Erectile dysfunction is the repeated inability of the male reproductive organ to maintain a firm erection which is sufficient to have a penetrative intercourse or sex. Most men experience this once in a lifetime, but majority of the cases are temporary and could be due to fatigue, stress, anger or depression. However temporary loss of erection is reversible and most men have a healthy sex life once the causative factor is removed. Studies done on general population shows that this disorder can reduce the general quality of life.

Research

Scientists conducted a study on sildenafil citrate to assess its efficacy and the maximum tolerated done on patients as a salvage therapy. Salvage therapy is the last attempt for patients who are unable to respond to all the other available therapies and the prognosis of the disease is poor.

Objective

To study the maximum recommended dose of sildenafil citrate.

Study

Sildenafil citrate is the key ingredients in most of the Viagra. It is an inhibitor of the enzyme phosphodiesterase type 5 (PDE-5) and has shown marked improvement in patients who are suffering from erectile dysfunction. This enzyme activates nitric oxide/ cGMP pathway when the person receives sexual stimulation by inhibiting PDE-5 isoenzyme which increases the level of cGMP. Due to this, there is rush of blood in the male reproductive organ and the erection is maintained. Sildenafil citrate is able to restore erection in most chronic erectile dysfunction patients including those who are suffering from diabetes, hypertension or cardiovascular diseases. However, the efficacy depends on the extent and severity of ED, the efficacy declines in patients who are suffering from vasculogenic ED, diabetic ED or post operations.

Studies have shown that sildenafil is successful in 65 % of cases. The maximum recommended does of Viagra is 100 mg is patients. Some patients do not respond to this dose also. Researchers selected patients who were suffering from chronic erectile dysfunction and had not shown a response to sildenafil (100mg). They were put on a therapy of 150 mg and 200 mg dose. The dose was increased till the maximum response dose or intolerable adverse effect took place.

The efficacy was evaluated based on the patient and the physicians review where the patients had to fill in a questionnaire.

The patients were grouped under the cause of erectile dysfunction

• arteriogenic ED- 24 %
• mixed vasculogenic ED- 30 %
• cavernosal veno-occlusive dysfunction- 17 %
• post radical retropubic prostatectomy ED- 20 %
• psychogenic ED – 9 %

Post four weeks of observation the research showed that

• 37 % of the patients improved with 100 mg dose
• 46.3 % of the patients improved with 150 mg dose
• 68 % of the patients improved with 100 mg dose

63 % of these patients experienced adverse effects such as headache, face flushing, dyspepsia, nasal congestion, dizziness and visual disturbances. Despite this researchers concluded that 200 mg of sildenafil citrate is an effective salvage therapy for 24.1 % of the non-responsive patients though it cannot be recommended due to its severe side effects.

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