What Are The Long-Term Effects of Viagra?

What is erectile dysfunction?

Erectile dysfunction (ED) is a man’s inability to achieve or maintain an erection suitable for satisfactory sex.
To understand erectile dysfunction, it’s important to understand how erections occur. When a man is sexually aroused, nerves and chemicals work together to relax smooth muscle tissue and widen arteries so that the penis can fill with blood. Veins constrict to keep the blood inside the penis, forming the erection. Once the man ejaculates, the blood is released back into the body.

 

What causes erectile dysfunction?

  • Hormonal issues;
  • Nerve damage. When a man is sexually aroused, his brain sends messages to his penis to start the erection process. But if there is nerve damage, these messages cannot be transmitted properly;
  • Poor blood flow to the penis;
  • Medication side effects;
  • Peyronie’s disease. Peyronie’s disease is a wound healing disorder marked by a distinct curvature of the penis. Many men with Peyronie’s disease develop erectile dysfunction, although experts aren’t sure exactly why;
  • Psychological and emotional issues;
  • Lifestyle. Smoking, obesity, drug and alcohol abuse, an unhealthy diet, and poor exercise habits can contribute to other health conditions associated with erectile dysfunction.

 

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Erectile dysfunction and age

Age is an independent risk factor for erectile dysfunction from which no males can escape. The relationship between age as an independent risk factor and erectile dysfunction has been well established throughout the medical literature. Among men over 40, 52% will have erectile dysfunction, the severity of which increases with age. As the population is ageing and the aged population is healthier, quality-of-life issues such as erectile dysfunction will need to be addressed. Wagner and colleagues reviewed five double-blind, placebo-controlled studies of the efficacy and tolerability of sildenafil in 482 elderly men (65 years or older). Efficacy was assessed using a GEQ, questions 3 and 4 of the International Index of Erectile Function (IIEF), and the five sexual function domains of the IIEF. All efficacy assessments indicated that sildenafil significantly improved erectile function both in elderly patients with erectile dysfunction of broad-spectrum aetiology and in elderly patients with erectile dysfunction and diabetes. The most common adverse events were a mild-to-moderate headache, flushing, and dyspepsia; rates of discontinuation due to adverse events were low and were comparable to the rates with placebo.

What is Viagra?

Viagra is one of the most commercially successful drugs on record. Within months of its approval, millions of prescriptions had been written, a number of mass-market paperbacks hit the stands, stories were frequent in mainstream media outlets, it was the subject of countless comedy monologues, cartoons and jokes, and hundreds of internet sites emerged which offered online prescriptions and home delivery.
In clinical trials, 74% of patients on Viagra reported improved erections, compared with 16% of those on placebo.

 

How well does it work?

Initially, there was scepticism as to how an oral pill could work selectively on the penis. The pivotal trials had been purposely designed to reflect a typical practice experience with liberal inclusion criteria. Patients had to have physician documentation of erectile dysfunction for 6 months and be in a steady heterosexual relationship. The heterosexual requirement was necessary because all of the questionnaires used to measure efficacy had been validated with heterosexual couples using vaginal penetration as an endpoint. There were limited restrictions as to aetiology, be they physical, psychological, or both.

 

What are the possible side effects?

The most common side effects for Viagra are:

  • Headaches;
  • Flushing;
  • Upset stomach;
  • Abnormal vision, such as changes in colour vision (such as having a blue colour tinge) and blurred vision;
  • Stuffy or a runny nose;
  • Back pain;
  • Muscle pain;
  • Nausea;
  • Dizziness;
  • Rash.

Heart attack, stroke, irregular heartbeat and death have happened rarely in men taking Viagra. Most, but not all, of these men had heart problems before taking this medicine. It is not known if Viagra caused these problems.
Tell your healthcare provider if you have any side effect that bothers you or does not go away

How does Viagra work?

Viagra works for men with erectile dysfunction (ED) by increasing blood flow to the penis, so you can get and keep an erection hard enough for sex. Viagra usually starts to work within 30-60 minutes. If you take Viagra after a high-fat meal (such as a cheeseburger and French fries), the medicine may take a little longer to start working. Viagra can help you get an erection when you are sexually excited. You may take it up to 4 hours before sexual activity.

So, don’t worry. There’s no need to rush.

Mechanism of action

The physiologic mechanism of erection of the penis involves the release of nitric oxide (NO) in the
corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood. Sildenafil has no direct relaxant effect on isolated human corpus cavernosum but enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Sildenafil at recommended doses has no effect in the absence of sexual stimulation.

