My doctor: sildenafil

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Sunday, October 12, 2008

Order viagra online, we accept: visa, mastercard, amex, e check

Sildenafil offers an opportunity to treat male erectile dysfunction with an effective, licensed oral
preparation.
• It is taken on a “when required” basis and only works in the presence of sexual stimulation.
• 70-80% of men in trials show a statistically significant improvement in erectile or sexual function
compared with about 25% of men who receive placebo. In the dose-escalation study in 329 men,
around 2 men would need to be treated with sildenafil for 12 weeks for one man to report improved
erections (NNT). There is no clear figure of how this relates to successful sexual intercourse, although
69% of all attempts were successful compared to 22% with placebo.
• Open label follow up studies indicate that most men who initially respond to the drug continue to take
it. A fully-published randomised controlled trial has also demonstrated the efficacy of sildenafil in men
with diabetes mellitus and erectile dysfunction.
• Sildenafil appears to be well tolerated. 2.5% of patients withdrew from studies because of adverse
effects, compared to 2.3% with placebo. The US Food and Drug Administration has reported 69
deaths in people taking sildenafil which led to an update of the US label. Forty-six deaths were known
to be due to cardiovascular events. Since sexual activity is itself a risk factor in cardiovascular death
the role of sildenafil is difficult to determine.
• As yet there are no direct comparisons of sildenafil with alternative treatments.
• The long-term safety profile of sildenafil is yet to be established.

Sildenafil is rapidly absorbed after oral administration
reaching maximum plasma concentration within 30-120
minutes of dosing in fasted subjects. It has a bioavailability
of about 40% and fatty food has been shown to reduce the
rate of absorption and the peak concentrations achieved,
without affecting the extent of absorption. It is therefore
advised that sildenafil is taken 30-60 minutes before planned
sexual activity. One small study, which is only available as
an abstract, has shown that sildenafil still has an effect on
erectile function for 4-5 hours after dosing [4].
Sildenafil is mainly eliminated by hepatic metabolism
(principally cytochrome P450 3A4) and converted to the
active N-desmethyl metabolite, which accounts for about
20% of its overall pharmacological effect. Both sildenafil
and the metabolite have terminal half-lives of about 4 hours
and are excreted predominately in the faeces. No significant
accumulation is expected to occur on single daily dosing.
Studies have shown that renal insufficiency (creatinine
clearance (CLcr) <30ml/min), hepatic insufficiency and age
(over 65 years) are all associated with increased plasma
concentrations when compared with matched controls.
Sildenafil and its major metabolite are highly bound to plasma
proteins

MALE SEXUAL DYSFUNCTION. Popular drug: Cialis and viagra

Sexual Dysfunction describes any of a group of sexual disorders characterized by inhibition either of sexual
desire or the physiological changes that usually characterize sexual response. Sexual dysfunction disorders
are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disor-
ders, and sexual pain disorders.
Male sexual dysfunction may reflect problems with the following factors: Libido, ejaculation, erectile func-
tion or a combination of these factors. Erectile Dysfunction (ED), also known as impotence, is the inability
to achieve and maintain penile erection and thus engage in sexual intercourse. This is a common, treatable
condition affecting an estimated 18 million men in the United States alone. Yet, data suggest that less than
10% of affected men actually receive treatment. Male sexual dysfunction may be a result of one or more of
the following conditions: medication side effects, endocrine disorders, peripheral vascular disease, neuro-
logical dysfunction, penile diseases, psychological disorders, and lifestyle factors. Once male sexual dys-
function is diagnosed, each of these potential causes must be carefully addressed prior to initiating
treatment.

Services eligible for coverage for men with sexual dysfunction due to organic

causes include:

a. Treatment of the underlying organic/medical condition causing sexual dysfunction.
b. Oral prescription medications for erectile dysfunction such as Viagra®, Levitra® and Cialis®.
Most BCBSNC benefit plans have a limit of 4 tablets per 30 days. These medications have been
shown to potentiate hypotensive effects of nitrates and are contraindicated in patients taking any
form of nitrates or have known allergy to nitrates. Caution should also be taken in patients taking
alpha-blockers as the combination may produce hypotension. Safety and efficacy of use with other
treatments for erectile dysfunction have not been studied and are not recommended. Viagra®,
Levitra® and Cialis® are not indicated for use by newborns, children or women.
c. Penile injection therapy which involves the self-injection of medications into the base of the penis.
Papavarine, phenotolamine, and/or prostaglandin E
1
(alprostadil) (Caverject®, Edex®) are com-
monly used. This type of therapy is most useful when used for organic impotence due to neuro-
genic causes and lesser for vascular problems. Most BCBSNC benefit plans have a limit of 4 units
per 30 days.
d. MUSE (Medicated Urethral System for Erection). This consists of a urethral suppository (alpros-
tadil) in a very small, smooth plastic applicator. Once the applicator is in place, a button is pushed
down which pushes the suppository out into the urethra where it is absorbed. Most BCBSNC ben-
efit plans have a limit of 4 units per 30 days.
e. A vacuum erection system which is an external device used to provide erection in men and may be
used in some cases as an alternative to the implanted device.
f.
Surgical implantation of a Penile Prosthesis. Implantation of a penile prosthesis may be considered
medically necessary for men who meet all of the following criteria:
i.
Results from Nocturnal Penile Tumescence (NPT) and/or rigidity testing (e.g., Rigi-scan) indi-
cate that the erectile dysfunction is organic and not psychogenic in nature; and
ii. Patient has attempted the above less invasive therapies (a, b, c, d, and/or e) with failure to have
an adequate erection.
g. Surgical revascularization. Penile revascularization may be considered medically necessary only in
men less than 50 years old who meet all of the following criteria:
i.
The erectile dysfunction is the direct result of an arterial injury caused by blunt trauma to the
pelvis and/or perineum; and
ii. A focal blockage of arterial inflow is demonstrated by duplex Doppler ultrasonography or arte-
riography; and
iii. Diagnostic work-up reveals normal corporeal venous function; and
iv. Member is not diabetic and has no evidence of systemic vascular occlusive disease; and
v. Member is not actively smoking.

