Classification of oral medications for treating erectile dysfunction in Western medicine and the application and safety of Viagra.

231.

Western medicine treatment of erectile dysfunction

Medication is currently the preferred treatment method.

In recent years, significant progress has been made in the treatment of erectile dysfunction. However, due to the complexity of its etiology and the lack of clarity regarding the erection mechanism, the efficacy of oral medications (both traditional Chinese and Western medicine) for treating erectile dysfunction has often been uncertain, and finding a truly ideal oral medication is also difficult. Fortunately, with the continuous deepening of research into the physiology of penile erection, it will be easier to discover new drugs to achieve the desired results.

Oral medications for treating erectile dysfunction can be divided into two main categories based on their site of action: central and peripheral drugs.

(1) Central nervous system stimulants: ① Caffeine, a central nervous system stimulant, can stimulate the central nervous system and heart, relax smooth muscles, and is used to treat impotence.

Take 0.03–0.1 grams each time, three times a day.

② Strychnine: It can selectively enhance the excitatory function of the spinal cord. The therapeutic dose (1 mg) can increase the irritability of the spinal cord response, shorten the reflex time, facilitate the conduction of nerve impulses, and cause skeletal muscle contraction, resulting in tonic-clonic seizures.

It is now believed that the mechanism of strychnine's excitatory effect is "de-inhibition," that is, the result of blocking the feedback inhibition and reciprocal inhibition of spinal cord interstitial cells.

It has a non-selective effect on erectile dysfunction and is often used as a general stimulant in combination with vitamin E, yohimbine, etc.

The usual dosage is 1 mg each time, once or twice a day, orally.

Its mechanism of treating erectile dysfunction may lie in stimulating the erection centers of two segments of the spinal cord.

(2) Adrenergic antagonists: The most commonly used are phentolamine and yohimbine.

Recent experience has shown that the combined use of yohimbine and clopidogrel is more effective than yohimbine alone.

(3) Smooth muscle relaxants: Nitrates and nitrites have the effect of relaxing vascular smoothing agents, thereby dilating blood vessels.

Nitroglycerin applied to the skin can be absorbed quickly.

Therefore, nitroglycerin is more suitable for treating vascular erectile dysfunction.

However, experimental research is still underway and further clinical confirmation is needed.

(4) Dopamine receptor agonists: Subcutaneous injection of apomorphine can induce penile erection in normal individuals and patients with erectile dysfunction.

(5) Microcirculation improver: Used for organic impotence, containing vitamin B₁, vitamin B₁₂, vitamin E, ATP, and amino acid.

(6) Low-dose tranquilizers: used for psychogenic impotence, including B vitamins, vitamin E, etc.

(7) β-adrenergic stimulants: Isosuprine has been reported to be effective in treating impotent patients who smoke heavily. The dosage is 10-20 mg orally three times a day, with few side effects.

(8) Aldose reductase inhibitors: effective for impotence caused by diabetic neuropathy. Sobinil is commonly used, but it has a very slow onset of action.

Due to the complexity of the erection mechanism, which involves multiple factors from the central nervous system to peripheral neurotransmitters, the combined use of several drugs may be more effective. However, it should be emphasized that because sexual function regulation is very complex, improper methods can be counterproductive.

Therefore, patients must not blindly follow the doctor's instructions and must strictly adhere to the prescribed medication regimen.

232.

Viagra as a treatment for erectile dysfunction

Viagra is an oral medication produced by Pfizer, Inc. in the United States. It was introduced in the last three or four years to treat erectile dysfunction. Since its launch in my country in 2000, it has been welcomed by many patients with erectile dysfunction due to its good efficacy and convenient administration.

The drug "Viagra" is called "Sildenafil Citrate" and its brand name is "Viagra".

It relaxes the smooth muscle of the corpus cavernosum and the smooth muscle of the small arteries of the penis, increasing blood flow into the cavernous sinuses and thus causing an erection.

So how effective is Viagra in treating erectile dysfunction? According to a report by Goldstein et al., who observed the effects and safety of Viagra in 861 patients with organic, functional, and mixed erectile dysfunction, the improvement in erectile function was positively correlated with the dosage of Viagra. That is, the higher the dosage, the greater the improvement in erectile function. The frequency of penile erection and successful vaginal penetration increased by 60%, 84%, and 100% respectively in the 25 mg, 50 mg, and 100 mg groups compared with before using Viagra.

After penile insertion into the vagina, the ability to maintain an erection increased by 121%, 133%, and 130% respectively compared to before using Viagra.

Orgasm, sexual intercourse satisfaction, and overall satisfaction also improved significantly, but the effect on libido was not obvious.

According to research results from relevant experts in my country, the overall clinical efficacy rate of Viagra is 81%, and its effects on erectile dysfunction caused by organic, functional, and mixed causes are similar.

This shows that Viagra is indeed effective in treating erectile dysfunction caused by different etiologies (including psychological, organic, and mixed factors).

However, it must be emphasized that although Viagra has the advantages of being convenient to use and having good effects, it is still very important to focus on treating the underlying cause of erectile dysfunction.

233.

Safety of Viagra in treating erectile dysfunction

Based on the use of Viagra to treat erectile dysfunction in recent years, both abroad and in my country, the main adverse reactions and side effects include headache, facial flushing, and indigestion. In a few cases, visual abnormalities, nasal congestion, urinary tract infections, diarrhea, and rashes may also occur. Furthermore, the number of adverse reactions increases with the dosage.

However, the vast majority of adverse reactions are mild and transient, and can be resolved without any treatment.

In my country, it is currently available in 50 mg/tablet and 100 mg/tablet packaging. It is generally taken 1 hour before sexual activity, and the daily dosage should not exceed 1 tablet. However, the effective dosage varies from person to person.

Studies have shown that oral administration of 100 mg of Viagra once a day is an effective and safe treatment for erectile dysfunction patients of various causes.

However, since sexual activity itself can trigger heart disease, heart disease patients should be cautious when using Viagra.

Experts advise that this medication should be used with caution in patients with heart disease, coagulation disorders, active ulcers, or retinitis, and should be used strictly according to medical advice.

In addition, Viagra has the potential to lower blood pressure, so it should not be used by men with erectile dysfunction who are receiving any type of nitrate medication, such as nitroglycerin tablets, drops, patches, or isosorbide dinitrate.