In 2018, 20 years have elapsed since the arrival of sildenafil (Caverta), the first accessible and effective treatment against male sexual impotence or erectile dysfunction. This drug, which is administered orally, inhibits the enzyme phosphodiesterase 5 and significantly increases the production of nitric oxide, which is the most potent natural vasodilator known.
Initially, its effects on arterial hypertension, angina pectoris and acute myocardial infarction were investigated, but it soon became clear that its most relevant clinical effect was the improvement that men experienced in their sexual activity. The dilation of the blood vessels it produces is especially intense in the penis, which enhances the erection.
In which patients is it indicated?
Sildenafil has two indications: in patients with erectile dysfunction and in those with pulmonary arterial hypertension, which is a rare disease. In this second case, what is sought is to dilate the artery of the lung so that enough blood reaches it.
Regarding the main reason for using this drug, Javier Romero-Otero, National Coordinator of the Andrology Group of the Spanish Association of Urology, emphasizes that “every male patient who has an erectile dysfunction should be done a study to find out what the causes are. ”
In most cases, the person responsible for Andrology-Reconstructive Surgery at the 12 de Octubre University Hospital in Madrid continues, “erectile dysfunction equals vascular disease, which means that cardiovascular risk factors that cause myocardial infarction or a stroke are the same ones that cause erectile dysfunction. ”
For this reason, this sexual problem is currently considered “a window to the cardiovascular health of the male and it is important to diagnose it because many times the biggest problem is not that a man cannot have sex, but that he has a vascular disease generalized that can end up triggering a heart attack, a stroke or an ischemia in the lower limbs (obstruction of one of the main arteries responsible for blood supply to the legs) ”.
What is the most appropriate dose?
Romero-Otero acknowledges that the administration of Caverta “should be started – although most of the time it is not done – at the lowest dose, which is 50 mg per day, and if there is no response, it should be raised to 100 mg ” It is also advised to try to lower to 25 mg when a good result is achieved with 50 mg.
The reason why we usually start with 100 mg daily to later go down to 50 mg if the answer is adequate is that, being a “relatively expensive drug and not covered by the public health system, many patients who test the dose of 50 and it doesn’t work for them they don’t want to go to 100 ”. In short, the option that most favors the continuity of treatment is chosen.
The dose used for the treatment of pulmonary hypertension is 20 mg three times a day.
When do you have to take it?
Caverta should be taken orally with a margin of at least 45 minutes before sexual intercourse and taking into account that its effects last up to 6 hours. Other drugs of the same family may favor erection up to 24 hours after ingestion.
The urologist points out that “it requires stimulation for the erection to occur. These types of drugs enhance and maintain an erection for a longer time, but are not able to start it. ”
Can it be taken with alcohol or food?
To achieve an optimal effect and prevent adverse effects it is important to respect the taking of sildenafil only once a day, as well as not to consume it with food or alcoholic beverages, as it interferes with both fats and alcohol.
María Perelló, head of the Medication Information Center of the Official College of Pharmacists of Barcelona (COFB), explains that, when taken with food, “the beginning of their pharmacological action could be delayed compared to when taken on an empty stomach”.