Tag Archives: Erectile Dysfunction

Health

Viagra, Cialis, Erectile Dysfunction Drugs Link to Eye Problems

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Photo: Getty (Getty Images)

Drugs known for helping men with erectile dysfunction may come with a higher risk of vision problems than currently thought. In new research out Thursday, scientists have documented an association between three serious eye disorders and drugs including Viagra and Cialis; the findings might prompt the need for added warning labels on these medications, the authors say, though the individual risk for experiencing these complications does appear to be very small.

Commonly used erectile dysfunction drugs such as sildenafil (sold under the brand name Viagra) and tadalafil (Cialis) primarily work by inhibiting an enzyme known as PDE5 that is found in the smooth muscle cells that line certain blood vessels. As a result, the drugs dilate these blood vessels and increase blood flow to specific parts of the body, including the penis during times of sexual stimulation. These drugs also can be used to treat high blood pressure linked to lung problems (pulmonary hypertension), and tadalafil is approved to help treat the symptoms of an enlarged prostate.

But no drug comes without some unwanted effects. PDE5 drugs have been linked to vision problems for quite some time, including a few serious complications. In 2005, the Food and Drug Administration required the makers of Viagra, Cialis, and Levitra to add a warning label about the association between their drugs and ischemic optic neuropathy (ION), a condition that can lead to permanent vision loss.

There have been case reports of other eye-related conditions tied to PDE5 use in the years since. And that made the researchers behind this latest study, published Thursday in JAMA Ophthalmology, curious about whether these reports were pointing to a real trend.

To find out, they analyzed insurance data from over 200,000 men who had been taking either Viagra, Cialis, Levitra, or Stendra. Importantly, none of these men had been diagnosed with vision problems prior to their use of these drugs. But when compared to similarly matched men not taking any PDE5 inhibitor, they were more likely to be diagnosed with ION as well as two other eye conditions, serous retinal detachment (SRD) and retinal vascular occlusion (RVO). The increased risk of these problems in PDE5 users was apparent even after accounting for other possible risk factors, such as high blood pressure.

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The findings seem to be the first from a large epidemiological study to link SRD and RVO to taking erectile dysfunction drugs. And according to lead author Mahyar Etiminan, it’s the first to quantify the added risk of these conditions. Compared to non-users, for instance, men taking these drugs were 2.58 times more likely to develop SRD, 1.44 times more likely to develop RVO, and 2.02 times more likely to develop ION. In general, they had a 85% increased risk of developing any one of these conditions.

This kind of research can’t definitively prove that these drugs are causing these conditions. But the authors suspect, Etiminan told Gizmodo in an email, that “these drugs can compromise blood flow to the optic nerve and arteries/veins of the retina.”

The authors note that the absolute odds of having any of these conditions following PDE5 use are still very small. But given that as many as 20 to 30 million men in the U.S. may have erectile dysfunction and could take these drugs, the risks are real enough that they warrant a clear warning label, they argue. They also say that people with preexisting eye problems should be more cautious about taking them.

“ION already has a warning but RVO and SRD don’t have strong warnings. We believe they should also have strong warnings,” said Etiminan, an eye disease researcher and epidemiologist at the University of British Columbia. “I would say men who have underlying ocular issues like glaucoma or retinal conditions should discuss with their ophthalmologist before starting the drugs.”

At the same time, he adds: “Men otherwise healthy should seek medical attention only if they see visual changes when taking these drugs.”

While this new study does indicate that PDE5 drugs in general can rarely cause these serious eye problems, the authors say that more research should be done to figure out whether certain drugs in this class are riskier than others.

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Health

Why having better sex could be good for the brain: study

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A boost in bed could spell benefits both below and above the belt for those with erectile dysfunction.

Pills like tadalafil, otherwise known as Cialis, increase blood flow by opening the arteries. It’s this function that allows ED patients to achieve erection. But a new study reveals that the same mechanisms that treat the sexual disorder could also slow cognitive decline in older patients — so their minds and mojo stay sharp.

As we age, veins tend to narrow and weaken throughout the body, which means less blood gets pumped to the brain and other organs.

