title: Sildenafil citrate (Viagra).
abstract: Sildenafil is the first of a series of orally active treatments for MED which has resulted in unprecedented demand for treatment and potentially high cost to the NHS. Further oral therapies are likely to follow in the next year or so. In clinical trials, sildenafil produced an erection (sufficient to achieve intercourse) lasting up to 4 h on around 70% of occasions. This was reduced to 50% in 'high-risk' groups (e.g. diabetics) and a placebo response in as many as 10-20% has been reported. Whether or not sildenafil should be prescribed at NHS expense has been more a matter for political, than clinical, debate. A clearer picture is now emerging with treatment available to those considered the 'most deserving' cases. The bigger picture is of impotence in large numbers of men with hypertension who are on antihypertensive therapy and have obvious small vessel disease. One option is to consign sildenafil to Schedule 10 (Black List) so that it is only available on private prescription. This would allay fears of the cost of treatment for those merely seeking to 'boost' already adequate sexual performance.
authors.forename: A M
authors.initials: AM
authors.lastname: MacConnachie
mesh_terms: D000284:Administration, Oral; D011307:Drug Prescriptions; D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D008297:Male; D018579:Patient Selection; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use*; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate