Hey there Guys,
In yesterday’s post I discussed the common causes of erectile dysfunction. Today I wanted to talk about some of the more popular treatments available.
As I mentioned in my previous post, there are a few medical conditions like low testosterone, thyroid dysfunction, diabetes and heart disease that can cause erection problems. While medications like Viagra, Cialis or Levitra may help erections in the short term, getting these problems addressed will help improve erections over the long term.
Performance anxiety can be very annoying and being able to feel more relaxed with your partner can certainly help. Changing to a different behaviour that is less penetration focused for a few minutes can also help erections where stress is involved. Massage can be a great way to decrease stress and can help increase erection strength via the reflex mechanism of skin stimulation.
For people who are living with diabetes and heart disease there can be a decrease in blood flow to the penis, leading to problems with erections. This is where medications can really help make a big difference to erection strength and staying power.
Today I wanted to give a brief overview of three of the oral medications: Viagra, Cialis and Levitra, and a also quick look at Caverject, an injected medication that is sometimes used if the tablets are not helpful.
Viagra
Viagra, otherwise known as sildenafil, was originally created as a blood pressure medication. During its early testing the participants where discovering erections as one of the side effects. Indeed this side effect has become medical history with its introduction as the first tablet used to treat erectile dysfunction.
Viagra comes in three strengths: 25mg, 50mg and 100mg. For many 50mg is the ideal starting dose and increased if needed. Viagra needs to be taken at least 30 minutes before you plan to have sexual activity, and lasts around four hours. Viagra can last up to 12 hours in some people.
It’s important to remember that Viagra was originally developed to reduce blood pressure, so if you already have low blood pressure there is a chance of fainting. Use of nitrate drugs (used to treat angina) at the same time can lead to significant drops in blood pressure. Amyl nitrate has a very similar effect, so if you are using Viagra it’s important to not use amyl at the same time.
Click here to read how the combination of amyl and Viagra can be quite dangerous.
If you have recently had a heart attack or stroke it is advised to avoid Viagra. It’s important to talk to your doctor to find the best treatment for you.
Finally, if you are taking a protease inhibitor for treatment of HIV, Viagra levels can become very high in the blood. It is advised to talk with your doctor before considering Viagra in this case. Recommendations include using very small doses such as 25mg and having at least two to three days between doses.
Levitra
Levitra, also called vardenalil, is a very similar drug to Viagra. Almost exactly the same action, Levitra is taken about 60 minutes before sexual activity and lasts around four hours but can last up to 12 hours in some people.
In Australia Levitra comes in 5mg, 10mg and 20mg doses with 5mg the standard starting dose.
The potential side effects are almost the same as Viagra so to recap:
- This medication is not recommended if you have recently had a heart attack or stroke
- If you are nitrate medications there is a risk of a significant drop in blood pressure so it’s not recommended.
- Using Levitra with amyl nitrate is dangerous and can cause fainting and significant blood pressure drops. Do not mix Levitra with amyl.
- If you are currently on a protease inhibitor to treat HIV, Levitra levels in the blood can increase up to 16 times. For this reason it’s recommended that no more then 2.5mg be taken and there is at least three days between doses.
Cialis
Cialis, also called tadalafil, is slightly different to Viagra and Levitra for two main reasons: firstly it lasts much longer in the body and secondly it’s the only medication that is also available for daily dosage.
Cialis is available in Australia in 10mg and 20mg tablets for “as needed use”, or as a 5mg tablet that is taken on a daily basis.
Cialis is different to Viagra and Levitra in that when it is taken at the 10mg or 20mg dose, it lasts in the body for up to three days. For this reason it was initially marketed as a “weekend” treatment for erectile dysfunction. This way men were able to take it on Friday and it would not wear off till Sunday.
While some people find this useful, if you are more spontaneous sexually or you tend to have sex evenly across the week, Cialis also comes in a daily 5mg tablet. Some people find that taking just one 5mg tablet 30 minutes before sex is equally as effective as taking it on a daily basis.
Cialis does not have quite as strong effect on blood pressure however it is not recommended to use it within 72 hours of any nitrate drugs or amyl nitrate.
Again, protease inhibitors used to treat HIV increase the blood levels of Cialis and the recommendation is to not have more than 10mg in a three day period, or 2.5mg per day if you are taking it daily.
Cialis is not recommended if you have recently had a heart attack or stroke.
Caverject
Caverject is a medication that is injected into the penis to help erections. It’s rarely used these days due to the great success of the other medications I have discussed.
Due to its complexity, users require additional training on how to use the medication. This is done at your doctor’s office where you will learn how to inject this medication into the penis.
Because of the risk of priapism (erections that do not go down), it’s important to only use this medication under medical guidance and if you have erections that do not subside, go to the emergency department quickly.
Important notes about these medications
Be sure to talk to your doctor:
While I understand that these medications can be bought over the Internet, it’s important to always discuss erection problems with your doctor. As I mentioned in my post about erectile dysfunction, there are lots of different causes of poor erections that simple treatments may be able to help.
If you are taking any medications you will be able to discuss potential interactions that might happen. The important drugs to note that might cause significant problems include:
- blood pressure medications
- nitrate medications used to treat heart pain
- protease inhibitors used to treat HIV
- any medications that can cause changes in liver enzymes
Careful review of your health and medications (if you take any) is important before starting any erectile dysfunction (ED) medications.
Use of ED drugs with non prescribed medications:
As mentioned above the use of any of these medications and amyl nitrate can lead to significant harm. This combination is dangerous due to the potential for a significant drop in blood pressure. This can at best cause fainting, but in the worst case scenario can result in a heart attack. If you are using these medications you need to avoid using amyl.
If these medications are taken with alcohol the chance of low blood pressure is also increased. If you already have low blood pressure be sure to avoid alcohol.
Erections that do not go down:
If after using these medications your erection does not subside it is vital you seek medical treatment urgently. Erections lasting more then two hours is called priapism and if not treated can result in permanent damage to the penis.
If your erection is not subsiding, is painful or has been present for more than two hours, go to your local emergency department immediately for urgent treatment.
Use of cock rings:
Because cock rings decrease the blood flow to the penis these medications can accumulate and there is an increased risk of priapism.
For this reason it is best not to use a cock ring if you are using these medications. If you choose to use a cock ring, be sure to use either a plastic or rubber ring that can be easily cut off, or a velcro or snap cock ring that allows easy removal.
As noted above, erections lasting more then two hours can cause significant damage to the penis and are considered an emergency. This requires swift treatment that can be done by attending your local emergency department straight away.
On a final note, I just wanted to share some great tips from the great team at Andrology Australia when it comes to medications for erectile dysfunction.
Tips for successful use of Viagra, Cialis and Levitra
- Do not expect too much too soon. The first few uses can cause anxiety in respect of success and side effects and this can interfere with the action of the drug. Many men need to use up to 6 doses to establish successful use.
- Follow your doctor’s instructions regarding the appropriate dose and any other special aspects.
- Experiment with the timing of taking the drug to work out what best suits you and your partner.
- Take note of the influence of food on the drug; Viagra particularly can be slowed by a fatty meal.
- Don’t drink too much alcohol because this can affect sexual performance.
- Consider the needs of your partner when planning to use these drugs – a satisfying sexual experience is more likely.
- Above all, relax and enjoy the benefits of the drug.
- Arrange a follow up appointment with your doctor to make sure that you are getting the best out of the drug.
Guys, I hope you have found this post helpful. If you have any questions please feel free to leave a comment below.
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Yours in good health.
Dr George
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