Medication and Device Tips

Viagra® and Related Drugs

Tip : Know the name of the drug you are taking or discussing with your doctor and considering taking. Also, know the name of the drug company that provides the drug so you can protect yourself from scams and false information from illegal sources.

The three drugs available today that help men get erections by blocking the body enzyme phosphodiesterase type 5 (PDE-5) are:

• Viagra® (sildenafil) (Pfizer (http://www.pfizer.com
•  Levitra® (vardenafil), Schering Plough (http://www.scheringplough.com) in partnership with GlaxoSmithKline
• Cialis® (tadalafil) (Eli Lilly (http://www.lilly.com)

Tip : Know how drugs in this country are legally approved and made available to the public. A good source of information about legally approved drugs in the United States is the U.S. Food and Drug Administration (FDA), Center for Drug Evaluation and Research (CDER): http://www.fda.gov/cder/cderorg.htm

Tip : Viagra and related drugs do not create sexual desire. For the drugs to work, you must have a way to stimulate yourself and feel sexual desire. Some men are not aware of this and become frustrated, thinking the drugs are not working for them.

Tip : Viagra and related drugs do not cure erectile dysfunction. They only help make erections easier. However, many men lose confidence after first experiencing problems with erections, and this negative feeling can itself create problems. You may find that after successfully achieving erections with medication and making lifestyle changes to make sure your emotional and physical health are sound, you can go on with your sex life without medication. (Discuss this with your doctor to make sure your expectations are realistic.)

Tip : Viagra and related drugs are not a form of birth control, and they cannot protect either partner against AIDS or other sexually transmitted diseases. You must take the same precautions against pregnancy and against sexually transmitted diseases as you normally would.

Tip : You must plan your sex life if you use Viagra or related drugs (but with each drug you have a window of opportunity to work with). If you are taking Viagra, you must take the recommended dose about 1 hour before you expect to have sex. The drug should start working about half an hour after you take it and last for up to 4 hours. Levitra should also be taken about 1 hour before sex. Cialis may be taken from 30 minutes to about 36 hours before having sex.

Tip : Avoid fatty meals (like hamburger and fries) for about 2 hours before taking Viagra to make sure it doesn’t take longer than usual to start working. A high-fat meal may also make Levitra take longer than usual to start working. Cialis is not affected by meals.

Tip : Viagra and related drugs should not be taken more than once a day and should not be taken in doses higher than that recommended by your physician. Remember that any drug can have toxic effects if you take too much or if you take it too often.

Tip : You should never take Viagra or related drugs if you are also taking any drugs that contain nitrates. Be sure to mention this to your physician if you realize this is being overlooked. If you have to be treated with nitrates as a result of unexpected hospital or emergency care, you should warn your physician if you have recently taken Viagra or a similar drug.

The combination of Viagra (or related drugs) and nitrates could cause you to have a sudden and large drop in blood pressure, which could cause a heart attack or stroke. Medications that contain nitrate include nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate. Some street drugs also contain nitrates, including amyl nitrate or nitrites (called “poppers”). Talk to your physician or pharmacist if you have concerns or need more information.

Tip : Some men have lost eyesight in one eye when using Viagra and related drugs. Men at higher risk for this adverse event have heart disease, high cholesterol, high blood pressure, are diabetic, smoke, are over 50 years old, and/or have certain eye problems already. Be sure to discuss this possible adverse event with your doctor, including any risk factors that you have. If you experience problems with eyesight when using Viagra or a related drug, stop using the drug immediately and contact your doctor right away.

Tip : Some men experience prolonged erections after using Viagra or related drugs. This is a condition that needs to be treated immediately to prevent scarring within the penis that would be very likely to cause still more problems with erections in the future. If you have an erection that lasts for 3 hours and does not go away, contact your doctor immediately for emergency help. If your doctor is not available or does not provide this type of emergency help, go to the emergency department of a hospital where you can be treated.

Alprostadil Pellets

Tip : Alprostadil pellets for insertion into the tip of your penis are known by the brand name Muse®, and are also called urethral suppositories. This medication is marketed by Vivus (http://www.vivus.com).

Tip : Some men experience prolonged erections after using alprostadil. This is a condition that needs to be treated immediately to prevent scarring within the penis that would be very likely to cause still more problems with erections in the future. If you have an erection that lasts for 3 hours and does not go away, contact your doctor immediately for emergency help. If your doctor is not available or does not provide this type of emergency help, go to the emergency department of a hospital where you can be treated.

Tip : If you have sickle cell anemia or trait, or leukemia or bone marrow tumor, you should not use alprostadil pellets because of the risk of prolonged erections causing damage to your penis. You should also not use alprostadil if you have a constriction or bending of the penis that would make erections painful.

Tip : You should not use alprostadil to have sex with a pregnant woman unless you use a reliable condom barrier. Without a barrier, the drug will be absorbed by the woman and may harm the unborn baby.

Tip : It will be easier to insert the applicator with the pellet if you are not lying down. Gently stretch the penis up and slightly squeeze the tip to make the urethral opening wide enough for the applicator. Follow the directions given by your doctor and the written product directions for inserting the alprostadil pellet.

Tip : After you’ve inserted the pellet, massage the penis from tip to base or roll gently from side to side to make sure the alprostadil medication is fully distributed along the inside of the penis.

