MARK R. LICHT, MD
`Head, Section of Sexual Dysfunction and Prosthetic Surgery,
`Cleveland Clinic Florida, Ft. Lauderdale
`
`Sildenafil (Viagra)
`for treating male erectile dysfunction
`Ia ILDENAFIL
`ITRATE (Viagra ) was recen tly
`Dl app roved by
`the Food and Drug
`Administration for treating ma le erectile dys(cid:173)
`fun ction. The manufacture r, Pfizer Inc,
`is
`aggre ively marketing the drug directly to
`pati nts, and media coverage h as bordered on
`sensationalism .
`
`• ABSTRACT
`Sildenafi I, the first oral drug for treating male erectile
`dysfunction, appears effective and well tolerated. However,
`more time and experience will be needed to establish this
`drug's true efficacy and safety.
`
`• KEY POINTS
`
`The usual dosage of sildenafil is 50 mg by mouth, 1 hour
`before initiating sexual activity.
`
`Sildenafi I is strictly contraindicated in patients using oral or
`transdermal nitrates, as it dangerously potentiates the
`hypotensive effects of these drugs.
`
`Patients should understand that sildenafil only potentiates
`penile tumescence: it is not an aphrodisiac and does not
`produce instant erections.
`
`See editorial, page 33 I
`
`N ot urprisingly, early sales h ave been out(cid:173)
`stand ing. In fact, patients are aggress ive ly
`dema nding the drug from physic ians in a fren(cid:173)
`zy never before seen with the re lease of a new
`medication.
`The sudden popularity of sildenafil may
`have taken many physic ian s by surprise.
`Howeve r,
`it remains incum be nt upon th e
`phy ician to perform a thorough history and
`physical examinati n before prescribing silde(cid:173)
`nafil, as well as to discuss r alistic expectations
`of th drug's effectiveness with the patient.
`This article review th pharmacology and
`use of sildenafil.
`
`• ERECTILE DYSFUNCTION
`IS COMMON
`
`By one estimate, 52% of m n between the ages
`of 40 and 70 have o me impa irment in erectile
`function.! Many treatments h ave been tried,
`including vacuum erect ion dev ices, prosthetic
`imp lants, and vasoactive drugs that are either
`inj ected into the corpus cavernosum or insert(cid:173)
`ed into the urethra. A lthough th ese th erapies
`can improve or restore erectile function, each
`of them eith er requires the use of mechanical
`dev ices or is invas ive. Up to now, no oral med(cid:173)
`ications for erectile dysfunction have been
`successful.
`
`CLEVELAND CLIN IC JOURNAL OF MED IC INE
`
`VO LU ME 65 • NUMBER 6
`
`JUNE 1998 301
`
` DRL - EXHIBIT 1016
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