sildenafil-citrate and Hypotension--Orthostatic

To assess the efficacy and safety of sildenafil citrate (Viagra) in men with erectile dysfunction and parkinsonism due either to Parkinson's disease or multiple system atrophy.. Twenty four patients with erectile disease were recruited, 12 with Parkinson's disease and 12 with multiple system atrophy, into a randomised, double blind, placebo controlled, crossover study of sildenafil citrate. The starting dose was 50 mg active or placebo medication with the opportunity for dose adjustment depending on efficacy and tolerability. The international index of erectile function questionnaire (IIEF) was used to assess treatment efficacy and a quality of life questionnaire to assess the effect of treatment on sex life and whole life. Criteria for entry included a definite neurological diagnosis and a standing systolic blood pressure of 90-180 mm Hg and diastolic blood pressure of 50-110 mm Hg, on treatment if necessary. Blood pressure was taken at randomisation (visit 2) and crossover (visit 5) lying, sitting, and standing, before and 1 hour after taking the study medication in hospital.. Sidenafil citrate was efficacious in men with parkinsonism with a significant improvement, as demonstrated in questionnaire responses, in ability to achieve and maintain an erection and improvement in quality of sex life. In Parkinson's disease there was minimal change in blood pressure between active and placebo medication. In multiple system atrophy, six patients were studied before recruitment was stopped because three men showed a severe drop in blood pressure 1 hour after taking the active medication. Two were already known to have orthostatic hypotension and were receiving treatment with ephedrine and midodrine but the third had asymptomatic hypotension. However, the blood pressures in all three had been within the inclusion criterion for the study protocol. Despite a significant postural fall in blood pressure after sildenafil, all patients with multiple system atrophy reported a good erectile response and were reluctant to discontinue the medication.. Sidenafil citrate (50 mg) is efficacious in the treatment of erectile dysfunction in parkinsonism due to Parkinson's disease or multiple system atrophy; however, it may unmask or exacerbate hypotension in multiple system atrophy. As Parkinson's disease may be diagnostically difficult to distinguish from multiple system atrophy, especially in the early stages, we recommend measurement of lying and standing blood pressure before prescribing sildenafil to men with parkinsonism. Furthermore, such patients should be made aware of seeking medical advice if they develop symptoms on treatment suggestive of orthostatic hypotension.

Topics: Aged; Blood Pressure; Cross-Over Studies; Diastole; Double-Blind Method; Ephedrine; Erectile Dysfunction; Humans; Hypotension, Orthostatic; Male; Middle Aged; Midodrine; Multiple System Atrophy; Parkinson Disease; Phosphodiesterase Inhibitors; Piperazines; Purines; Quality of Life; Severity of Illness Index; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Systole; Time Factors; Treatment Outcome; Vasoconstrictor Agents

Erectile dysfunction (ED) is often associated with cardiovascular disease (CVD) and the risk of sildenafil-induced orthostatic hypotension (OH) in subjects with CVD is a matter of concern. We describe our experience in using the tilt test (TT) with continuous plethysmography to evaluate the occurrence of OH in patients with CVD and ED after a test dose of sildenafil. When sildenafil was added on top of their usual pharmacological treatment two patients out of 32 (6.2%) developed asymptomatic OH, with a maximum blood pressure fall of 40/20 mm Hg. The low prevalence and modest clinical relevance of OH in our high-risk population coupled with the known high sensitivity and reproducibility of the TT seem to suggest that sildenafil is haemodynamically safer than is generally believed even when added on top of vasoactive treatment. These findings should be put into perspective against the growing wealth of evidence that PDE5 inhibitors may have therapeutic potential for a number of CV conditions.

Topics: Aged; Blood Pressure; Erectile Dysfunction; Humans; Hypotension, Orthostatic; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Piperazines; Population Surveillance; Purines; Risk Factors; Sildenafil Citrate; Sulfones; Supine Position; Tilt-Table Test; Vasodilator Agents

We describe pronounced hypotension in a patient during orthostatic testing while receiving treatment with sildenafil and tamsulosin, but not with placebo. The patient was 71 years of age and had no history of orthostatic reactions. He had been diagnosed with benign prostatic hyperplasia (BPH) and glaucoma simplex (open-angle glaucoma). The only regular medication used was a combination of latanoprost and timolol one drop daily into each eye. The patient was among 16 men with BPH enrolled in a study of the haemodynamic effects of tamsulosin and sildenafil. The present patient was excluded from data analysis because of atypical reactions: he experienced a decrease in peripheral vascular resistance upon orthostasis during treatment with sildenafil and tamsulosin. This led to marked hypotension and cancellation of the tilt tests with both sildenafil alone (Riva-Rocci [RR] 75/50 mm Hg) and a combination of sildenafil and tamsulosin (RR 60/45 mm Hg); however, tamsulosin alone also lowered blood pressure to some extent (RR 100/80 mm Hg). In conclusion, even though sildenafil and tamsulosin are considered haemodynamically safe, they may induce considerable vasodilation and, subsequently, harmful hypotension in susceptible patients.

Topics: Aged; Heart Rate; Humans; Hypotension, Orthostatic; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfonamides; Sulfones; Tamsulosin; Vascular Resistance