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DAVID R. MARKS, MD: Hi and welcome to our webcast. I'm Dr. David Marks.
The drug Viagra has revolutionized the treatment of erectile dysfunction, but there are other drugs on the horizon and we're going to talk about the evolution of treatment of erectile dysfunction.
With me to do that is an expert in the field. He's Dr. Françoise Eid, and he is the director of advanced urological care in Manhattan.
Tell us about the benefits and the drawbacks of Viagra.
J. FRANÇOISE EID, MD: First, we focused on the erectile function and we saw that Viagra really improved the erections of about two-thirds of men who had erectile dysfunction. But also what we're seeing now is that it helps them in a lot of different respects.
As you know, men who have erectile dysfunction suffers from vascular disease. Most of these patients either have either high cholesterol levels, diabetes, which affects blood vessels. And the erection is really a manifestation or a reflection of the health of the vascular system.
DAVID R. MARKS, MD: It's not a perfect drug.
J. FRANÇOISE EID, MD: Not a perfect drug.
DAVID R. MARKS, MD: Originally it was touted as kind of a miracle treatment for this disease.
J. FRANÇOISE EID, MD: Exactly.
DAVID R. MARKS, MD: But there are some drawbacks to it.
J. FRANÇOISE EID, MD: There are some drawbacks and there are some side effects. The side effects are very mild, they're transient, they're very well-tolerated.
And the drawbacks are that you need to plan sex. Sex is an activity that we human beings like spontaneity. And with Viagra, you have to plan. You can't eat, because anything that you take that delays gastric emptying will decrease the efficacy of Viagra. So you can't eat any fatty food, or if you eat a meal, it has to be a very light meal. And then you have to wait about an hour to an hour-and-a-half before you engage in sexual activity.
DAVID R. MARKS, MD: But there are some other side effects, too.
J. FRANÇOISE EID, MD: Exactly.
DAVID R. MARKS, MD: Some visual problems, you can tell us about, and also there were some reports of men having some cardiac problems.
J. FRANÇOISE EID, MD: Exactly.
DAVID R. MARKS, MD: So maybe some drug interactions. Tell us about these.
J. FRANÇOISE EID, MD: I think the first is that Viagra is absolutely contraindicated in patients who take nitrates. Nitrates is a class of medications that men who have coronary heart disease -- angina, blocked arteries to the heart -- need to take in order to help their chest pain.
So the most common side effects are headache, flushing of the face, stuffy nose and heartburn. A few patients, about 3% of patients develop visual disturbances at 100 mg, the large dose. And what patients complain of is a hypersensitivity to light or a bluish tinge to light.
DAVID R. MARKS, MD: What if a person's going to have a couple of alcoholic drinks, some wine, a couple of shots of tequila? Can they take Viagra?
J. FRANÇOISE EID, MD: Yes, they can, but all this alcohol will diminish their already diminished erectile function. So it's a little bit counterproductive.
DAVID R. MARKS, MD: Are there any other oral medications that men can take that might help them with their erectile dysfunction?
J. FRANÇOISE EID, MD: Currently there are none that are actually effective. There are a lot of herbal medications that are being advertised for erectile dysfunction, none of them work.
Now there are two medications that are being closely investigated and they have actually completed clinical trials, and the new drug application have been filed for both medication with the FDA.
DAVID R. MARKS, MD: Meaning that we may be seeing them on the market soon.
J. FRANÇOISE EID, MD: Exactly. On June 28th of 2001, an application was filed for a drug called Cialis. And that medication works in a similar fashion that Viagra does, but it has some other properties. It is absorbed slightly faster, it can be taken with food -- which is a big plus, because sex can be spontaneous -- and it lasts longer in the bloodstream. The medication may stay in the bloodstream for about 34 hours. So that's 1 1/2 days.
DAVID R. MARKS, MD: Is that a good thing?
J. FRANÇOISE EID, MD: Well, it's a good thing and a bad thing. It's a good thing because let's say you take it on a Friday and you want to have sex Saturday night, you don't need to the medication again. Or you can have sex spontaneously.
However, let's say you get a side effect from that medication. Then that medication is on board and the side effect may stay longer.
DAVID R. MARKS, MD: You walk around with an erection for --
J. FRANÇOISE EID, MD: No, you don't walk around with an erection, because you have to remember that the way these medications work is that they block the enzyme that takes away an erection. So to bring an erection forth, you have to actually being sexually stimulated, aroused.
DAVID R. MARKS, MD: What's the second one?
J. FRANÇOISE EID, MD: Vardenafil, a very similar medication to Viagra. It is active at lower doses and a little bit more specific for the chemical that takes away erections. In other words, it's perhaps a cleaner medication. Now that medication doesn't have the same visual disturbances, for example.
DAVID R. MARKS, MD: Can these drugs treat all patients with erectile dysfunction? Is this enough of a choice?
J. FRANÇOISE EID, MD: We believe that these drugs will treat about two-thirds to 80% of men who suffer from erectile dysfunction. There are a third of patients who have severe endstage erectile dysfunction, will not respond to these medications, and these patients will require more advanced treatment options such as a penile prosthesis or an internal penile pump.
The other thing that's interesting, David, is every time there's a new treatment in the field of erectile dysfunction, what it does is it brings more patients into the treatment pool. Patients who've tried Viagra once and never wanted to try it again for whatever reason -- either the dose was not strong enough -- will want to maybe try this. People who are satisfied with Viagra will want to come back and try this. People who were afraid of Viagra will say, "Gee, you know, now there's a second drug on the market. Maybe it is safe after all. Let me try it."
DAVID R. MARKS, MD: Do you have any words of advice to a patient out there who has erectile dysfunction who maybe hasn't decided to actually seek treatment yet?
J. FRANÇOISE EID, MD: Well, the advice is, number one, make sure that individual gets evaluated. Because really, erectile dysfunction as we talked earlier is a sign of an underlying disorder, which can be more serious, such as high cholesterol levels, diabetes and so forth.
So, number two, every man who suffers erectile dysfunction can be successfully treated 2002. There isn't a man that we cannot treat.
DAVID R. MARKS, MD: The most important thing is evaluation, seek help, go to the right doctor and follow-up. Okay.
J. FRANÇOISE EID, MD: Exactly. Yes.
DAVID R. MARKS, MD: Good, thank you very much.
J. FRANÇOISE EID, MD: Thank you, David.
DAVID R. MARKS, MD: And thank you for joining our webcast. I'm Dr. David Marks, goodbye
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