Viagra and women. The drug eases some sexual problems for women taking anti-depressants

Viagra is well established for treating male impotence. A new study slated to appear in the Journal of the American Medical Association suggests the drug can also relieve some sexual difficulties in women caused by antidepressant use.

Women and men taking antidepressants called serotonin reuptake inhibitors sometimes experience a fading libido. An estimated 30 to 70 percent of people taking these antidepressants register sex-related complaints at some point. SRIs include Prozac, Paxil, Zoloft, Lexapro, Celexa and Anafranil.

In women, this change can be compounded by decreased genital sensitivity, vaginal dryness, delayed or absent orgasms and general dissatisfaction with sex.

Viagra, also called sildenafil citrate, has been a blockbuster drug for men with sexual dysfunction and for its maker, Pfizer Inc. But Pfizer largely gave up on testing Viagra in women four years ago after thousands of women receiving it had failed to register much effect.

The company did continue to fund research for certain subgroups of women for whom the drug might still have potential, including those in the new study who were taking SRI antidepressants.

In men, Viagra boosts the natural effect of nitric oxide, which induces blood vessels to relax and facilitates blood flow to the penis, causing an erection. In women, blood vessels in the vagina and clitoris also swell in response to the drug, but studies in women had failed to show clear gains in sexual function.

Viagra doesn’t directly enhance libido. Scientists have suggested that the drug didn’t work on women because their cascade of arousal, desire and orgasm is more complicated than men’s.

Indeed, the results of this study might not be applicable to other women, the authors say. It remains unclear why Viagra would work for women taking anti-depressants, but not for other women. “The bottom line is we don’t know for sure,” says study coauthor Julia Heiman, a clinical psychologist who is director of the Kinsey Institute at Indiana University in Bloomington. But these women might have been more motivated than women in previous studies. “We were giving this drug to women who wanted this to change,” she says.

Using newspaper advertisements, postings and referrals, Heiman and her colleagues recruited 100 women, ages 18 to 50, who reported having sexual difficulties while on an SRI. None had pre-existing sexual troubles. The researchers randomly assigned half of the women to get Viagra and half to receive a placebo. They instructed the women to take a pill one or two hours before having sex.

The women recorded their experiences in diaries and each woman met with a researcher four times during the eight-week study, including visits at the start and finish. These discussions and the diary entries enabled doctors, using a standardized set of questions about sexual interactions, to come up with a composite score of sexual function for each woman before the study and after the eight weeks had elapsed.

While the women taking placebos registered only a very slight improvement overall in benchmarks of sexual function, women receiving Viagra reported significant gains, the researchers report in the July 23/30 JAMA. In particular, the women said their ability to reach orgasm and their orgasm satisfaction improved markedly. Other aspects of sexual function — arousal, desire and natural vaginal lubrication — improved less.

The work represents the first randomized trial to show a positive effect from Viagra in women with SRI-linked sexual problems, the researchers note. Earlier studies in which participants knew they were receiving the drug had also suggested Viagra might work in this group.

“This study doesn’t come completely out of the blue,” says John Markowitz, a psychiatrist at the New York State Psychiatric Institute in Manhattan. The findings reflect a clinical concern that doctors have with these anti-depressants. Sexual dysfunction “is probably the Achilles heel of SRIs,” Markowitz says. Although Viagra isn’t approved specifically to be prescribed for women, he says, “doctors have been doing it for a long time. This provides some evidence to back up what I suspect is a widespread practice.”

Women who experience sexual side effects while taking antidepressants are three times as likely to stop taking SRIs as are other women on these antidepressants, previous research showed. Women participating in the new trial continued to take SRI antidepressants during the eight-week test period.

Heiman cautions that the trial was relatively small with significant but modest effects. It doesn’t suggest a broad new standard for women who have sexual troubles. “For this subgroup of women, this approach could be somewhat helpful, and could be enough to make a difference,” she says.

Meanwhile, other studies continue to search for a “pink Viagra,” centering on women’s use of testosterone patches, a combination estrogen-testosterone pill, and Wellbutrin, an antidepressant that acts differently from the SRIs.

Viagra Cialis Levitra: Ed Treatments Compared

Viagra, Cialis and Levitra have taken over the erectile dysfunction (ED) market. In fact, Viagra alone is breaking all sales records for prescription drugs of any sort.

Not surprisingly, the triad - Viagra / Cialis / Levitra - are the most purchased products online, leaving old technology like penile implants and vacuum pumps in the dust.