When Treatment of Male Sexual Dysfunction is not covered

•
When the above medical criteria and guidelines are not met.
•
Viagra®, Levitra® and Cialis® are not indicated for newborns, children, or women.

Policy: Sexual Dysfunction Treatment, Male

•
Treatment of sexual dysfunction not related to organic disease is excluded under most plans.
•
Sural nerve graft in association with radical prostatectomy is considered investigational.
•
Oral yohimbine therapy.
•
Arterial reconstructive procedures, dorsal vein arterialization procedures, or penile venous occlusive
surgery (e.g., venous ligation, dorsal vein ligation) in men with erectile dysfunction secondary to arte-
riosclerotic occlusive disease are considered investigational.
•
Topical cream or gel containing vasodilators are considered investigational.
•
Extracorporeal shock wave therapy (ESWT) for Peyronie’s Disease is considered investigational.

Policy: Sexual Dysfunction Treatment, Male

Iatrogenic
any adverse condition in a patient occurring as a result of treatment by a physician or surgeon, espe-
cially to infections acquired by the patient during the course of treatment.
Neurogenic
arising from or caused by the nervous system.
Neurological
pertains to the nervous system.
Organic
refers to a physiological cause; pertaining to or arising from an organ or the organs.
Potentiate
increasing of potency; particularly, the synergistic action of two drugs, being greater than the sum of the
effects of each used alone.
Prostatectomy
surgical removal of the prostate gland.
Vascular
pertains to blood vessels in the body.

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Friday, October 10, 2008

Got the Viagra Blues?

Charles Dickens stated in A Tale of Two Cities, “It was the best of times. It was the worst of times”.
How true is this statement today! Instead of two cities, we have the bedroom representing two places: a
place to sleep and a place to make love. With the introduction of Viagra, we had hoped that the bedroom
would become the best of times. However, when medications are not effective, the bedroom can represent
the worst of times.

It is estimated that more than 20 million men in the United States are affected by erectile
dysfunction (ED). In the majority of these cases, the actual cause is related to poor circulation and blood
flow in the penis. Just think of it. The coronary arteries surrounding the heart are four times the size of
the arteries feeding the penis. If there should be any degree of hypertension, elevated cholesterol, or
diabetes, blood flow problems affecting the heart lag way behind any adverse effects these diseases have
on the flow of blood into the penis. Patients who have been treated for prostate cancer by surgery or by
various forms of radiation have compromises of their blood flow into the penis.
Viagra and its newer “me too” concoctions can resurrect successful erections in about 70% of men.
Therefore a large number of sufferers of ED will require a more advanced treatment option. Currently the
best option for men who do not respond to Viagra is the internal penile pump. The internal penile pump
makes my patients feel as normal as possible and allows men to regain their confidence and security in the
bedroom.
Many of my patients who have used the pump for over 15 years are constantly thanking me for
recharging their sex life and enabling them to enjoy spontaneous lovemaking again.
The internal penile pump is an inflatable, saline-filled device. During the course of a 45-minute
outpatient procedure, the pump in inserted through a one-inch opening in the scrotum. Squeezing the
pump, which is completely in the scrotal sac, for less than one minute, brings fluid into the penis that
causes a lasting erection. The erection is maintained until the man squeezes the pump again so that the
fluid retreats and the penis can return to its original state. The patient controls the duration of the erection.
If a patient has an orgasm too quickly, the erection is not lost, and the patient is able to maintain it until
this partner is satisfied. Men between the ages of 45 and 90 years old, sexually motivated and active, men
who have had prostate, bladder, or colon cancer treatment, and men who have penile deformity and/or
atrophy are all excellent candidates for the internal pump. Men are excited and relieved for the
opportunity for spontaneous sexual activity. The pump is under the skin, totally concealed and eliminates
self-consciousness. The penis feels and performs naturally, and men are thrilled to have a young, plump
penis once again, like they had when they were 25. Once in place, there is no maintenance required for
the pump, which can remain inserted and useful for a lifetime.
The highlight of this treatment is that it restores the patient’s control over his own body, so that he is
able to obtain and maintain an erection at his disposal. Normal sensation, including orgasm and
ejaculation, is not affected. Compared to Viagra, the internal penile pump is the best long term option for
patients with advanced erectile dysfunction. The internal penile pump enables men who suffer from
advanced erectile dysfunction to resume a normal, spontaneous sex life. For these men, it represents a
cure. The procedure is covered by most insurance policies, including Medicare.

My doctor

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Sunday, October 12, 2008

Order viagra online, we accept: visa, mastercard, amex, e check

MALE SEXUAL DYSFUNCTION. Popular drug: Cialis and viagra

Friday, October 10, 2008

Got the Viagra Blues?

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My doctor

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Sunday, October 12, 2008

Order viagra online, we accept: visa, mastercard, amex, e check

MALE SEXUAL DYSFUNCTION. Popular drug: Cialis and viagra

Friday, October 10, 2008

Got the Viagra Blues?

Blog Archive