Dangers of On-Line Viagra Prescriptions
Viagra has helped impotent men worldwide. Although the number of prescriptions written for this medication has dropped dramatically since its introduction in March of 1998, the numbers are still staggering. Viagra appears to be safe, even though we have all read about deaths associated with it. Many of these deaths have occurred in patients who probably should not have had the medication due to severe heart disease, intolerance to normal sexual function, or the fact that the patients were taking the contraindicated nitroglycerin or nitrate medications.
Excluding this group of patients, the safety record of Viagra has been exceptionally good, and its effectivenessis in the range of 50 to 75%. Many patients consider it a drug that should be sold over the counter, and, in fact, many have been able to obtain prescriptions for this drug on-line at various prescription web sites without ever seeing, talking to, or being examined by a qualified, licensed physician.
Why is prescribing Viagra, either over the counter or on-line, not good for the health of the impotent male? Erectile dysfunction often is a symptom of another problem and it is important diagnose the underlying problem since it may have consequences worse than the symptoms of impotence.
A full history, medical and sexual, a full physical, and basic blood studies must be done to rule out those disorders that are either easily correctable or treatable but could develop into future problems that are more serious than the problems of erectile dysfunction. For example, a relatively young male 45 to 65 years of age may have erectile dysfunction as his first symptom of serious underlying coronary artery disease. He may not have chest pain or angina and the only indication of decreased blood flow is the decreased blood flow to the penis. Evaluation may suggest a vascular cause for his impotence and basic cardiac testing including an electrocardiogram or better yet a thallium stress test would indicate asymptomatic heart disease, prevent a future heart attack, and possibly save the life of this patient. Further evaluation determines that he has a brain tumor or a tumor of the pituitary gland which in some situations can be life threatening.
Viagra should not be given to any patient who has severe heart disease or is unable to tolerate normal sexual activity. Basically the amount of energy necessary to have normal sexual activity (6 calories/second) is equivalent to the ability of climbing oneflight of stairs without chest discomfort. A qualified physician must obtain a thorough patient history and should know the patient in order to provide an accurate diagnosis.
There are approximately 75 drugs that contain nitrates, including generic sublingual nitroglycerin and nitrate patches. Many patients are taking medications containing nitrates and don't even realize it. Only by a careful, compulsive history done by a physician can the drugs be identified. Every drug a patient takes must be identified during the patient evaluation and history. If these drugs contain nitrates, the medication must be changed to a non-nitrate drug or Viagra must not be prescribed. The combination of Viagra and inorganic nitrates is potentially lethal causing a drop in blood pressure and the possibility of subsequent stroke or heart attack.
Patient follow-up is imperative since not everybody will get 100% response to Viagra. In those patients who have a poor response the physician will then be able to assist the patient in other more aggressive effective therapies, and in those patients in whom the response is suboptimal, there are many ways of improving the suboptimal results by either changing the method and timing of the Viagra pill or adding in a timely manner other effective medications such as intraurethral Prostaglandin (Muse therapy).
All patients on Viagra or treated for impotence should have adequate follow-up therapy on a regular basis, and for many patients this may be the only male health evaluation. Bi-annual or annual prostate examination, PSA testing, and urinalysis will be done during those visits and to help prevent other significant male health problems including prostate cancer.