Erectile Dysfunction: Medicines to Treat ED

By WebMD

Some men with erectile dysfunction, or ED, find they can return to an active sex life by treating an underlying condition, such as high blood pressure, or with counseling and lifestyle changes. But others find they may need medication to get and keep an erection.

The FDA has approved several prescription drugs you take orally to treat ED.
What Medications Are Available?

All of these work by relaxing your muscles and boosting blood flow to your penis, making erections easier to get and maintain. They are:

  • avanafil (Stendra)
  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra, Staxyn)

Caution: Do not use these ED medications if you take nitrates, such as nitroglycerin or a similar medicine, for chest pain. The combination can cause dangerously low blood pressure.
Are There Differences in Them?

These medications all work similarly to each other. However, there are subtle differences in how long they stay effective and how quickly they begin to work.

Levitra takes about 30 minutes to start working and the effects last a little longer than Viagra, about 5 hours.

Staxyn dissolves in your mouth. It contains the same active ingredient as Levitra and can begin working in about 15 minutes.

Viagra takes around 30 minutes to become effective and lasts about 4 hours.

Cialis lasts much longer — up to 36 hours in some cases.

Stendra can start doing its thing in as little as 15 minutes, and its effects last up to 6 hours.
Can I Make a Switch?

Yes. You may find that one works better for your schedule or that there are differences in the side effects for you. But these medications work the same basic way, so you’re likely to have similar results.
What Precautions Should I Take?

Again, do not use these ED medications if you take nitrates, such as nitroglycerin or a similar medicine, for chest pain. But there are other situations that may make these medications unsafe as well. Before you take Viagra or one of the others, tell your doctor:

Get emergency medical help if you have signs of an hypersensitive reaction to Cialis: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
due to the fact scientific trials are performed under extensively various situations, destructive response rates discovered inside the scientific trials of a drug can’t be directly compared to rates within the medical trials of every other drug and won’t mirror the quotes observed in exercise.
Buy cialis day by day, it can soak up to five days for the full effect to come back into effect, as the low dose builds up gradually. But, after this time it’ll work constantly.
Preservation dose: 5 to 20 mg orally as soon as an afternoon, as wanted, previous to sexual pastime based on character efficacy and tolerability.

If you are allergic to any medications, including other ED medications
About any prescription or nonprescription medications you take, as well as any herbal and dietary supplements
If you are scheduled for surgery, even dental surgery
If you take alpha-blockers for blood pressure or prostate problems. These can lower your blood pressure when taken with ED pills.

Always follow the directions on your prescription label carefully. Also, make sure to ask your doctor or pharmacist to explain anything you don’t understand. Take these drugs exactly as directed.

Source: http://www.webmd.com/erectile-dysfunction/guide/cialis-levitra-staxyn-viagra-treat-ed

Drugs Not Equal Against Bladder Infection

By medpagetoday.com

For uncomplicated bladder infections, cefpodoxime (Vantin) may not be a viable antibiotic alternative to fluoroquinolone ciprofloxacin (Cipro, Proquin), a randomized trial suggested.

More women needed further treatment after a short course of the cephalosporin than after the same duration of ciprofloxacin (clinical cure rate 82% versus 93%), Thomas M. Hooton, MD, of the University of Miami, and colleagues found.

The difference didn’t meet criteria for noninferiority (P=0.57), the researchers reported in the February 8 issue of the Journal of the American Medical Association.

Fluoroquinolones are considered the most reliable for treating urinary infections, but the search has been on for other, effective antimicrobials in this setting because of rising resistance to fluoroquinolones, the group explained.

“These findings, along with concerns about possible adverse ecological effects associated with other broad-spectrum beta-lactams, do not support the use of cefpodoxime as a first-line fluoroquinolone-sparing antimicrobial for acute uncomplicated cystitis,” Hooton and colleagues concluded.

Use of broad-spectrum cephalosporins has been seen to promote resistance across the beta-lactamase class, with one study linking parenteral use to gram-negative extended-spectrum beta-lactamase antibiotic resistance, they explained.

And largely citing concerns for resistance to lead to more serious and difficult-to-treat infections outside the urinary tract, the Infectious Diseases Society of America has recommended that fluoroquinolones be reserved for important uses other than acute cystitis.

The bottom line is that clinicians should look to other antibiotics before fluoroquinolones and beta-lacams like cefpodoxime, the researchers emphasized. Other recommended options are:

  • Nitrofurantoin
  • Trimethoprim-sulfamethoxazole, except in areas of known high the resistance prevalence
  • Fosfomycin (Monurol)
  • Pivmecillinam (Selexid, not available in the U.S.)

The trial randomized 300 women, ages 18 to 55, with acute uncomplicated cystitis to double-blind treatment with a three-day course of either ciprofloxacin orally (250 mg twice daily) or oral cefpodoxime (100 mg twice daily).

For the primary endpoint, ciprofloxacin gave a statistically significant 11% higher overall clinical cure rate, defined as no requirement for antimicrobial treatment during 30 days of follow up.

That difference exceeded the predetermined 10-percentage point margin for noninferiority of cefpodoxime that the researchers suggested would have been clinically acceptable.

Changing the assumption that women lost to follow up had been cured of their infection to one in which they were considered to have not responded to treatment didn’t change the results. Cefpodoxime still came out significantly worse with a clinical cure rate of 71% compared with ciprofloxacin’s 83%.

The difference between efficacy of the drugs was greatest among women who reported not having a urinary tract infection within the prior year, while ciprofloxacin barely came out ahead of cefpodoxime among women who had at least one recent urinary tract infection (84% for ciprofloxacin versus 80% for cefpodoxime).

Microbiological cure rates came in at 96% with ciprofloxacin compared with 81% with cefpodoxime, a statistically significant difference of 15% (95% CI 8% to 23%).

More than 80% of the women in both groups had vaginal colonization with Escherichia coli at baseline, which cefpodoxime was not effective at clearing.

By the first follow up at around five days, 16% of women in the ciprofloxacin group versus 40% on cefpodoxime still had vaginal E. coli colonization. At 30 days, the rate was still 29% versus 40%.

Those findings suggest one reason why beta-lactam antibiotics like cefpodoxime yield lower clinical response than other first-line antimicrobials, the researchers pointed out.

They noted that the highly compliant, largely white student population in the study might limit generalizability.

Source: https://www.medpagetoday.com/urology/urology/31084