, there is no way to predict what effect two or more antihypertensives may have on a single patient. And since Viagra was originally designed as a drug to treat angina (which is closely linked to high blood pressure), your blood pressure might drop severely the first time you used Viagra. The lowest effective dose of Viagra is often far less than what is initially prescribed. The myth that more Viagra produces a stronger erection in ALL men is just that: a myth.

 

I would recommend that you talk to your physician. Several options are available and rather inexpensive--variations on different types of medical devices akin to cockrings (yes...there are some that are classified as medical devices!!). But I recommend you talk to a urologist AND your primary care physician so that a full history, physical and any required diagnostic tests or procedures be completed prior to adding, discontinuing or changing your drug regimen to use Viagra. This might seem time consuming and expensive, but in the long run I would rather be alive WITH an erection (thanks to my hubby) than dead without one!

 

Please see your physician. If he/she does not help, seek a second opinion. I respect patients who show the initiative and I do not take the rather stunted view (held by so many of my colleagues) that I am being second-guessed. My patients (few as they are since I am in research now) and their well-being is far more important to me than my ego.

 

Thanks for listening! Or should I say...viewing?!

[adriano46]

RE: Second Drug for ED

 

DG,

 

Thanks. I would not have expected a clinical answer... I used to be in the medical field (not an MD... but hospital Orderly), and would not ask for any diagnosis over the internet. I thought there was a more non-medical approach. I appeciate all you wrote.

 

It IS important to remind guys out there who do take medicine to control blood pressure to refrain from other drugs which may enhance sexual performance. I actually think my own problem is more psychological than physical... having been closeted for so many years, guilt still crops up... especially if I feel something for the other guy beyond lust.

[Guest travisnyc]

RE: Second Drug for ED

 

As the good doctor said, try a cock ring. A person I know, in his 70's, was having trouble with keeping an erection. He tried a few cock rings, found one he liked, and has no more problem. I always wear one for sex. Physically and mentally they help. As far as Viagra is concerned, I use it once in a while. I take a 100 mg pill and split it into 3 parts. That little bit does quite a bit.