Posts Tagged ‘Viagra’
Viagra (sildenafil): Safe and Effective for Those With Diabetes
The big brouhaha over Viagra (sildenafil) has pretty much settled down, but that doesn’t mean we know everything there is to know about it. Three studies were presented at the scientific sessions of the American Diabetes Association in San Antonio, Texas, reporting that the first oral medication for treating erectile dysfunction is safe and effective for diabetics.
A multicenter group of researchers led by Andre Guay, MD of Peabody, Massachusetts, and Lawrence Blonde, MD of the Ochsner Clinic in New Orleans, analyzed the data from 11 randomized, double-blind, placebo-controlled trials that ranged from 12 weeks to 6 months in duration. The studies used doses of 25 mg to 100 mg of sildenafil to treat erectile dysfunction.
Overall, these studies included 152 men with type 1 diabetes, 822 with type 2 diabetes, and 1693 patients without diabetes. Their average age was 56.5 years, and they’d had erectile dysfunction for an average of 4.4 years. The type 1 diabetics had had the disease for an average of 26.5 years, the type 2 diabetics for 12.1 years. The researchers reported their findings in two presentations, one focusing on effectiveness and one on safety.
The percentage of men who reported that sildenafil improved their erections was 59 for type 1 diabetics, 63 for type 2 diabetics, and 83 for non-diabetics. The drug was significantly more effective than placebo in all three groups.
The researchers concluded that sildenafil was about as effective in men with type 1 diabetes as in men with type 2. They noted, however, that both groups had a lower response rate than men without diabetes.
The number of men who stopped taking the drug was similar for all three groups, and most of these men stopped because they didn’t feel it was helping. The only side effect that differed between those with type 1 and type 2 was flushing, which occurred in 13.5 percent of those with type 1 and 5.5 percent of those with type 2. Other side effects included headache, upset stomach, and dizziness, all of which occurred in fewer than 10 percent of men taking the medication.
The third study was led by Andrew Boulton, MD of the Manchester Royal Infirmary in Manchester, England. In this study, 219 men (average age 59) with type 2 diabetes and erectile dysfunction were randomly assigned to receive either sildenafil or placebo for 12 weeks. The men had had diabetes for an average of about nine years, and erectile dysfunction for about four years.
At baseline, the average number of successful attempts at intercourse reported by the men was 14.4 percent. After three months of taking sildenafil, it was 58.8 percent. Among those taking placebo, this average did not change significantly from baseline to the end of the study period.
The researchers concluded that in this sample, “sildenafil was well tolerated, effective, and increased the number of successful attempts of intercourse.” They noted that the response rate was actually better than that reported in a large study using a mixed group of participants with and without diabetes.
These are the first studies to look specifically at men with diabetes, and their results are reassuring. Overall, these three reports suggest that sildenafil is safe and effective for men with either type 1 or type 2 diabetes.
Editorial Commentary: Impotence is a common problem in men with diabetes. It occurs through a variety of different mechanisms and is often difficult to treat. The first approach to impotence in men with diabetes is to prevent it from ever occurring. We believe that this can be done through keeping blood glucose, cholesterol and blood pressure levels in the normal range right from the start -when a man first starts to develop diabetes. Unfortunately many people who have diabetes don’t know they have it and early diagnosis is important to effective treatment. Once men with diabetes develop impotence they can be helped through use of Viagra. It is important for each patient to be fully evaluated by their physician for the cause of their impotence before they start on Viagra. Men with diabetes may have other problems, such as low testosterone levels, that could contribute to their impotence. Also, men who take certain medications for treating angina should not take Viagra and patients must carefully review their medications with their physician to be sure they do not take any that are contra-indicated with the drug. Once starting Viagra although men with diabetes respond at lower rates than those found in nondiabetic men, many still improve. Often this requires a higher dose—many of my patients require 100 mg rather than 50 mg for a response. Finally, if Viagra doesn’t work newer agents are becoming available. These drugs work differently than Viagra does and may further improve our ability to treat impotence in diabetic men.