We read with great interest the article by Francesco Montorsi et al reviewing the literature on vardenafil in the treatment of erectile dysfunction. The personal experience of the authors integrated with the clinical evidences from the literature on this matter brings out a paper very useful in the clinical practice. We focused our attention on the brief discussion on the haemodynamic effects of vardenafil, especially when associated with alpha blockers. Benign prostatic hyperplasia (BPH) is a condition that commonly affects older men and is often associated with lower urinary tract symptoms (LUTS) and sexual dysfunction [1]. The successful management of patients with LUTS associated with BPH should include assessments of sexual function and monitoring of medication-related sexual side effects. According to the revised labelling of vardenafil, Montorsi et al suggest that concomitant treatment of vardenafil should be initiated only if the patient has been stabilised on alpha blocker therapy for benign prostatic hyperplasia (BPH) and the maximum dose of vardenafil must not exceed 5 mg. Since the issue of concomitant use of vardenafil and alpha-blockers remains controversial, based on the findings of our studies, we would like to address our personal point of view. We investigated the influence of vardenafil 10 mg on blood pressure (BP) and heart rate (HR) in normotensive men with ED [2]. Four patients taking α1-blocker therapy (3 doxazosin; 1 tamsulosin) for BPH were also enrolled in our study. We performed multiple administrations and therefore multiple measurements of BP and HR changes. Worthy of note we observed an unexpected “first-dose effect” on cardiovascular parameters. In fact although BP and HR were significantly influenced by vardenafil 10 mg first administration, especially in patients on doxazosin, this interaction became clinically non-significant during following intakes. We believe this finding of some interest. Safety does not change but more attention is required. The association of vardenafil and alpha-blocker could have a synergistic effect of vasodilatation and the maximum 5 mg dosage of vardenafil suggested by Montorsi in patients on alpha-blocker therapy is probably a good recommendation. Unfortunately sometimes it could be insufficient to treat ED. Personally we believe that vardenafil 10 mg could be used even in those patients in treatment with alpha1-blockers for BPH. We only suggest, before starting therapies with vardenafil 10 mg in such patients, to measure baseline cardiovascular parameters and monitor them during the first drug intake.
Re:Montorsi F, SaloniaA,BrigantiA,Barbieri L, Zanni G, Surdi N, Cestari A, Montori P, Rigatti P. Vardenafil for the Treatment of Erectile Dysfunction: A Critical Review of the Literature Based on Personal Clinical Experience
MORELLI, GIROLAMO
2005-01-01
Abstract
We read with great interest the article by Francesco Montorsi et al reviewing the literature on vardenafil in the treatment of erectile dysfunction. The personal experience of the authors integrated with the clinical evidences from the literature on this matter brings out a paper very useful in the clinical practice. We focused our attention on the brief discussion on the haemodynamic effects of vardenafil, especially when associated with alpha blockers. Benign prostatic hyperplasia (BPH) is a condition that commonly affects older men and is often associated with lower urinary tract symptoms (LUTS) and sexual dysfunction [1]. The successful management of patients with LUTS associated with BPH should include assessments of sexual function and monitoring of medication-related sexual side effects. According to the revised labelling of vardenafil, Montorsi et al suggest that concomitant treatment of vardenafil should be initiated only if the patient has been stabilised on alpha blocker therapy for benign prostatic hyperplasia (BPH) and the maximum dose of vardenafil must not exceed 5 mg. Since the issue of concomitant use of vardenafil and alpha-blockers remains controversial, based on the findings of our studies, we would like to address our personal point of view. We investigated the influence of vardenafil 10 mg on blood pressure (BP) and heart rate (HR) in normotensive men with ED [2]. Four patients taking α1-blocker therapy (3 doxazosin; 1 tamsulosin) for BPH were also enrolled in our study. We performed multiple administrations and therefore multiple measurements of BP and HR changes. Worthy of note we observed an unexpected “first-dose effect” on cardiovascular parameters. In fact although BP and HR were significantly influenced by vardenafil 10 mg first administration, especially in patients on doxazosin, this interaction became clinically non-significant during following intakes. We believe this finding of some interest. Safety does not change but more attention is required. The association of vardenafil and alpha-blocker could have a synergistic effect of vasodilatation and the maximum 5 mg dosage of vardenafil suggested by Montorsi in patients on alpha-blocker therapy is probably a good recommendation. Unfortunately sometimes it could be insufficient to treat ED. Personally we believe that vardenafil 10 mg could be used even in those patients in treatment with alpha1-blockers for BPH. We only suggest, before starting therapies with vardenafil 10 mg in such patients, to measure baseline cardiovascular parameters and monitor them during the first drug intake.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