This Viagra / Cialis / Levitra buying frenzy confirms at least two things:

Sex is still the main preoccupation of the human race. Other treatments for erection problems are considered clumsy and prehistoric by comparison.

To really understand why Viagra / Cialis / Levitra have become so very popular, you need to know a little about the other ED treatments and how they work. Only then can you truly appreciate the advantages of the “magic blue pill”.

Time Travel

For a moment, let’s go back to 1997, the year before Viagra came on the market. Let’s go back to a time before Viagra / Cialis / Levitra were readily available.

The Dark Ages.

A time when an impotent man had only a few ways to treat his erection problem and not very appealing ones at that… at least, not as appealing as popping a pill and getting an erection within minutes.

Alternatives to Viagra / Cialis / Levitra

Testosterone Replacement Therapy:

ED can result when a man’s body ages and starts producing less testosterone. Testosterone replacement therapy can improve his ability to achieve and maintain an erection.

It is taken either by intramuscular injections every 2 to 3 weeks, a testosterone gel, a patch worn on the body, or a sticky material applied to the gums.

This ED treatment is considered very safe but there are some side effects, and testosterone therapy cannot be used by men with prostate or breast cancer.

Penile Injections:

They’re called intercavernosal injections and they involve injecting medications into the chambers of the penis to help achieve and maintain an erection. Penile injections can be effective but are not widely used because the needles are painful, may scar the penile tissues, and may cause priapism (an erection that won’t go away.)

Penile Suppositories:

Pellets full of medication are inserted into the urethra. Like injections, they are an unpopular alternative to Viagra / Cialis / Levitra because the suppositories may cause pain, bleeding and dizziness. The female partner may also have a reaction to the medication.

Vacuum Devices:

These mechanical devices involve a tube placed over the penis and a pump that sucks the air out of the tube. This creates a vacuum that draws blood into the penis and expands it long enough to have sex.

The technique works for most men with erection difficulties and has few side effects, but spontaneity and romance are often lost in the process.

Surgery:

Surgery for ED is usually considered as a last resort when other options have failed. The surgeon implants rods (either flexible or inflatable) that the man can manipulate to make the penis erect when needed. Mechanical breakdowns and infection are possible complications.

Surgery can also be used to open up blocked arteries and veins that deliver blood to the penis. This surgery is more useful for young men who have suffered injuries, less successful for older men with very blocked arteries.

Counseling: Psychological therapy helps to decrease feelings of anxiety a man might associate with the sex act. This method requires patience, as it may take time, and the partner’s full cooperation and participation.

Lifestyle Changes:

This involved changing or controlling the factors that contribute to erectile dysfunction: medications that produce ED as a side effect, high blood pressure, smoking, alcohol and substance abuse, excess weight, diabetes, depression and anxiety.

Summing Up

Depending on the causes of a man’s ED and his health condition, any of the above treatments may be prescribed by his doctor or urologist. But more and more men and their doctors are turning to the triad - Viagra / Cialis / Levitra - as appropriate and convenient treatments for erection problems when prescribed and used correctly.

Viagra, Cialis and Levitra

These are considered the best erectile dysfunction (ED) treatment pills and they are the top rated drugs in the male impotence category. Viagra is considered as the #1 ED pill, Cialis comes next, and last but not least Levitra. The three are FDA-approved prescription drugs that are mainly used to treat erectile dysfunction (male impotence) in addition to some other conditions, such as pulmonary arterial hypertension (PAH) and others.

The generic name of Viagra is Sildenafil Citrate. Viagra is a little blue pill that starts working within 30 minutes (lees or more) and lasts for about 4 hours. Viagra tablets come in three strengths (dosage): 25 mg, 50 mg, and 100 mg.

Cialis (generic name: Tadalafil) is better known as the weekend pill because it can last up to 36 hours of hardness! The strengths of Cialis tablets are: 5 mg, 10 mg, and 20 mg.

Levitra has the generic name Vardenafil. Levitra doses come in four strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg with an effect that can last for approximately 4 hours.

These three drugs work by the same means and they have almost similar side effects, of which the most common are headache and facial flushing.

Follow your doctor’s directions as described in your prescription when taking any of these drugs and seek immediate medical attention if you experience any unusual side effects.

Tenth anniversary of Viagra prompts vital discussion on men’s health

The world’s most recognized drug by name, Viagra, is this year celebrating 10 successful years on the market, prompting a major discussion around the implications and importance of the treatment in the Middle East.

