From the Department of Urology



Hints on the Use of Viagra (Sildenafil)

Sildenafil, Viagra, is a good drug for the treatment of erectile dysfunction (ED). It is safe, relatively free of side effects and effective. The main "don't" is not to prescribe it to patients on nitrate donors.

Leaving aside the Government guidelines, Viagra can be used as first line treatment in any patient presenting with significant erectile dysfunction of any cause. I usually start the patient with 8 x 50 mg tablets (Viagra comes in packets of 4). I tell the patient to try 50 mg, if that works, well and good. If it does not they should try a second 50 mg tablet (not within 24 hours of the first). If that does not work, next time they should take 2 x 50 mg tablets at the same time (i.e., 100 mg). If that works all is well, that is then their "maintenance" dose. If 100 mg does not work then some other form of treatment will be required (e.g. intra-cavernosal injections, suggest referral to a urologist).

A small number of patients who respond well to 50 mg may only need 25 mg.

Patients should be told to take the medication one hour before anticipated sexual activity. Spontaneous erections will not occur. Some form of stimulation will be required. The effect lasts for about 2 hours after onset.

The main side effects are reported to be headaches and disturbance of colour vision.

Viagra should not be taken more than once in 24 hours.

It should not be taken with nitrates, either short or long acting.



Robert Cox
Consultant Urologist



Effects ofGovernment Regulations


As I understand it, under the Government guidelines (effective from 1st July 1999) GPs may prescribe Viagra to men with ED who have had radical pelvic surgery, have been treated for prostate cancer, treated for renal failure (transplant or dialysis), spinal cord or severe pelvic injury, diabetes, multiple sclerosis, single gene neurological disease, poliomyelitis, spina bifida and Parkinson's disease or who have had a prostatectomy.

Prescriptions should be limited to one dose of Viagra per week.

It appears that GPs may also prescribe Viagra to patients who are not in the above categories but who were receiving drug treatment for erectile dysfunction, e.g. Caverject or MUSE, on the 14th September 1998.

Men who do not fall into the above categories may receive private prescriptions from the GPs (for which apparently you cannot make a charge!). There is also a clause about men suffering exceptional hardship as a result of erectile dysfunction who do not fall into the above categories who may need specialist assessment. Quite why a specialist, presumably in urology, should be better able to make an assessment of who is suffering hardship as a result of untreated ED than a family physician is hard to know. This matter remains unresolved.

I hope you find these notes helpful and it may enable you to reduce the number of patients you refer with erectile dysfunction.

Finally, careful reading of the latest Government circular indicates that the prescribing rules for Viagra also apply to all medical treatment for impotence. This has considerable implications for the treatment of men with erectile dysfunction in Cornwall which require further consideration.

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