Viagra (Sildenafil) Treatment for Opioid Induced Erectile Dysfunction

Sildenafil Citrate is sold as Viagra or Revatio. FDA approves Viagra for erectile dysfunction and pulmonary hypertension. Viagra is a phosphodiesterase-5 (PDE5) inhibitor, which in turn modulate enzyme cGMP. Enzyme cGMP regulates blood flow to penis. Increased penile blood flow to cavernous sinuses results in erection. Erectile dysfunction is often caused by lower testosterone. Opioid lowers testosterone level. Low testosterone level result in libido and inability to sustain an erection. Viagra improves blood circulation in penile cavernous tissue resulting in erection. Viagra is also effective in treating female sexual dysfunction caused by long acting opioid. Opioids are very effective in pain management. Long-term opioid use may cause liver and kidney toxicity. Metabolism and excretion of Viagra is slow in patients suffering with liver and kidney diseases.

Viagra (Sildenafil) Treatment for Opioid Induced Erectile Dysfunction

Most of the Viagra in patients suffering with liver diseases remains in active form since breakdown (metabolism) of Viagra in liver is slow. Concentration of Viagra is higher in patients taking opioids for long time and suffering with liver disease. Patient taking opioids for chronic pain must check liver function routinely if Viagra pills are prescribed for erectile dysfunction. Prolonged half-life of Viagra occurs secondary to slow metabolism of Viagra caused by liver diseases and/ or slow excretion caused by kidney diseases. Prolonged half-life and increased blood concentration of Viagra may eventually result in multiple side effects including priapism. Viagra also adds analgesic effects to opioids. Recent study published by Yoon M suggests Viagra when use intrathecally in mice has anti-nociceptive effects like morphine.1 Dihydrocodone opioid has caused prolonged erection (priapism) when used with Viagra.2

VIAGRA: Side Effects and Complications

Allergic Reaction

  • Hives
  • Difficulty breathing
  • Swelling and angioneurotic edema of face, lips, tongue, or throat.
  • Loss of hearing, ringing in the ears and dizziness may occur.
  • Sudden vision loss secondary to non-arteritic anterior ischemic optic neuropathy

These symptoms can be life threatening, go to ER or call your doctor immediately, if necessary call 911.

Symptoms and Signs Observed During Sexual Activity:

  • Dizziness
  • Nauseated
  • Chest pain radiating to shoulder or left arm
  • Numbness, or tingling over chest, arms, neck, or jaw
  • Penis erection - painless and lasts 4 hours or longer,
  • Priapism - painful erections greater than 6 hours in duration

Go to ER or call your doctor immediately.

Symptoms and Sign That May Need Immediate Attention:

  • Myocardial Infarction
  • Ventricular Arrhythmia
  • Cerebrovascular Hemorrhage
  • Transient Ischemic Attack
  • Chest Pain
  • Syncope
  • Wheezing
  • Dyspnea

The above symptoms can be life threatening, go to ER or call your doctor immediately, if necessary call 911.

Common Side Effects May Not Be Life Threatening

  • Facial Flushing
  • Headaches
  • Stomach Pain
  • Nasal Congestion
  • Nausea
  • Diarrhea
  • Inability to Differentiate Between the Colors Green and Blue.

Call your doctor immediately if there is increase in any symptoms..

Avoid Viagra in Following Conditions:

Viagra should be avoided in following conditions while taking following medications and illnesses.

Nitrates - Nitrites like glyceryl trinitrate, sodium nitroprusside and amyl nitrate

  • Cardiovascular Disease
  • Hepatic Impairment
  • Severe Renal Impairment
  • Hypotension
  • Stroke
  • Retinal Disorders

Viagra Side Effects, Which May Need Further Investigations

Viagra may cause multiple side effects secondary to drug sensitivity, decreased metabolism and associated illnesses. Side effects which may not be life threatening are as follows -

A. General Symptoms

  • Nausea
  • Sweating
  • General ill feeling
  • Gingivitis
  • Dry mouth
  • Breast Enlargement
  • Physical deformity of the penis (such as Peyronie's disease)

