Erectile Dysfunction Treatment
Since the launch of Viagra in 1998, awareness of erectile dysfunction has increased, as has the recorded incidence. Prior to the introduction of the first oral medication to treat this common affliction associated with the aging process, most men simply had to suffer in silence with the sort of resignation they applied to balding or sagging skin.
Erectile dysfunction is now known to be primarily organic in nature, resulting from vascular, hormonal or neurological complications. In addition, ED can be a marker for other pathological conditions or undiagnosed organic diseases. On top of the physical symptoms of ED, quality of life is significantly reduced and depression and loss of self confidence are frequent.
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Treatments
Erectile dysfunction can be treated in a number of different ways but the first line of treatment is now oral medications. There are three oral medications available on the market, all of which are PDE-5 inhibitors which are administered to the patient shortly before sexual activity. Patients can also make lifestyle changes (such as losing weight) to improve erectile quality.
The advent of oral medication to treat erectile dysfunction leaves patients and prescribing practitioners with the dilemma of which medication to select. All three medications (Viagra, Cialis and Levitra) all have similar success rates but with different molecular structures, the pharmacokinetic properties vary between each medication. All three medications are rapidly absorbed from the gastrointestinal tract. Peak plasma concentrations of Viagra and Levitra are reached within one hour. Peak plasma concentrations of Cialis are reached after approximately 2 hours.
Food, in particular fatty foods, appears to inhibit the absorption of both Viagra and Levitra but food does not inhibit the absorption of Cialis when compared with the fasted state. When taken with food, peak plasma concentrations of Viagra are reduced by 30% and the maximum concentration is delayed by one hour. Food also delays the maximum plasma concentration of Levitra by one hour, with a 20% reduction compared with the fasted state. The pharmacokinetics of each of the drugs are not affected by alcohol consumption although there is a causal link between alcohol consumption and erectile dysfunction so alcohol should be avoided by patients being treated for ED.
Viagra and Levitra both have a terminal half lie of approximately 4 hours. Cialis has a terminal half life of approximately 17.5 hours. None of the drugs have an immediate onset. Most studies have demonstrated that the drugs have an onset action of between 30 and 60 minutes but the rate of onset varies between individuals.
The PDE-5 inhibitors showed marked differences in their duration of effect. Viagra and Levitra showed a duration of effect of 4-5 hours while Cialis, consistent with its longer half life, showed a duration of effect of up to 36 hours, thereby providing patients with a broad window of responsiveness.
Although comparative studies have been conducted to examine the relative effectiveness of each of the drugs, most of the studies eliminated patients who did not respond to Viagra. This can seriously undermine the value of the data produced.
One study by the University of North Carolina concentrated solely on patients for whom Viagra was not successful. This demonstrated in a 12 week study that Levitra was successful for 61.8% of patients for whom Viagra was not successful. Patients were administered with a 10 mg does of Levitra and allowed to titrate to a 5 mg dose or a 20 mg dose at weeks 4 and 8.
A double blind crossover study was conducted to test patient preference between Viagra and Cialis. No such study has been conducted with Levitra. The study covered 219 patients who were randomised to determine the order in which they received Cialis or Viagra. After 12 weeks the patients were crossed over to the other treatment and of those who wished to participate in the study’s extension period, 70% decided to choose Cialis. A recent open label multi-centre European study confirmed this with 71% wishing to continue with Cialis compared with 29% wishing to continue with Viagra. Taken together, these studies seem to demonstrate that the pharmacological differences between the PDE-5 inhibitors can affect patient preference.
The fact that a patient has not responded to one of the PDE-5 inhibitors does not necessarily mean that he will not respond to one of the alternative treatments from the same family. Patients should not be deemed true treatment failures until they have failed to respond to the maximum dosage on at least 8 occasions. In a study of 137 men who had previously not responded to Viagra, 55% became successful after re-education and counselling.
Advice is available on each of the three PDE-5 inhibitors to registered patients of The Online Clinic. It is also possible to buy Viagra, buy Levitra and buy Cialis from the clinic following approval from one of the clinic’s doctors. All consultations take place online over a secure network.
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