Treating ED in Patients with CVD

Phosphodiesterase Inhibitors

Oral nitrates are not prognostically important drugs and can therefore be discontinued and, if needed, alternative agents substituted. After oral nitrate cessation, and provided there has been no clinical deterioration, PDE5 inhibitors can be used safely. It is recommended that the cessation time interval prior to PDE5 inhibitor use is five half-lives which equals 5 days for the most popular once-daily nitrate agents. Sildenafil and vardenafil both have a short half-life, which makes them the viagra canada drugs of choice in patients with more severe CVD, allowing early use of support therapy if an adverse clinical event occurs.

In contrast, because of its long half-life, tadalafil online Australia may not be the first choice for the patients with more complex cardiovascular disease.

However, as 80% of patients with cardiovascular disease stratify into low risk, it is an alternative for the majority. Tadalafil 10 mg is equivalent to sildenafil 50 mg and 20 mg to 100 mg.

Of particular interest is the daily use of tada-lafil 2.5 and 5 mg. In on-demand failures, a regular dosing regime has been successful in 60% without increased adverse effects. This has increased the chance of success with important implications for the more difficult cases such as cardiac failure. There is no evidence of increased cardiovascular risk with on-demand, three times weekly, or daily dosing.

but specialized training is needed. There is no evidence of increased cardiovascular risk from using any of these therapeutic options. If surgical intervention with general anesthetic is being anticipated, a full cardiological risk evaluation is recommended.

Non-arteritic Anterior Ischemic Optic Neuropathy

The reports of risk of “blindness” following PDE5 inhibitor use has caused concern. Several case reports have linked PDE5 inhibitors to Non-arteritic Anterior Ischemic Optic Neuropathy (NAION).

No explanation as to the mechanism currently exists and it is most likely coincidental, given the widespread use of PDE5 inhibitors in men who are at risk, being older and with vascular disease. The only identifiable risk factor is a small cup-disc ratio.

It seems sensible to avoid PDE5 inhibitors in those previously suffering NAION in one eye.

Key Points

  • Cardiac disease is not a contradiction to sexual activity.
  • High risk cases require a cardiac assessment, not a negative attitude.
  • PDE5 inhibitors are safe and effective drugs if used correctly.
  • Alternative therapies to PDE5 inhibitors are available and do not increase cardiac risk in properly assessed patients.

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Other Therapies

When oral agents are not effective, intracavernous injection therapy, transurethral alprostadil, or a vacuum pump are alternatives requiring specialized referral and advice. Warfarin is not a contraindication to vacuum pump or injections.

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