Cheap Tadalafil

The drug tadalafil appears to improve erectile function in men with spinal cord injuries, according to an article posted online today that will appear in the November 2007 print issue of Archives of Neurology, one of the JAMA/Archives journals.

Between 10.4 and 83 individuals per million worldwide experience spinal cord injuries every year, according to background information in the article. “Throughout the world, spinal cord injury occurs most often in young men, resulting in negative physical, social and psychological consequences,” the authors write. “Erectile dysfunction, defined as the inability to attain and maintain penile erection sufficient for satisfactory sexual performance, is a common complication in men with spinal cord injury.” Only 25 percent of men with spinal cord injuries are able to have erections that are adequate for having intercourse.

Francois Giuliano, M.D., Ph.D., of the Raymond Poincare Hospital, Garches, France, and colleagues, conducted a randomized, double-blind study of tadalafil in 197 men with spinal cord injuries (average age 38). After a four-week period during which none of the men received treatment, 142 were randomly assigned to the tadalafil treatment group and 44 to the placebo group. During the 12-week treatment phase, the participants were instructed to take the medication as needed before the potential for sexual activity, with a maximum of one dose daily. Those assigned to take tadalafil were given a 10-milligram dose at first and were evaluated every four weeks, at which time patients were switched to a 20-milligram dose based on their response to the treatment.

At the beginning of the study, the men’s average score on the International Index of Erectile Function—a 15-item questionnaire on which a score of 25 or lower indicates erectile dysfunction—was 13.4. After 12 weeks of treatment, men taking tadalafil had an average score of 22.6 (indicating mild erectile dysfunction) and men taking placebo had an average score of 13.6 (indicating moderate erectile dysfunction). Men taking tadalafil were, on average, successful 75.4 percent of the times they attempted penetration and 47.6 percent of the times they attempted intercourse, compared with a 41.1 success rate for penetration and 16.8 percent for intercourse among men taking placebo.

“Tadalafil was safe and well tolerated with few treatment-emergent side effects,” the authors write. Fifty (35 percent) of patients in the tadalafil group and 15 (34 percent) of those in the placebo group experienced at least one adverse effect. Among those taking tadalafil, the most common side effects were headache (8.5 percent of patients) and urinary tract infection (7.7 percent of patients).

“As in other erectile dysfunction studies that include patients who were difficult to treat owing to pre-existing conditions (e.g., prostatectomy, diabetes mellitus), tadalafil was efficacious for the treatment of erectile dysfunction after a traumatic spinal cord injury,” the authors write. “On-demand treatment with tadalafil (10 milligrams or 20 milligrams) may help improve the sex lives of patients with erectile dysfunction and spinal cord injury and their partners.”

Although medication can help extend the lives of men with chronic heart failure, several factors associated with this disease can interfere with a person’s ability to engage in and enjoy sexual activities.

Fatigue, depression, medication side effects and the fear of damaging the heart can cause people with chronic heart failure to lose interest in sex or wonder whether this activity is safe for them.

A literature review published in the October issue of Mayo Clinic Proceedings finds that with proper screening and treatment, many patients with chronic heart failure can safely engage in sexual activity.

Co-authors Stacy Mandras, M.D., Patricia Uber, Pharm. D., and Mandeep Mehra, M.D., conducted systematic independent literature searches using the MEDLINE database and examined a broad range of medical research that focused on chronic heart failure, sexual activity and sexual dysfunction. This literature included data from patient surveys and clinical trials.

Many people with chronic heart failure worry that having sex will place too great a strain on the heart. To address this issue, Drs. Mandras and Mehra analyzed studies that showed the impact of sexual activity on heart rate, blood pressure and respiratory rates, which typically increase during sexual activity and other forms of exertion.

One study the authors reviewed measured these changes in middle-aged men with and without coronary artery disease. This study found that the peak heart rate during intercourse was lower than heart rates measured during the patients’ normal daily activities. The study participants’ peak oxygen consumption levels during intercourse were moderate — comparable to their oxygen consumption levels during moderate activities such as walking on level ground at 3 to 4 miles per hour, climbing stairs slowly or doing general housework such as vacuuming.

The authors also addressed how to counsel and treat chronic heart failure patients who are coping with erectile dysfunction, difficulty achieving or maintaining an erection. Researchers estimate that erectile dysfunction affects 60 percent to 70 percent of people who have chronic heart failure.

The authors observe that multiple factors may be involved. In addition to decreased exercise capacity, patients with chronic heart failure have blood vessel and circulation abnormalities that can reduce blood flow into the penis and interfere with the ability to maintain an erection. And erectile dysfunction can be caused or worsened by many of the medications that are commonly prescribed to treat chronic heart failure.

Currently, the preferred treatment for erectile dysfunction includes sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). However, numerous experts have raised concerns about the use of these drugs in patients with chronic heart failure who also take nitrates (or other medications that relax and widen blood vessels). This drug combination has been shown to be dangerous, because it can increase the risk for a life-threatening drop in blood pressure.

To further explore this potential risk, the authors reviewed results from a variety of studies in which male patients with congestive heart failure took sildenafil. The authors observed that more data are needed to determine the safety of the newer drugs, vardenafil and tadalafil, for these patients.

For those patients who cannot take erectile dysfunction medications, the authors counsel that an exercise training regimen may be an appropriate substitute therapy to enhance sexual function and quality of life. The authors stress that clinicians should focus on the sexual activity history of chronic heart failure patients and not ignore it, since addressing this element can substantially improve their quality of life.

Chronic heart failure often develops after other cardiac problems have damaged or weakened the heart, leaving it too weak or too stiff to fill and pump efficiently. Many underlying heart conditions can lead to heart failure. It can develop quickly after damage caused by a heart attack, or it can develop gradually after years of high blood pressure or coronary artery disease.

A peer-review journal, Mayo Clinic Proceedings publishes original articles, reviews and editorials dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally.

Tadalafil may improve lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH). Researchers from Nashville, Dallas, San Antonia and Indianapolis presented these findings during the 104th Annual Scientific Meeting of the American Urological Association (AUA).

In this study, researchers randomly separated 200 men, with an age equal to or older than 40 years and at least a six month diagnosis of BPH-LUTS with an International Prostate Symptom Score (IPPS) greater than or equal to 13, into two groups taking either 20 mg of tadalafil once daily or a placebo. After 12 weeks of treatment, the men taking tadalafil experienced improved detrusor pressure at urinary flow rate, peak flow rate (Qmax), bladder capacity, post-void residual volume and bladder voiding efficiency. Relative symptom improvement in the IPSS also was significantly better in the tadalafil group. At the end of the study, the proportion of obstructed patients in the placebo group increased, while the proportion in the tadalafil group decreased.

“Dr. Dmochowski, the study author, and colleagues have added further evidence to the growing body of research that suggests that in addition to their well known effect on erectile dysfunction, PDE-5 inhibitors may be able to help with management of bladder outlet symptoms as well. This is an exciting concept for men’s health,” said Anthony Y. Smith, MD, an AUA spokesman.