Tip : While you’re waiting for the alprostadil medication to work, sit, stand, or walk – don’t lie down because you need blood flow to go toward the penis to get a full erection.

Tip : Don’t use the applicator again. Each one is single-use only.

Alprostadil Penile Injection Therapy

Tip : If you have sickle cell anemia or trait, or leukemia or bone marrow tumor, you should not use alprostadil injection because of the risk of prolonged erections causing damage to your penis. You should also not use alprostadil injection if you have a constriction or bending of the penis that would make erections painful.

Tip : Some men experience prolonged erections after using alprostadil injection. This is a condition that needs to be treated immediately to prevent scarring within the penis that would be very likely to cause still more problems with erections in the future. If you have an erection that lasts for 3 hours and does not go away, contact your doctor immediately for emergency help. If your doctor is not available or does not provide this type of emergency help, go to the emergency department of a hospital where you can be treated.

Tip : After injecting alprostadil, you should be able to get an erection in about 5 to 20 minutes, with the erection lasting about 1 hour.

Tip : You may notice a small amount of bleeding after injecting alprostadil. Call your doctor if you are taking blood thinners or have a condition that interferes with blood clotting, or if you notice too much bleeding.

Tip : Because injecting alprostadil can cause a small amount of bleeding, you and your partner will be exposed to the possibility of infection through this route as well as through sex. Alprostadil does not provide you with any protection against AIDS or other sexually transmitted diseases. Make sure you take any precautions against sexually transmitted diseases that are needed in your situation.

Tip : Make sure you are taught to inject alprostadil and that you know where to inject it before you try to administer it to yourself. Follow your physician’s instructions and all written product information that you have received from your physician or pharmacist.

Tip : If the tip of the needle for injection is bent, don’t use it. The tip may break off and need to be surgically removed from your penis. Use the needle, syringe, alcohol swabs, and vials only once, then throw them away in a special container made for disposing of sharp medical waste, which your doctor or pharmacist can give you.

Tip : Wash your hands and keep your injection supplies clean and sterile as directed by your physician and the written product information. Dirty injections can cause infections.

Tip : Every time you use alprostadil injection, alternate the side of the penis that gets injected to give the other side a rest and allow healing.

Tip : Don’t inject the alprostadil solution if it is cloudy, colored, or contains particles. These are signs that something is wrong with it, and you will need to get a replacement solution.

Penile Device Therapy

Tip : Don’t use a vacuum pump, penile constriction ring, or penile splints to try to enlarge or extend your penis. They are not made for this, and you would be running the very real risk of causing tissue damage and permanent scarring within the penis. This can eliminate the ability to have erections.

Tip : Be sure you are always know how to take this type of device off quickly in case you feel pain or sense any other indications of damage to your penis. Don’t use them if you are likely to fall asleep or pass out, or if you are not fully alert.

Tip : Don’t use this kind of device if you have numbness in your penis or can’t feel your penis (this may be because of previous injury or nerve damage). You would not be able to tell if the device is harming your penis. If you develop numbness while using the device, stop using it immediately and call your doctor.

Tip : Don’t use this kind of device if you have decreased hand strength because this may make it difficult for you to take the device off.

Tip : When using a vacuum device, use the least amount of vacuum needed to get an erection. Too much vacuum can bruise your penis.

Tip : If you can’t get an erection when using a vacuum device, check the written troubleshooting suggestions provided by the manufacturer. Common problems include inexperience, air leak, too little lubrication, too much pubic hair, or pumping incorrectly.

Tip : Don’t use a constriction ring if you have Peyronie’s disease, are at risk for prolonged erections, or have scarring within the penis. A constriction ring can aggravate these conditions.

Tip : Some men experience prolonged erections after using constriction rings. This is a condition that needs to be treated immediately to prevent scarring within the penis, which would be very likely to cause still more problems with erections in the future. If you have an erection that lasts for 3 hours and does not go away, contact your doctor immediately for emergency help. If your doctor is not available or does not provide this type of emergency help, go to the emergency department of a hospital where you can be treated.

Tip : Don’t use a constriction ring for more than 30 minutes at a time. Using it for a prolonged amount of time could severely and permanently damage the penis.

Tip : Use the largest size constriction ring that works for you. Don’t use rings that are too small because too much constriction can damage the penis.

Tip : If you feel pain or discomfort while using any device on your penis for erections, stop using it, make sure you are using it correctly and have it positioned correctly, and call your physician if there is any risk of tissue damage to your penis.

Tip : Don’t use a device on your penis for erections if you are allergic to the materials it is made of (for example, latex).

Psychological Treatment (Sex or Couples Therapy)

Tip: The mind is the organ that really drives sex. Men often think of problems with erections as entirely physical. However, persistent negative feelings or bad situations that cause emotional stress may be important factors causing problems with erections. If so, going to a qualified therapist can do a lot of good, and spares you the side effects and potential problems of drug or device treatments. (Be sure the therapist is qualified to avoid fraud.)

Tip: Options for psychological therapy for yourself alone include identifying negative or self-defeating thoughts or assumptions that you have about your part in sex, and replacing them with thoughts and ideas that allow you to relax, be more positive, stop blaming yourself, and have more fun during sex.

Tip: Options for couples therapy include teaching couples to understand each other and communicate more positively about sex, giving them an opportunity to explain to each other what they want during sex, and discussing ideas for how couples can become more relaxed and playful when they have sex.