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Early sildenafil dose optimization and personalized instruction improves the frequency, flexibility, and success of sexual intercourse in men with erectile dysfunction

International Journal of Impotence Research volume 19, pages 154–160 (2007)Cite this article

Abstract

We investigated the effect of early sildenafil dose optimization and personalized instructions on sexual intercourse success in 1109 men beginning sildenafil therapy for erectile dysfunction. In phase 1 (4 weeks), patients followed the instructions contained in the sildenafil (50 mg) sample pack and had 1.4 sexual intercourse attempts per week with 82% success. Patients (17%) had a second intercourse attempt (80% successful): 58% occurred within 4 h, 20% within 5–8 h, and 22% within 9–24 h of the first attempt. In phase 2 (4 weeks), sildenafil was adjusted as needed (53% to 100 mg, and 2% to 25 mg), and investigators provided personalized instructions to facilitate patient success. Sexual intercourse attempts increased to 1.7 per week, with 91% success, and 18% were followed by a second attempt, of which 91% were successful. Most patients requested the 100-mg dose, which helped improve sexual intercourse frequency, flexibility and success.

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References

  1. Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E et al. Sexual problems among women and men aged 40–80 years: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 2005; 17: 39–57.

    Article  CAS  PubMed  Google Scholar 

  2. World Health Organization. Preamble to the Constitution of the World Health Organization as adopted by the International Helath Conference, New York, 19–22 June 1946, and entered into force on 7 April 1948. Available at: http://www.who.int/about/definition/en/. Accessed January, 2006.

  3. Althof SE . Quality of life and erectile dysfunction. Urology 2002; 59: 803–810.

    Article  PubMed  Google Scholar 

  4. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA . Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998; 338: 1397–1404.

    Article  CAS  PubMed  Google Scholar 

  5. Buvat J, Lemaire A, Ratajczyk J . Acceptance, efficacy and preference of sildenafil in patients on long term auto-intracavernosal therapy: a study with follow-up at one year. Int J Impot Res 2002; 14: 483–486.

    Article  CAS  PubMed  Google Scholar 

  6. Hatzichristou DG, Apostolidis A, Tzortzis V, Ioannides E, Yannakoyorgos K, Kalinderis A . Sildenafil versus intracavernous injection therapy: efficacy and preference in patients on intracavernous injection for more than 1 year. J Urol 2000; 164: 1197–1200.

    Article  CAS  PubMed  Google Scholar 

  7. Althof SE, Cappelleri JC, Shpilsky A, Stecher V, Diuguid C, Sweeney M et al. Treatment responsiveness of the Self-Esteem And Relationship questionnaire in erectile dysfunction. Urology 2003; 61: 888–892.

    Article  PubMed  Google Scholar 

  8. Cappelleri J, Duttagupta S, Sherman N, Siegel R, Crowley A, Tseng L et al. Self-esteem, confidence, and relationships in men with erectile dysfunction treated with sildenafil citrate. J Gen Intern Med 2004; 19 (Suppl. 1): 209–210.

    Google Scholar 

  9. Levinson IP . Erectile function is associated with sexual and relationship satisfaction: a pooled analysis of 26 randomized, double-blind, placebo-controlled trials. J Sex Med 2005; 2 (Suppl 1): 59.

    Google Scholar 

  10. VIAGRA®. Full Prescribing Information, Sildenafil Citrate. Pfizer, Inc.: New York, NY, 2002.

  11. McCullough AR, Barada JH, Fawzy A, Guay AT, Hatzichristou D . Achieving treatment optimization with sildenafil citrate (Viagra®) in patients with erectile dysfunction. Urology 2002; 60 (Suppl 2B): 28–38.

    Article  PubMed  Google Scholar 

  12. Moore R, Edwards J, McQuay H . Sildenafil (Viagra) for male erectile dysfunction: a meta-analysis of clinical trial reports. BMC Urol 2002; 2: 1–12.

    Article  Google Scholar 

  13. Son H, Park K, Kim SW, Paick JS . Reasons for discontinuation of sildenafil citrate after successful restoration of erectile function. Asian J Androl 2004; 6: 117–120.

    CAS  PubMed  Google Scholar 

  14. Souverein PC, Egberts AC, Meuleman EJ, Urquhart J, Leufkens HG . Incidence and determinants of sildenafil (dis)continuation: the Dutch cohort of sildenafil users. Int J Impot Res 2002; 14: 259–265.

    Article  CAS  PubMed  Google Scholar 

  15. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A . The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.

    Article  CAS  PubMed  Google Scholar 

  16. Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH . Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 1999; 54: 346–351.

    Article  CAS  PubMed  Google Scholar 

  17. Althof SE, Corty EW, Levine SB, Levine F, Burnett AL, McVary K et al. EDITS: development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction. Urology 1999; 53: 793–799.