The leading medication, best known for its treatment of erectile dysfunction (ED), has been used by more than 35 million men in over 120 countries. More than 1.8 billion ‘little blue’ Viagra tablets have been consumed.

A major meeting of the Africa Gulf Society for Sexual Medicine in Cairo this week discussed the medical, emotional and social impact of the treatment.

The break-through treatment has been a market leader in the Africa and Middle East region since its introduction onto the market. The Kingdom of Saudi Arabia and the United Arab Emirates can claim to be the region’s largest per capita consumers of Viagra.

“The treatment has transformed the lives of millions of couples worldwide since its launch ten years ago, and has also had a profoundly positive medical impact in Africa and the Middle East region. Even as we predict greater numbers of men with ED in the coming decades, Viagra has already well-established itself as the ‘gold standard’ treatment for erectile dysfunction,” said Prof. Khaled Dabees, President of Africa Gulf Society of Sexual Medicine.

Continued safe and effective ED treatment worldwide is critically important, said Dr. Dabees, because the number of men diagnosed with ED will increase from 152 million in 1995 to 322 million by the year 2025.

“Viagra has dramatically changed the way people think and talk about sexual medicine,” said Dr. Amr Gad, Riyadh-based President of the Saudi Andrology Group. “Men once hid their crippling ED conditions; now they feel much more comfortable approaching their doctors and speaking up about their frustrating ED symptoms and much earlier than ever before.”

Cairo-based Prof. Tarek Anis, President of the Pan Arab Society of Sexual Medicine, adds that Viagra’s impact on quality of life has been studied extensively, and findings demonstrate clearly that satisfaction with sex life is closely related to satisfaction with life in general both for the man being treated with Viagra and his partner.

The safety and efficacy of Viagra has been well documented in more than 120 clinical studies, including 67 double-blind, placebo-controlled trials of more than 14,000 patients. Viagra has been approved by regulatory authorities in over 120 countries and is among the world’s most widely-prescribed medications.

In response to Viagra’s position as probably the world’s most copied drug, Pfizer has said that it remains committed to the global fight against the counterfeiting of medicines of any kind, as counterfeit drugs are often very dangerous to consume, in addition to being a legal infringement on the intellectual property rights of the drug’s maker.

FDA Safety Changes: Cialis, Sonata, Lunesta

In December 2007 and January 2008, the US Food and Drug Administration (FDA) approved safety labeling revisions to advise of the risks for drug interactions with once-daily tadalafil therapy, concerns regarding once-daily tadalafil use in patients with renal or hepatic impairment, and the risks for abnormal thinking and behavioral changes in patients receiving zeleplon or eszopiclone for the treatment of insomnia.

Once-Daily Tadalafil (Cialis) Linked to Drug Interactions

On January 7, 2008, the FDA approved safety labeling revisions for tadalafil tablets (Cialis; Eli Lilly and Co) to warn of the potential for drug interactions associated with use of a once-daily dose for the treatment of erectile dysfunction. The recommended starting dose for this regimen is 2.5 mg taken once daily without regard to food.

Although dose increases to 5 mg are allowed based on efficacy and tolerability, healthcare clinicians should be aware that the continuous tadalafil levels produced by the once-daily regimen may lead to drug interactions with other medications and alcohol.

Because tadalafil is metabolized predominantly by the cytochrome P450 isoenzyme 3A4 (CYP3A4), the once-daily dose should not exceed 2.5 mg in patients receiving concomitant therapy with potent CYP3A4 inhibitors such as ritonavir, ketoconazole, and itraconazole. For those using tadalafil on an as-needed basis, dosing should not exceed 5 mg taken every 72 hours.

Alcohol and phosphodiesterase type 5 inhibitors, such as tadalafil, are both mild vasodilators, and their concomitant use may have an additive effect on lowering blood pressure. Patients should be informed that substantial consumption of alcohol (eg, ≥ 5 units) in combination with tadalafil can increase the risk for orthostatic signs and symptoms, including increased heart rate, decreased standing blood pressure, dizziness, and headache.

Once-daily use of tadalafil is not recommended for patients with severe renal insufficiency because of increased drug exposure, limited clinical experience, and the lack of ability to influence clearance by dialysis. For these patients, as-needed use should not exceed 5 mg every 72 hours.

According to the FDA, no dose adjustments to the once-daily regimen are required for patients with mild or moderate renal insufficiency. This is also true of as-needed dosing in mild renal impairment; patients with moderate impairment should take a starting dose of 5 mg as needed, not to exceed 10 mg in 48 hours.