“Narrowing of the brain arteries is a common contributor to cognitive decline in older people and currently has no treatment,” said Dr. Jeremy Isaacs, a consulting neurologist at St. George’s Hospital in the UK, who worked on the study. It was published in the journal Alzheimer’s & Dementia.

Isaacs’ team asked volunteers, both male and female, to take either a single dose of tadalafil or a placebo, then undergo an MRI that would determine how much blood was making it to the brain.

Their findings revealed no significant difference in brain blood flow between the tadalafil and placebo groups. However, participants over 70 showed increased flow to the brain’s white matter, in particular.

The white matter refers to a dense network of neural connections that enmesh the four lobes of the brain — and a crucial factor of vascular dementia. The disease causes a progressive loss of brain function by starving it of blood over time.

For similar reasons, risk factors for vascular dementia are similar to those for ED, including high blood pressure, diabetes, high cholesterol, cardiovascular disease and heart failure.

The clinical trial suggests that tadalafil, as well as similar-acting treatments such as sildenafil (Viagra) and vardenafil (Levitra), may have use beyond helping ED patients get their groove back.

“This was a landmark study in which we attempted to reverse the reduction in brain blood flow characteristic of this condition,” Isaacs said in a hospital news release, according to Health Day. “Although we did not find a significant effect following a single dose of tadalafil, we can’t rule out the possibility of benefits from longer-term use, for which further research is needed.”

Dr. Atticus Hainsworth, the study’s lead investigator, urged for more research into how old drugs could help new problems.

“Repurposed drugs have the increased benefits of a shorter development time, a known safety profile and low cost, once their original patent has expired,” said Hainsworth, a St. George’s cardiologist. “We hope that further investigations will prove fruitful and provide new options for clinicians treating dementia.”

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Health

‘Covid Dick’ Is, Sadly, Real

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Photo: Roberto Machado Noa/LightRocket (Getty Images)

It seems we can add sexual dysfunction to the long list of unexpected and unpleasant effects of the coronavirus. Thankfully, this doesn’t appear to be a common occurrence, and there are some potential remedies that those afflicted can try.

This week, the Slate-run sex advice podcast How to Do It discussed the harrowing tale of an anonymous letter writer who was suffering from what’s come to be known as “covid dick.” The writer, who identified as a heterosexual man in his 30s, said that he had gotten very sick and was hospitalized from covid-19 last July. After he was discharged, he began experiencing erectile dysfunction (ED). Though his symptoms did improve after seeing a doctor, the man reportedly was left with a glaring reminder of his ordeal. Describing himself as above average in penis size before covid-19, he said that his penis had now shrunk about 1.5 inches and that he had “become decidedly less than average.”

The podcast hosts, to their credit, also interviewed a pair of urologists who rightly noted that there’s a clear trail of evidence linking covid-19 to erectile or sexual dysfunction. A study this past November, for instance, found that men with covid-19 were about three times as likely to develop a new case of ED than those who didn’t catch covid-19. Some research has suggested that the risk may be nearly six times higher, yet other estimates are smaller, suggesting around a 20% increased risk. A small percentage of people with long covid, including women, have also reported sexual dysfunction as one of their symptoms. And sometimes, ED can indeed lead to shrinkage, especially if it’s caused by physical damage and scarring that causes the penis to stop becoming regularly erect.

There are a few theories as to how covid-19 can cause ED. The infection can possibly reach penile tissue and directly damage to the surrounding blood vessels. It may also be due to the indirect effects of infection on the immune system, which may trigger damaging inflammation. (An over-reacting immune system and blood vessel damage are also the prime suspects behind “covid toes.”) And the experience of hospitalization in severe cases can take a toll on the body, penis included. The risk of ED from blood vessel damage is probably greater in people who already have other relevant health conditions that can affect circulation, such as type 2 diabetes. Many cases of ED can also be chalked up to stress and anxiety, and covid survivors are unfortunately at higher risk of experiencing that as well.