B. Skin

  • Rash
  • Urticaria
  • Pruritus
  • Skin ulcer
  • Dermatitis - Contact dermatitis, and exfoliate dermatitis

C. Ears

  • Ringing in your ears, or sudden hearing loss
  • Tinnitus
  • Deafness
  • Ear Pain

D. Eyes

  • Mild and Transient Blue or Colored Tinged Vision
  • Mydriasis
  • Conjunctivitis
  • Photophobia
  • Eye hemorrhage
  • Cataract
  • Dry eyes

F. Musculoskeletal Problems Related to Use of Viagra

  • Bone Pain
  • Muscle Pain - Myalgia, Myasthenia, Tendon Rupture and Tenosynovitis,
  • Synovitis
  • Joint Pain - Gout, Arthritis and Arthrosis
  • Back Pain

G. Nervous System Side Effects of Viagra

  • Headache
  • Migraine
  • Dizziness
  • Ataxia
  • Tremor
  • Vertigo
  • Sleep Abnormalities-Insomnia, Somnolence, and Abnormal Dreams
  • Memory Problems
  • Cerebral Thrombosis
  • Neuropathy-Neuralgia, Paresthesias and Hypesthesia.
  • Depression
  • Decreased Reflexes

H. Cardiovascular Problems Related to Viagra

  • Tachycardia
  • Hypotension
  • Hypertension
  • Palpitation
  • Postural Hypotension
  • Myocardial Ischemia
  • Heart Failure
  • Cardiomyopathy

I. Gastrointestinal Side Effects of Viagra

  • Glossitis
  • Esophagitis
  • Dyspepsia
  • Stomatitis
  • Stomach - Gastritis, upset stomach
  • Abnormal Liver Function Tests
  • Diarrhea
  • Abdominal Pain
  • Intestine-Diarrhea, Gastroenteritis, Colitis
  • Rectal Hemorrhage

J. Respiratory Problems Related to Viagra

  • Pharyngitis
  • Nasal Congestion
  • Sinusitis
  • Bronchitis
  • Pulmonary Hypertension (PH)
  • Increased Sputum Production

K. Genitourinary Side Effects of Viagra

  • Urinary Tract Infection
  • Bladder Symptoms-Cystitis, Nocturia and Urinary Frequency in 2% of patients
  • Urinary Incontinence
  • Abnormal Ejaculation
  • Genital Edema

L. Hematologic

  • Anemia
  • Leukopenia

M. Metabolic

  • Thirst
  • Hyperglycemia
  • Hypoglycemia
  • Hypernatremia

Viagra: Drug Interactions

Patient taking opioids and Viagra should be carefully monitored for side effects.

Protease Inhibitors - Protease inhibitors inhibits metabolism of Viagra and thus increases blood concentration of Viagra. Side effects are severe because of increased blood level of Viagra. Protease inhibitors are used for treatment of HIV.

Drugs that prolong metabolism of Viagra - Erythromycin, cimetidine.

Blood Pressure Medications - Viagra may cause low blood pressure in-patient taking alpha-blocker for hypertension.

Pregnancy Guidelines for Viagra: Approved by FDA are as follows

  • Avoid during pregnancy to prevent congenital abnormalities to an unborn baby.
  • Breast Feeding- Avoid Viagra treatment during period of breast feeding. It is not known if sildenafil passes into breast milk or if it could harm a nursing baby.

Investigation

  • Blood Examination - To rule out liver and kidney diseases.
  • MRI - To diagnose liver and kidney diseases.
  • Ultrasound.
  • Electrocardiogram - To evaluate cardiac side effects.
  • X-ray - To evaluate side effects affecting lungs and bronchi.

About Viagra Pills

  • Color - Blue
  • Shape - Diamond
  • Logo - Pfizer on side and VGR xx on other side
  • Strength - 25, 50 and 100 mg.

Dosage

  • Take one pill per day, 30 minutes to 4 hours prior to sexual intercourse.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 10, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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