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Doctors' Answers to "Frequently Asked Questions" - Impotence

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Impotence [posted 1/7/99]
Question: I am 49 years old and currently taking Rezulin and Insulin for diabetes. I had a triple bypass 8 months ago and began taking Norvasc, Accupril, and Atenolol. I have been having a significant problem in maintaining or even getting an erection. Can this be related to the medications I am taking? If so which ones?

Answer: Could be the diabetes, the medications or a secondary cause. First, check your prolactin, TSH and testosterone levels. This will rule out secondary causes. Secondly, check with your doctor, but cut out or decrease the dosage of one of your meds one at a time a week or so. There is some risk here depending on whether you have angina and what your bp is. Lastly, consider viagra, which is very effective in diabetes and some medication induced impotence, but has some risk due to your previous coronary disease.

Impotence & Viagra [posted 12/04/98]
Question: For the last appox. 3 years, I've been having a problem with some form of impotence. I'm a Diabetic. I also have a problem with my heart. I have strong desire for sex, and I do reach partial errection, but not a full errection. Is this a problem that could be the result of poor circulation? Can this problem be solved with Viagra? If so,can I take viagra with the heart problem and medications that I'm already taking? What are your suggestions?

Answer: Viagra should not be taken with nitroglycerin. Otherwise fairly safe if you don't over do it. When there is a soft erection, it usually works great. Have your thyroid function and testerone level checked. Both can cause this problem and are easily fixed with replacement meds which would not involve use of viagra.

Impotence Concerns [posted 10/30/98]
Question: I'm a 28 year old male that has had a problem getting and maintaining a strong erection. With some extensive effort I can get a weak erection, but its nothing like I'm used to seeing in myself. Infact, it feels and appears as if there is room for the penis to continue growing. If I am able to get an erection there is little sexual feeling in the head and shaft of my penis. I feel no pain. Have no trouble peeing or see any red or unusual coloring in my urine. Everything seems normal other than the forementioned. I have the drive. I lack the libido. I love sex and I love women, so what could be wrong. I don't believe I'm overly stressed or depressed, but not being able to 'perform' is causing some emotional distress. I saw a family practitioner a few weeks ago who prescribed yohimex. I've been on it for about 2weeks and have seen little to no improvement. Do I need to stay on it longer? The doctor mentioned the potential of Viagra as a method of maintaining the erection, but I feel I'm much too young to have to be placed on such medication....or to even be having this condition. What's going on or what can I do?

Answer: First, diagnose the cause. This could be low testerone, high prolactin or low/high thyroid levels. If these are normal, I would check with an endocrinologist. Not usual for a young man and I would try to diagnose the cause.

Viagra or Caverjet Injections for Erection Problems [posted 10/15/98]
Question: I am a 58 year old male, who is experiencing the inability to keep an erection long enough for normal intercourse. A recent check up indicated no medical peoblems at all. I have seen a urologist and have a prescription for the Caverjet injections. They work OK, but are very expensive. I can only use one every 24 hours, though. This is not good on week-ends! Is there a cheaper generic for Caverjet? Or, would it be cheaper to use Viagra? Other than the cost, what are the pros and cons of penile implants? Got any other suggestions?

Anser: Don't get an implant as long as the caverjet and/or viagra works. Try the viagra, sounds perfect for your problem.

Impotence & Carisoprodol [posted 10/1/98]
Question: I was given carisoprodol for relief of muscle spasms in my shoulder after an ac separation. Since I started taking this I have not been able to maintain an erection for over 5 min. Could this drug be causing this or am I just blaming the wrong thing? thank you

Answer: Probably the drug.

Impotence & Siunus Medications [posted 9/29/98]
Question: I have been taking PAN MISTtm LA containg Pseudoephedrine HCI 90 mg & Guaifenesin for a sinus infection for about a week. I have been impotent for two days now. Is there a connection here? I have never suffered this problem in the past.

Answer: No obvious connection-give it some time after your recovery.

Impotence Treatment with Oral Phentalomil [posted 8/13/98]
Question: I recently received an offer for (brand name) Oral Phentalomil, a pill that purportedly reverses impotence. It is offered by mail from the U.S. Academy of Urological Sciences. Is this an accredited organization and is there any truth to their claims that Oral Phentalomil actually works, or is it just another "sugar" pill?

Answer: Never heard of the drug or the organization. You might note that it cannot be prescription and I'm not aware of any non-prescription drug that works for impotence.