That said, age is by far the largest risk factor for ED, with as much as 70% of men experiencing some level of it by their 70s. And while we don’t seem to have solid data on the actual prevalence of covid-related ED, it doesn’t appear to affect a huge proportion of men. The November study, for instance, found that slightly less than 5% of men in the sample were diagnosed with ED after covid-19.

As the Slate hosts note, there are readily available treatments for ED, such as the drug sildenafil (Viagra). And even a shrunken penis can be treated or prevented through what one urologist refers to as “penile rehab,” which can involve stretching exercises and/or penis-pumping devices. So not all hope is lost if you’re worried about the dreaded covid dick. And for the record, there’s no evidence at this time of a link between ED and getting vaccinated for covid-19.

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Health

Viagra may prolong life for men with coronary artery disease

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Taking Viagra does more than improve men’s performance in bed — it may also help those with coronary artery disease live longer and have a lower risk of experiencing a new heart attack, according to a new study.

“Potency problems are common in older men and now our study also shows that PDE5 inhibitors may protect against heart attack and prolong life,” said study lead author Martin Holzmann, an adjunct professor of medicine at the Karolinska Institute in Stockholm, Sweden.

Impotence, also known as erectile dysfunction, may be linked to impaired blood flow — and can be an early warning sign of heart disease in healthy men, the authors noted.

ED can be treated either locally with the injected drug alprostadil, which dilates the blood vessels, or with drugs known as PDE5 inhibitors, which include the little blue pills and Cialis, according to Health Day.

Holzmann’s team compared the effect of alprostadil and PDE5 inhibitors among 18,500 men who had already suffered a heart attack or had undergone a procedure such as a bypass or angioplasty, and were diagnosed with what’s known as “stable” coronary artery disease.

“The risk of a new heart attack is greatest during the first six months (after such interventions), after which we consider the coronary artery disease to be stable,” Holzmann wrote.

The subjects began taking some form of erectile dysfunction drug at least six months after their heart attack or heart procedure. About 16,500 of the men took Viagra, Cialis or some other PDE5 drug, while the others took injected alprostadil.

The researchers followed the men’s health for an average of almost six years, during which time about 2,800 of them died.

Those taking a PDE5 drug had a 12 percent lower risk of dying during that follow-up than men who took alprostadil, the team reported in the Journal of the American College of Cardiology.

Men taking a PDE5 drug also had a lower risk of a new heart attack, heart failure or the need for an angioplasty or bypass procedure than those who got alprostadil, according to the report, which had no drug industry funding.

The protection was dose-dependent, meaning that the more frequently a man used a PDE5 inhibitor, the lower his risk.

Holzmann cautioned that the study wasn’t designed to prove a cause-and-effect relationship, saying other factors could be at play.

“It is possible that those who received PDE5 inhibitors were healthier than those on alprostadil and therefore had a lower risk [of heart issues],” he said as an example.

“To ascertain whether it is the drug that reduces the risk, we would need to randomly assign patients to two groups, one that takes PDE5 and one that doesn’t. The results we have now give us very good reason to embark on such a study,” Holzmann added.

Two experts in the United States who weren’t connected to the study said the findings are intriguing, but stressed that more study is required.

PDE5 drugs “are ‘vasoactive,’ meaning they have an effect on the blood vessels making them less stiff, and able to vasodilate,” Dr. Guy Mintz, director of cardiovascular health at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, NY, told Health Day.

“These agents may also have anti-inflammatory effects,” he said, stressing
that “this is not a therapy for all patients with coronary artery disease — only those that have impotence as well.”

He added: “There is a need to do follow-up studies to see if PDE5 inhibitors are directly responsible for the beneficial effects, or is the benefit due to having a partner (not being lonely), an active sex life (exercise), or a happier approach to life (a sense of well-being).”

Dr. Michael Goyfman, who directs clinical cardiology at Long Island Jewish Forest Hills, agreed that the Swedish findings are only useful to generate theories for now, not to change medical practice.

He suggested that the better outcomes for men taking a PDE5 were based on their underlying health — perhaps only the sicker ones got alprostadil — or income, because those better off could afford the ED drugs.

“While the study is interesting, it would not change practice until further, randomized controlled trials are performed,” Goyfman said.

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