Caution is advised when using once-daily tadalafil therapy in patients with mild to moderate hepatic impairment; the dose should not exceed 10 mg for those taking tadalafil on an as-needed basis. Lack of clinical data precludes recommending its use in patients with severe liver dysfunction.

Zaleplon (Sonata) and Eszopiclone (Lunesta) Linked to Risk for “Sleep-Driving”

On December 12, 2007, and January 29, 2008, the FDA approved safety labeling revisions for zaleplon capsules (Sonata; King Pharmaceuticals, Inc) and eszopiclone tablets (Lunesta; Sepracor, Inc), respectively, to warn of the risks for abnormal thinking and behavioral changes associated with use of these and other sedative-hypnotic drugs.

Because sleep disturbances may indicate a physical or psychiatric disorder, patients with insomnia that does not remit after 7 to 10 days of therapy should be evaluated for the presence of a primary illness.

Worsening of insomnia or the emergence of new thinking or behavioral abnormalities during treatment can likewise indicate an underlying physical or psychiatric disorder. Use of sedative-hypnotics in primarily depressed patients has been linked to worsening depression, including suicidal thoughts and actions and completed suicide.

Complex behaviors have been reported in treatment-naive and treatment-experienced patients who are not fully awake after taking sedative-hypnotics such as zaleplon and eszopiclone. These behaviors are associated with amnesia and include “sleep-driving” (driving while not fully awake after taking a sedative-hypnotic), preparing or eating meals, telephone calls, and having sexual intercourse.

Although these behaviors can occur with normal doses of a sedative-hypnotic, the likelihood of performing activities while asleep increases with excessive doses and concomitant use of alcohol or other central nervous system depressants.

Because of the risk to the patient and to the community, strong consideration should be given to discontinuing therapy in patients who report “sleep-driving” episodes.

All newly emergent behaviors should be evaluated, although it may not be possible to discern whether they are of spontaneous origin, drug-induced, or the result of an underlying disorder. Because of the risk for withdrawal symptoms, treatment should not be abruptly withdrawn, and rapid dose decreases should be avoided. Some events related to sedative or hypnotic use appear to be dose related, necessitating use of the lowest effective dose, particularly in elderly people.

The FDA also warned that rare cases of angioedema involving the tongue, glottis, or larynx have been reported in patients taking the first or subsequent doses of sedative-hypnotics. In some cases, these symptoms were accompanied by dyspnea, throat closing, or nausea and vomiting that suggested anaphylaxis and required emergency care. Because airway obstruction can cause death, patients in whom angioedema develops after taking zaleplon or eszopiclone should not be rechallenged with a sedative-hypnotic.

Eszopiclone and Zaleplon are indicated for the treatment of insomnia.

The real and the fake

Viagra, Cialis and Levitra are the three oral drugs approved for the treatment of erectile dysfunction or impotence here.

Known as PDE-5 (phosphodiesterase type-5) inhibitors, they suppress the PDE-5 enzyme in the body. This increases blood flow to a man's penis so that he will get an erection when sexually stimulated.

They are usually taken 30 minutes before sex. All three are available only by prescription, and cost about $20 a pill.

According to health information website WebMD, Levitra works a little longer than Viagra. They both take effect in about 30 minutes. With Levitra, the effects last for about five hours. With Viagra, the effects last approximately four hours.

Cialis works a bit faster (within about 15 minutes), and the effects last much longer - up to 36 hours in some cases.

THE FAKE

There are hundreds of them out on the market, but the ones which made the news recently are Power 1 Walnut, Fake Cialis, Santi Bovine Penis Erecting Capsule and Zhong Hua Niu Bian.

Available in some shops and the back lanes of red-light districts, they are illegally manufactured in countries such as China, Indonesia and India.

Many contain potent substances. Power 1 Walnut for instance has traces of sildenafil - the key ingredient in Viagra - but dangerous levels of glibenclamide, a prescription drug for diabetes which can result in lethally low blood sugar levels.

There have been more than 30 confirmed, and 70 suspected, cases of adverse reactions from these fake drugs. Two victims fell into a coma and died, while scores of others were hospitalised for nausea, vomiting and dizziness.

The drugs come in all colours, shapes and sizes although the fake Viagra, Cialis and Levitra pills are made to look like the real thing.

These potentially lethal drugs cost between $1 and $5 a pill.