Dr. Randall B. Meacham: There are currently three medications that have been approved by the FDA for the treatment of erectile dysfunction; Vardenafil, the trade name for that is Levitra, Sildenafil, the trade name for that is Viagra, and Tadalafil and the trade name for that is Cialis. All of these medications work in a common fashion.
Dr. Frank J. Costa: Levitra, as you know, is a newer introduction to the market of oral medications for erectile dysfunction and in my experience, there is a faster onset of action with Levitra and it improves the quality of erection better than what we had previously with Viagra. As a matter of fact, there are several studies that also demonstrate that in addition to my own clinical experience. There is a study called the Proven Study that shows that patients that actually have failed in Viagra, they do respond better to Levitra in a high percentage of patients. So that there are certain characteristics to the medication Levitra that allow to act, I believe, in a superior fashion when compared to Viagra.
Dr. Randall B. Meacham: When someone has as erection, they have the erection because sexual stimulation will allow the release of a product called nitrous oxide in the tissues of the penis. Nitric oxide then establishes a whole set of other mechanisms which ultimately result in the relaxation of the smooth muscular elements within the penis, which allow more arterial blood flow into the penis, and at the same time, restrict the outflow of blood through the veins from the penis. More blood flows in, then flows out, the erection takes place.
This is all mediated by one enzyme called cyclic-GMP. When the erection goes away or abates, it's because cyclic-GMP is broken down by a specific enzyme called type-5 phosphodiesterase. What these medications do is they block type-5 phosphodiesterase from breaking down cyclic-GMP, more cyclic-GMP accumulates in the penis, the erection is more rigid, and it last longer. So simply stated, all these medications are doing is they are increasing the amount of substance within the penis which naturally occurs allowing an erection. They prevent it from being broken down so the erection in the best scenario is more rigid and lasts longer.
Dr. Frank J. Costa: There are people with comorbid conditions that I should not take ED drugs and also while we are on the topic comorbid conditions, there also have been studies that show that certain drugs like Levitra actually performed very well in patients that do these comorbid conditions. So that patients, that are very difficult patients, that have diabetes, or high blood pressure, or high cholesterol levels, to take a medication like Levitra where they may have failed in other medication like Viagra would in fact, in many instances, respond in a way that is satisfactory and allows them to have a normal sexual function.
If a patient takes nitroglycerin, he shouldn't take any of the medications that are known as the PD-5 inhibitors; Viagra, Levitra, or Cialis. If a patient is a true cardiac cripple or very much compromised as it relates to his cardiac state, that patient should use these medications only under the strict supervision of a physician, and only after he has been cleared from a cardiac standpoint as to whether or not he can take this.
So we must choose commonsense before we have the patients to just randomly take these medications and the patient often times will come in. I had an elderly gentleman, not very long ago that came in on oxygen and had a bad heart, and he came in and asking for an erectile dysfunction drug, and as much as I wanted to give it to him, I understood that this would compromise or risk his health, and so naturally, I couldn't give this to him because I didn't think it was in the patient's best interest even though he himself thought that he would perhaps be a candidate for these drugs.
So the physician must use good clinical discretion prior to prescribing these drugs and there are certain cases where there are absolute contraindications as I mentioned. For instance, a patient who takes nitroglycerin or a drug that has nitrates in it, and in some cases, if they are taking a medication that may lower the blood pressure what is known as a alpha-blocker, where sometimes patients also take these drugs for prostrate conditions, you have to use some caution in giving these drugs in those patients who take these types of medications.
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