david89 Posted December 9, 2015 Share Posted December 9, 2015 Hello all I was wondering if i could ask for some guideline when prescribing viagra or cialis for patients with erectile dysfunction. my field is family medicine please and thank you Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 9, 2015 Administrator Share Posted December 9, 2015 1) There are at least two other PDE-5's on the market that I'm aware of off the top of my head--Stendra and Levitra. 2) No nitrates, ever. 3) Never prescribe branded Viagra unless you own stock in Pfizer. Sildenafil Citrate 20 mg tabs are far cheaper, even if you have to use 2-5 at a time. 4) ASK. Especially your chronic pain patients or those on beta blockers or SSRIs. 5) Never put a 40-60 year old male on a beta blocker as a first line HTN medication as a primary care clinician. If their cardiologist did it, leave them on it and work with the ED meds. 6) If you're giving ED meds to an unmarried gentleman, be sure to address safer sex, too. BUT, realize that ED med use doesn't always require a partner. 7) Be sure to address the underlying, reversible/controllable conditions which can lead to ED--stress, certain medications, DM II, etc. My $0.02. Link to comment Share on other sites More sharing options...
david89 Posted December 9, 2015 Author Share Posted December 9, 2015 thank you for the helpful tips Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 9, 2015 Share Posted December 9, 2015 Make sure the patient is healthy for sex. A resting BP of 180/110 is not ok for any type of ED drug or vigorous sex. When a guy is more worried about his rx than his stroke level bp - you have a prioritization problem. When 4 L of O2 by NC only garners an O2 sat of 93 - ED is truly the least of the worries. The most reversible types of ED are smoking, etoh, bp and dm - and this is usually an all inclusive deal. Smoking a pack a day, 6-12 beers a day, high BP and an A1c of 9 or more = ED - no real chemical fix. If those are ALL broken - all the ED drugs in the world might not help and patients have lost sight of the forest and are only looking for one strong tree - pun intended. Stress fixing the underlying problems. Dementia and ED drugs are not a good mix either. If the partner is in the room and looks terrified of the idea of an ED drug - investigate the relationship and see if both parties are willing and able participants and if there are psychological issues in the couple or dementia. Generic Viagra at the 20 mg pill dose is a great idea. It is usually used for pulmonary hypertension but works the same at the 40-60-80-100 mg dosing as 50mg or 100 mg of brand Viagra. Don't forget psych issues and how SSRIs dampen orgasmic response. This isn't ED - it is SSRI side effect. Don't confuse the two. Taking a pill to fix another pill to fix another issue becomes a circus of side effects and bad outcomes. NOTHING is like the cutesy commercials on the TV - ever. Link to comment Share on other sites More sharing options...
BruceBanner Posted December 9, 2015 Share Posted December 9, 2015 Agree with above---general approach is to ask if they have a lack of sexual desire or a mechanical erectile problem. BBs, SSRIs are common medication culprits. If it is purely mechanical, testosterone is unlikely to be the culprit and cialis, levitra, or sildenafil are all interchangeable. Stendra sucks, I've tried it on several patients and it did nothing for them. If it is a combination of low libido and ED, then check testosterone. I've solved many men's ED issues by putting them on TRT when indicated. Link to comment Share on other sites More sharing options...
swooshie1 Posted December 13, 2015 Share Posted December 13, 2015 I always ask if they still get morning (or mid-sleep) erections; if yes, more likely psychogenic, if no, check all the physiological culprits. prescription based only on those findings. Link to comment Share on other sites More sharing options...
UGoLong Posted December 13, 2015 Share Posted December 13, 2015 Any insurance or pharmacy push-back on ordering the pulmonary hypertension dose of sildenafil and then not tid, which is the dose for that? Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 13, 2015 Moderator Share Posted December 13, 2015 need to be able to walk a flight of stairs with out stoping or getting winded go with what ever is cheapest safe sex talk no nitrates, never ever - send those patients to Cardio if they insist.... Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 13, 2015 Administrator Share Posted December 13, 2015 Any insurance or pharmacy push-back on ordering the pulmonary hypertension dose of sildenafil and then not tid, which is the dose for that? Nope. I have had it covered as a generic nonpreferred, which can be about the same as cash price of ~$1.25 a pill, about 1/6th the price of branded viagra. Link to comment Share on other sites More sharing options...
LKPAC Posted December 14, 2015 Share Posted December 14, 2015 generic Viagra = a tongue depressor and a rubber band. Link to comment Share on other sites More sharing options...
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