Red Oak Cardiovascular Center

VIAGRA^(TM) AND HEART DISEASE -- IT'S NO JOKE!

It is unlikely that any medication that has come along in the past fifty years has produced as many one-liners and jokes as the oral medication for impotence, Viagra(TM). But the drug's potential side effects when taken by patients under treatment for cardiovascular disease are no laughing matter.

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Manufactured by Pfizer, Inc., this drug (generic name: sildenafil citrate) was ironically first tested as a heart medication. While it proved ineffective for that purpose, many of the men participating in the clinical trials reported that their sexual function improved dramatically after using the drug. As a result of this "happy accident," the pharmaceutical company conducted extensive testing of Viagra(TM) as a medication to treat impotence instead. Before the FDA approved the drug for this purpose, more than 4,000 men with erectile dysfunction participated in clinical trials. The results were very promising: 64 percent to 72 percent of the men reported sexual "success" after taking the medication.

During the trials, the men reported some minor side effects -- headache, flushing, stomach ache, urinary tract infection, dizziness, as well as mild and temporary visual changes (color perception changes and blurred vision) -- but it wasn't until the drug had been released by the FDA that its potential dangers to heart patients were discovered. After six months in use, more than 3.6 million prescriptions for Viagra(TM) had been filled, and tragically, some patients had died after taking the drug.

This extreme -- although fairly rare -- reaction to the drug prompted the manufacturer, the FDA, the American College of Cardiology and the American Heart Association to issue specific advice about who should not use the drug. Pfizer, in consultation with the FDA, revised its Patient Package Insert for Viagra(TM) and communicated new and expanded safety information directly to health care professionals about prescribing the medication.

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Experts agree that the "drug is absolutely contraindicated (prohibited) in patients who are taking any chronic nitrate drug therapy (nitroglycerine) or who utilize short-acting nitrate-containing medications because of the risk of developing potentially life-threatening hypotension (low blood pressure)." There may also be cardiovascular side effects in patients with certain medical profiles such as:

• those with active coronary artery disease but who are not on nitrates;
• patients with congestive heart failure and borderline low blood pressure;
• patients on a blood-pressure lowering program; and,
• patients who take several specific drugs or who have liver or kidney disease than can prolong the "half-life" of Viagra(TM).

As the usage of this drug increases, it may ultimately become appropriate for men who use it to wear a medical alert to notify medical personnel about contraindications in the event of an emergency. ER physicians and paramedics called to treat a possible heart attack victim, for example, would need to be aware of the danger of administering short-acting nitrates (which would routinely be administered to a patient experiencing chest pain) to a man who had taken Viagra(TM).

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"This new safety information makes it quite clear that this medication is not for everyone," explained Juan R. Amell, M.D., founder and medical director of Red Oak Cardiovascular Center. "It is absolutely critical that any man who is thinking about requesting a prescription for this drug get a complete physical check up and have a candid conversation with his doctor about the risks involved. One important consideration is whether or not the man is capable of engaging in a level of physical activity that might involve more exertion than usual."

According to medical experts, sex can be hard work. Intercourse can increase the heart rate from about 70 beats a minute to more than 100 and cause an increase in blood pressure rates, as well. There have been a number of studies about heart attacks triggered by sexual activity and the risk turns out to be very low in the general population -- a two-in-a-million chance per hour. For people who do not exercise and who have an untreated cardiovascular disease, on the other hand, the risk of having a heart attack during sex could come closer to one in a thousand.

When it comes to taking Viagra(TM), heart specialists are recommending that cardiac patients who have been relatively sedentary and want to get on the medication first take part in a cardiac rehab program, and stress a go-slow approach to resuming sexual activity. Unfortunately, impotence is relatively common among men with heart disease, since atherosclerosis can block blood vessels and impede genital blood flow necessary to sustain an erection. Even if the disease process does not cause impotence, sometimes the medications used to treat it (e.g., beta blockers and diuretics) might do so. Some couples have trouble resuming their intimate relationship after one spouse has had a cardiac event because of fear that it might trigger another.

"The logical place to start for cardiac patients who are concerned about their sexual ability," said Dr. Amell, "is to overcome their reluctance to discuss this private problem with their doctors. Then, a visit with their urologist is appropriate to determine if they are a potential candidate for the medication."

"The fact that so many men keep quiet about impotence or sexual dysfunction is what has caused this problem to be known as a 'silent epidemic," he continued. "Too much emphasis has been placed on Viagra(TM) as a solution for all problems with sex; and we know that it is not. There may be other alternatives -- adjusting medication for example -- that might help correct the problem. Sometimes, simply helping the patient and his spouse take a realistic look at their fears can help the couple resume sexual relations."

For additional information about restrictions in the use of Viagra(TM) by cardiac patients, please contact our office (281)893-8640 and ask for Dr. Amilcar Avendaño or the Nurse Educator.