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Thorough medical history and physical examination is to be undertaken in order to diagnose erectile dysfunction, to determine potential primary causes and name the appropriate treatment.
There is a degree of cardiac risks associated with sexual activity. Therefore, physicians may wish to consider the cardiovascular position of the patient before starting any treatment for erectile dysfunction.
Clinical Trials Sildenafil (Viagra) has shown to have systemic vasodilatory properties that result in transient decreases in blood pressure, which is of little or no significance in most patients. Nevertheless, prior to prescribing sildenafil, physicians should carefully consider whether their patients with certain underlying conditions could be adversely affected by such vasodilatory effects, especially in combination with sexual activity. Patients with increased susceptibility to vasodilators include those with left ventricular outflow obstruction (aortic stenosis, hypertrophic obstructive cardiomyopathy) or those with the rare syndrome of multiple system atrophy manifesting as severely impaired autonomic control of blood pressure.
Drugs for the treatment of erectile dysfunction should be used with caution in patients with anatomical deformation of the penis (angulation, cavernosal fibrosis or Peyronie’s disease) or in patient who have conditions which may predispose them to priapism (sickle cell anemia, multiple myeloma or leukemia).
Drugs for the treatment of erectile dysfunction should not be used in men for whom sexual activity is inadvisable.
The safety and efficacy of combinations of Viagra with other treatments for erectile dysfunction have not been studies. Therefore, using a combination of both is not recommended.
Patients on alpha-blocker must be cautioned as the co-administration may lead to symptomatic hypotension in a few susceptible individuals. Patients should be stable on alpha-blocker therapy prior to initiating sildenafil treatment in order to minimize the potential for developing postural hypotension. Initation of Viagra at lower doses should be contemplated. Physicians must advised patients what to do in the event of postural hypotension.