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References - Erection
Problems
2. Gould D. Combined
testosterone and sildenafil treatment more effective than
sildenafil alone. Int.J Impot.Res. 1999;11:237-238.
Notes: Confirms the finding of the earlier report by
Carruthers, M (ref 3)
Abstract: Viagra was prescribed to 442 patients aged
between 21 and 84 presenting with erectile dysfunction. All
patients had a comprehensive consultation and full physical
examination. Blood samples were analysed for full blood count,
biochemistry, liver and kidney function, plasma glucose, PSA,
testosterone and SHBG levels. Prolactin measurements were
made if testosterone levels were below 7 nmol/l.
The usual contraindications were observed. These included
severe cardio-vascular disease, severe penile arterial insufficiency
and venous leak (supported by Penile Colour Doppler Ultrasound)
and patients with hypotestosteronaemia. Several patients in
the last group tried Viagra between the time of diagnosis
to response from treatment with testosterone. Patients taking
medicines associated with erectile dysfunction were managed
appropriately. Patients were allowed to self-titrate between
25 mgm, 50 mgm and 100 mgm. All patients were asked to complete
a questionnaire about dosage, efficacy and adverse events.
Efficacy was based upon the two principal questions (the ability
to achieve and also maintain an erection satisfactorily for
sexual intercourse) from the International Index of Erectile
Dysfunction (ILEF)' which were used as primary study endpoints
in the main clinical trials of Viagra. The presence of the
following adverse events was asked for (headache, flushing,
indigestion, diarrhoea, nasal congestion, dizziness, visual
disturbance,other).
Of the163 questionnaires returned, 9% of patients titrated
their dose to 25 mg tablets, 66% to 50mg and 25% to
100mg. Viagra was effective in 96.9% of patients who returned
questionnaires. In order to mitigate bias 20 patients
who had not returned the questionnaire were followed up and
Viagra was reported to be fully effective in all of them.
Adverse events were reported with the following frequencies:
headache 21.5%, flushing 29.4%, indigestion 12.3%, nasal congestion
10.4%, diarrhoea 5.5%, dizziness 4.9%, visual disturbance
9.27%, muscle pains 4.3%, rash 1%. These rates are similar
to those reported in two of the main clinical trials.
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