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In all cases, the subject returned to the study and completed the OLE phase without further worsening of the MS symptoms. None of the serious AEs were attributed to the study medication.

Sildenafil significantly improved erectile function and the ability to engage in satisfactory sexual activity in men with ED due to MS. Treatment with sildenafil was well tolerated, with 98% of the patients completing the study. Furthermore, oral sildenafil treatment resulted in significant improvements in both general and disease specific QoL variables, and the treatment therefore represents an important advance in the management of ED in this group of patients.

Although men participating in this study were ambulatory, indicative of their relatively mild spinal cord involvement (Kurtzke EDSS 13, 14 Although the pharmacological mechanism of sildenafil is not expected to affect desire and orgasmic function, both domains showed improvement in this current study. These improvements are thought to happen secondary to improvements in erectile function, with men feeling good about their ability to resume sexual activity and sildenafil enabling them to sustain an erection until orgasm is achieved. During the DB phase, AEs associated with sildenafil use occurred more frequently than in the placebo group, raising an issue about patients being unblinded and introducing bias when answering subjective questionnaires.

However, this is a potential issue in many clinical trials and the incidence of AEs related to sildenafil treatment in this study was comparable to that in other trials, for example, in patients with diabetes, 20 depression, 21 or SCI 22 (range, 31–40%). Efficacy of sildenafil is comparable in men with ED and concomitant MS (current study) or SCI. 13, 14 The ability to achieve an erection (IIEF Q3) was improved 1.6-fold in MS patients and 1.8-fold in SCI patients, whereas the ability to maintain an erection (IIEF Q4) improved 1.9-fold in MS patients and 2.1-fold in SCI patients. From the GEQ, the percentage of MS patients reporting improved erections was 90% for sildenafil users compared with 24% for placebo users; the percentage of SCI patients reporting improved erections was 75% for sildenafil users compared with 7% of placebo users. These data demonstrate that patients with ED due to spinal disease respond well to treatment with sildenafil. The results are comparable to or better than a population of patients with ED of mixed etiology (72–79%) 23 and markedly higher than in patients with diabetes mellitus (48–72%), 24 whose poorly preserved vasculature might be the main reason for low efficacy.

Interestingly, there appears to be a greater efficacy of sildenafil in patients with MS than in patients with diabetes, since 64% of men with MS preferred the 100 mg dose, compared with 75% of men with diabetes choosing that dose.

Moreover, greater efficacy in patients with MS may be due to the fact that sildenafil acts peripherally, and although pyschogenically driven erections are likely to have been impaired by spinal cord disease, reflexogenic responses, subserved by sacral segmental pathways, are still intact.

The average age of patients in this study is relatively young and with healthy peripheral neurovasculature a good erectile response is obtained by reflex mechanisms and what psychogenic responsiveness remains available.

Sildenafil was well tolerated in this study, as the majority of AEs reported during both phases were mild to moderate in severity and non-serious. AEs were those known to be associated with the mechanism of action of sildenafil, such as headache, vasodilation, and dyspepsia.

The following clinical investigators contributed to this study: Dr Hans Jacob Hansen, Arhus, Denmark; Dr Andreo Larsen, Helsinki, Finland; Dr Ragnar Stien, Moelv, Norway; Dr Morten Andersen, Moelv, Norway; Dr Sten Fredrikson, Huddunge, Sweden; Professor Clare Fowler, London, UK; Dr Mohammed K.

Sharief, London, UK; Dr Jackie Palace, London, UK; Dr Ronald Murray, Englewood, CO, USA; Dr Douglas Jeffery, Winston-Salem, NC, USA; Dr Michael Kaufman, Charlotte, NC, USA; Dr Mary Ann

Picone

VIAGRA is a phosphodiesterase-5 (PDE5) inhibitor indicated for the treatment of erectile dysfunction (ED) (1) DOSAGE AND ADMINISTRATION.

For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. However, VIAGRA may be taken anywhere from 30 minutes to 4 hours before sexual activity (2.1) Based on effectiveness and toleration, may increase to a maximum of 100 mg or decrease to 25 mg (2.1) Maximum recommended dosing frequency is once per day (2.1) DOSAGE FORMS AND STRENGTHS.

Tablets: 25 mg, 50 mg, 100 mg (3) CONTRAINDICATIONS.

Administration of VIAGRA to patients using nitric oxide donors, such as organic nitrates or organic nitrites in any form. VIAGRA was shown to potentiate the hypotensive effect of nitrates (4.generic viagra soft tabs online 1, 7.1, 12.2) Known vipps online pharmacy viagra hypersensitivity to sildenafil or any component of tablet (4.2) Administration with guanylate cyclase (GC) stimulators, such as riociguat (4.3) WARNINGS AND PRECAUTIONS. Patients should not use VIAGRA if sexual activity is inadvisable due to cardiovascular status (5.1) Patients should seek emergency treatment if an erection lasts >4 hours.

Use VIAGRA with caution in patients predisposed to priapism (5.2) Patients should stop VIAGRA and seek

medical

VIAGRA should be used with caution, and only when the anticipated benefits outweigh the risks, in patients with a history of NAION.

Patients with a "crowded" optic disc may also be at an

increased