Impotence [posted 8/7/98]
Question: I am a 26 year old male and I have high blood pressure. I am currently taking norvasc. I used to take procardia about a year ago. It seems that when my wife and I got together in 1992, our sex life was very good, as I would be able to last for hours at a time. This went on for about two years, then the erection problems started happening. It's been almost two years since this problem has been happening. I thought that it might be the medicine and also me because I am overweight, but I really don't know. I would like to know if it's the medicine, so I can get back to the way things were when my wife and I first met.

Answer: Why did you stop the Procardia? It is a calcium channel blocker also, but works very differently from Norvasc. Try the procardia again unless there is a contraindication or take a holiday from the Norvasc for a day or two and see what happens to your sexual prowess.

Impotence Treatment
Question: What can be done for impotence. I read an article in a newspaper about Viagra. Is it available? When will it be on the market?

Answer: There are three or four medications just about to be released for impotence. I suspect it will be available within the next six months.

Oral drugs for Impotence
Question: There are three drugs now in various(Phase III) stages of research: Viagra(Pfizer) Apomorphine(Tap) and Vasomax (Zonagen). Which of these is most effective for venous leakage causes of erectile dysfunction?

Answer: I don't have enough experience with them as yet to tell you. At this point, I would check with a Urologist who specializes in erectile dysfunction.

Prescription Drugs and Impotence
Question: Are there newer drugs for the treatment of high blood pressure, diabetes, and heart medication that do not have the side effect of sexual impotence in men?

Answer: Impotence with drugs is a very individual process. That is, what produces impotence in one will not in the other. Consequently, a selective approach by eliminating one at a time is a good place to start. Some classes like ACE inhibitors tend to be less, but no class is free of this problem. If you send me the names of the drugs, I can tell you what I'd start with. Certain drugs are more likely than others. Also, depending on the severity of the hypertension, etc... a drug holiday can work(that is, skipping the drugs once a week on those times that you'd like to have sex). Start by finding the drug that is causing the problem.

Question: Why do tenormin and other beta blockers keep a man from obtaining erection?

Answer: There are several reasons and they probably differ from individual to individual. Getting an erection is an incredibly complex undertaking. It takes just the right balance between the sympathetic and parasympathetic nervous system. It also requires sufficient blood pressure to extend the chambers of the penis necessary to obtain erection. Any blood pressure pill can interfere with either of the nervous systems or the blood supply. The only effective way to avoid the problem is to switch medications or take short drug holidays, depending on why you are on beta-blockers. This needs to be discussed with your physician.

Question: My husband is taking 10 mg Prinivil and 40 mg Corgard daily. Do either of these drugs, taken alone or together, cause impotence?

Answer: Either of these can cause erectile dysfunction. Discuss this with his physician, but generally holding them for a day or two won't be a major problem. If this fixes the problem then add them back one at a time to see if either alone is causing the problem or if it is an additive effect. Many men will take 12-24 hour drug holidays to get an erection. However, this depends on why he is taking the drugs - is it for a serious problem? Also, switching to other drugs might eliminate the problem.

Question: Is using Trazadone for impotence worth trying? How does it work?

Answer: Trazadone would not be my first pick for impotence. The first step in evaluating impotence is to check the testosterone, prolactin, and TSH levels (for low thyroid). Each of these in the wrong levels (high or low) can cause erectile dysfunction. If these hormones are normal then evaluation of the vascular supply is next. There are several mechanical ways to attain an erection. You'll need to see a physician to utilize these. Antidepressants usually decrease sexual drive and the ability to have orgasm, but not erections per se. Often anxiety, depression, etc., will lead to erectile dysfunction. Treatment with Trazadone might help this type of dysfunction.

Impotency and Causes
Question: Is there any truth to the old adage of "use it or loose it" in regards to if you are not sexually active it can cause impotency? My husband is being treated for impotency with the drug, Yohimbine (5.4 mg one tablet 3 times per day). He believes that his impotency was cause by our not being sexually active enough.

Answer: Sounds good, but it is not true. However, not having sex for whatever reason can produce psychological blocks which will lead to impotency. I would focus on the reasons for not having sex rather than assess blame.

Question: I take flonase, acupril, and claritan d for allergies. Could these drugs cause a problem with achieving a erection or keeping one?

Answer: Accupril is an ACE inhibitor. Usually used for treatment of blood pressure and other assorted problems. I'm not aware of any benefit from treating allergies. However, it commonly causes erectile dysfunction.

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