LONG-TERM EFFICACY OF SILDENAFIL AND TACHYPHYLAXIS EFFECT

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Sep 2001LONG-TERM EFFICACY OF SILDENAFIL AND TACHYPHYLAXIS EFFECT RIZK EL-GALLEY, HARRY RUTLAND, RIYADH TALIC, THOMAS KEANE, and HARRY CLARK RIZK EL-GALLEYRIZK EL-GALLEY More articles by this author , HARRY RUTLANDHARRY RUTLAND More articles by this author , RIYADH TALICRIYADH TALIC More articles by this author , THOMAS KEANETHOMAS KEANE More articles by this author , and HARRY CLARKHARRY CLARK More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65866-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We observed that patients who initially responded to sildenafil frequently became resistant to it with time. We evaluated the long-term efficacy of sildenafil. Materials and Methods: A telephone survey was conducted of patients during the first year of sildenafil usage, and another one was completed 2 years later of the same group. Results: During the first survey, the etiology of impotence included post radical prostatectomy in 25, arterial insufficiency in 26, diabetes in 19, neurogenic impotence in 12, suspected venous leak in 9, proved venous leak in 7, Peyronie’s disease in 6 and unspecified in 47 patients. The overall improvement rate, which was defined as the ability to initiate and maintain erections for successful intercourse, was 74%. The dose necessary to achieve this response was 100 mg. sildenafil in 15% of patients, 50 mg. in 83% and 25 mg. in 2%. During the second survey, information was collected on 82 patients and only 43 (52%) had continued treatment. Of the 69 patients who reported an initial good response 41 (59%) were still using sildenafil, and of the 43 who were still using it 16 (37%) had to increase the dose by 50 mg. to achieve an adequate result. There was no significant relationship between the need to increase the dose and frequency of treatment per month. Reduction in efficacy ranged from 15% to 50% (mean 36 ± 12%) and the time to loss of efficacy ranged from 1 to 18 months (mean 11 ± 5). Of the 82 patients in the second surgery, 39 (48%) stopped using sildenafil. A total of 28 (74%) patients reported a good initial response on the first survey, and 6 had spontaneous erections and no longer needed treatment. However, 14 (50%) patients discontinued sildenafil because of the loss of efficacy. In this group 10 patients had side effects, mainly headache and flushing of the face and nose, and only 2 discontinued treatment because of them. Conclusions: Our data suggest that there is a possible tachyphylaxis effect with sildenafil. Of the patients who were followed for 2 years 20% had to increase the sildenafil dose to have the same effect and 17% discontinued use due to loss of efficacy. References 1 NIH consensus development panel on impotence. Impotence. JAMA1993; 270: 83. Google Scholar 2 : Treatment of erectile dysfunction after radical prostatectomy with Sildenafil citrate (Viagra). Urology1998; 52: 963. Google Scholar 3 : Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol1996; 78: 257. Google Scholar 4 : Clinical guidelines panel on erectile dysfunction: summary report on the treatment of organic erectile dysfunction. The American Urological Association. J Urol1996; 156: 2007. Link, Google Scholar 5 : Intracavernous injection of papaverine for erectile failure. Lancet1982; 2: 938. Google Scholar 6 : Treatment of male erectile dysfunction using the vacuum assisted device. 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Google Scholar From the Departments of Urology, University of Alabama, Birmingham, Birmingham, Alabama, and Emory University, Atlanta, Georgia, and King Khalid University, Riyah, Saudi Arabia© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited BySafarinejad M and Hosseini S (2018) Salvage of Sildenafil Failures With Bremelanotide: A Randomized, Double-Blind, Placebo Controlled StudyJournal of Urology, VOL. 179, NO. 3, (1066-1071), Online publication date: 1-Mar-2008.Burnett A (2018) Erectile DysfunctionJournal of Urology, VOL. 175, NO. 3S, (S25-S31), Online publication date: 1-Mar-2006.STEPHENSON R, MORI M, HSIEH Y, BEER T, STANFORD J, GILLILAND F, HOFFMAN R and POTOSKY A (2018) TREATMENT OF ERECTILE DYSFUNCTION FOLLOWING THERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER: PATIENT REPORTED USE AND OUTCOMES FROM THE SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS PROSTATE CANCER OUTCOMES STUDYJournal of Urology, VOL. 174, NO. 2, (646-650), Online publication date: 1-Aug-2005.MUSICKI B, CHAMPION H, BECKER R, KRAMER M, LIU T, SEZEN S and BURNETT A (2018) IN VIVO ANALYSIS OF CHRONIC PHOSPHODIESTERASE-5 INHIBITION WITH SILDENAFIL IN PENILE ERECTILE TISSUES: NO TACHYPHYLAXIS EFFECTJournal of Urology, VOL. 174, NO. 4 Part 1, (1493-1496), Online publication date: 1-Oct-2005.LIN G, XIN Z, LUE T and LIN C (2018) Up and Down-Regulation of Phosphodiesterase-5 as Related to Tachyphylaxis and PriapismJournal of Urology, VOL. 170, NO. 2S, (S15-S19), Online publication date: 1-Aug-2003.Steers W (2018) Editorial: Tachyphylaxis and Phosphodiesterase Type 5 InhibitorsJournal of Urology, VOL. 168, NO. 1, (207-207), Online publication date: 1-Jul-2002. Volume 166Issue 3September 2001Page: 927-931 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordstreatment outcomepenisimpotencetachyphylaxisMetricsAuthor Information RIZK EL-GALLEY More articles by this author HARRY RUTLAND More articles by this author RIYADH TALIC More articles by this author THOMAS KEANE More articles by this author HARRY CLARK More articles by this author Expand All Advertisement PDF DownloadLoading ...