Before you take Viagra, tell your doctor if you:

  • have ever had any heart problems (e.g., angina, chest pain, heart failure, irregular heartbeats, heart attack or narrowing of the aortic valve);
  • have ever had a stroke;
  • have low or high blood pressure;
  • have ever had severe vision loss;
  • have a rare inherited eye disease called retinitis pigmentosa;
  • have ever had any kidney problems;
  • have ever had any liver problems;
  • have ever had any blood problems, including sickle cell anaemia or leukaemia;
  • are allergic to sildenafil or any of the other ingredients of Viagra tablets;
  • have a deformed penis, Peyronie’s disease, or ever had an erection that lasted more than 4 hours;
  • have stomach ulcers or any types of bleeding problems;
  • are taking any other medicines.

 

Warning

There are a few things you can do to make the use of the medicine as safe as possible:
Purchase Viagra from a reliable source. Within manufacturing, quality control measures are in place to ensure that the drug is what it says it is, that the correct amount of drug is present in each individual capsule and that both the active pharmaceutical ingredient (drug) and the excipients (other compounds used in production of a tablet, other than the drug) have limited contamination with potentially harmful impurities or micro-organisms;
Viagra interacts with other drugs. Care should be taken when using Viagra and the above medications together and should any side effects present, the Viagra should be stopped immediately;
Ensure that you take the medicine in accordance with the instructions provided by your doctor or your pharmacist or if all else fails, on the patient information leaflet.

 

Long-term effects of Viagra

Long-term use of Viagra can potentially increase the risk of psychological dependency.
Because sildenafil citrate is a treatment, not a cure, for erectile dysfunction (ED), many men may choose to use it for an extended period.

Sensory

Long-term use of Viagra has been associated with various problems affecting the auditory (hearing) and visual systems. Loss or decrease of hearing has been reported in association with the use of Viagra. An article published on Newsinferno.com (Oct 2007), cited reports of hearing loss cases in patients taking Viagra prompted the Food and Drug Administration (FDA) to add this serious side effect on the warning labels. Long-term use of Viagra can also increase the risks for double vision and temporary vision loss. Dailymed, an online site providing information on FDA approved drugs by the National Library of Medicine, cited retinal haemorrhaging and vascular diseases as potentially serious side effects of Viagra.

Cerebrovascular and Cardiovascular

Short-term serious side effects of Viagra are strokes and heart attacks. Vascular side effects are seen in long-term users of Viagra, such as cerebrovascular haemorrhage and Transient Ischemic Attack (TIA). Cardiomyopathy (enlarged heart), arrhythmia (irregular heartbeat), and heart palpitations have been reported. An article published in The Journal of Medical Case Reports, by researcher Jeppe G Rasmussen, concluded that heart arrhythmia like ventricular tachycardia can potentially be an adverse effect of the drug.

Gastrointestinal

Viagra affects the gastrointestinal (GI) tract and the genito-urinary tract (GU). Long-term use can increase the frequencies of dyspepsia and intestinal problems, such as diarrhoea and gastritis. Additional side effects can include issues relating to urinary tract functions, for example, incontinence, increase the risk for urinary tract infections, and cystitis. Some reports of anorgasmia or the inability to ejaculate, including abnormal ejaculation, have been documented. Drugs.com cited some relationship between Viagra use and anorgasmia in less than 2% of patients on Viagra clinical trials.

Psychological

Long-term Viagra use can increase the potential to develop a psychological dependency. An article published on Biopsychiatry.com, dated April 2004, in the Anchorage Daily News, cited that men who do not have erectile dysfunction problems are taking the drug for recreational purposes and are at risk for developing a psychological dependency for the medication.

 

Will I develop a tolerance to Viagra if I use it long term?

People taking certain medications, such as painkillers, sleeping pills, and antibiotics, gradually develop a tolerance for these drugs and find that they need more of the drug to produce the same results. However, the same phenomenon has not been observed in men using Viagra according to their doctors’ instructions.
A study of men taking Viagra to overcome symptoms of radiation-related erectile dysfunction caused by prostate cancer treatment found that men responded to the drug four years after beginning treatment as well as they had at the start, according to WebMD.com. Michael Zelefsky, M.D led the study, which followed 360 men with radiation-associated erectile dysfunction who had all responded to the drug when they first took it.
Zelefsky and his colleagues tracked these men for up to four years and were surprised to find that 96% of them reported that the drug was still as effective as it had been at first. Zelefsky expressed amazement, saying, “I expected that for many men the effect would diminish with time.”

 

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References:

  1. http://www.issm.info/sexual-health-qa/what-is-erectile-dysfunction1/;
  2. Andrew R McCullough. Four-Year Review of Sildenafil Citrate. Rev Urol. 2002; 4(Suppl 3): S26–S38; PMCID: PMC1476025. PubMed PMID: 16986012;
  3. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.19.2.147;
  4. www.viagra.com;
  5. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020895s033lbl.pdf;
  6. https://www.livestrong.com/article/75866-longterm-effects-using-viagra/.

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