    Article  CAS  PubMed  Google Scholar 

  18. Mulhall JP, Montorsi F . Evaluating preference trials of oral phosphodiesterase 5 inhibitors for erectile dysfunction. Eur Urol 2006; 49: 30–37.

    Article  CAS  PubMed  Google Scholar 

  19. Bull SA, Hu XH, Hunkeler EM, Lee JY, Ming EE, Markson LE et al. Discontinuation of use and switching of antidepressants: influence of patient-physician communication. JAMA 2002; 288: 1403–1409.

    Article  PubMed  Google Scholar 

  20. Sleath B, Roter D, Chewning B, Svarstad B . Asking questions about medication: analysis of physician–patient interactions and physician perceptions. Med Care 1999; 37: 1169–1173.

    Article  CAS  PubMed  Google Scholar 

  21. Morris LA, Tabak ER, Gondek K . Counseling patients about prescribed medication: 12-year trends. Med Care 1997; 35: 996–1007.

    Article  CAS  PubMed  Google Scholar 

  22. Dinsmore WW, Hodges M, Hargreaves C, Osterloh IH, Smith MD, Rosen RC . Sildenafil citrate (VIAGRA) in erectile dysfunction: near normalization in men with broad-spectrum erectile dysfunction compared with age-matched healthy control subjects. Urology 1999; 53: 800–805.

    Article  CAS  PubMed  Google Scholar 

  23. Nichols DJ, Muirhead GJ, Harness JA . Pharmacokinetics of sildenafil citrate after single oral doses in healthy male subjects: absolute bioavailability, food effects and dose proportionality. Br J Clin Pharmacol 2002; 53 (Suppl 1): 5S–12S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Milligan PA, Marshall SF, Karlsson MO . A population pharmacokinetic analysis of sildenafil citrate in patients with erectile dysfunction. Br J Clin Pharmacol 2002; 53 (Suppl 1): 45S–52S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Moncada I, Jara J, Subriá D, Castaño I, Hernández C . Efficacy of sildenafil citrate at 12 h after dosing: re-exploring the therapeutic window. Eur Urol 2004; 46: 357–361.

    Article  CAS  PubMed  Google Scholar 

  26. Gingell C, Sultana S, Hodgson G, Wulff M, Gepi-Attee S . Duration of action of sildenafil citrate in men with erectile dysfunction. J Sexual Med 2004; 1: 179–184.

    Article  CAS  Google Scholar 

  27. McCullough AR . Optimizing patient response to oral erectogenic pharmacotherapy. Curr Sexual Health Reports 2004; 1: 24–28.

    Article  Google Scholar 

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Acknowledgements

This study was funded by Pfizer Inc. Editorial support was provided by Carl Clay, PhD, at Complete Healthcare Communications Inc., and was funded by Pfizer Inc. The authors thank all investigators who contributed to this study: Abraham Morgentaler, MD, Brookline, MA; Robert Lesser, MD, New Orleans, LA; Barton Wachs, MD, Long Beach, CA; Robert Lipetz, MD, San Diego, CA; William Borkon, MD, Minneapolis, MN; Glen Wells, MD, Birmingham, AL; David Mobley, MD, Houston, TX; Donald Kidd, MD, Mobile, AL; Gilbert Dale, MD, Fresno, CA; David Kaufman, MD, New York, NY; Stephen Auerbach, MD, Newport Beach, CA; Marcia Miller, MD, Gainesville, FL; Gordon Brody, MD, Arlington, TX; Gary Oshinksy, MD, Garden City, NY; Han Hanafy, MD, Harrisburg, IL; Emerson Harrison, MD, Decatur, GA; Robert Modarelli, MD, Tacoma, WA; Irving Fishman, MD, Houston, TX; Simon Mirelman, MD, Birmingham, AL; Irvin Hirsch, MD, Philadelphia, PA; Adrian James, MD, New Orleans, LA; James Bailen, MD, Jeffersonville, IN; John Cudecki, MD, Chicago, IL; James McMurray, MD, Huntsville, AL; John Mulhall, MD, New York, NY; Vahan Kassabian, MD, Atlanta, GA; Mark Swierzewski, MD, Tampa, FL; Gary Karlin, MD, Lawrenceville, NJ; Lynn Conrad, MD, Germantown, TN; Albert Canas, MD, Miami Beach, FL; Charles White, MD, Mobile, AL; Martin Dineen, MD, Daytona Beach, FL; Michael O'Leary, MD, Boston, MA; Neil Baum, MD, New Orleans, LA; Brian Roberts, MD, Myrtle Beach, SC; Joseph Banno, MD, Peoria, IL; William Fitch, MD, San Antonio, TX; Robert Gessler, MD, Laurel, MD; Michael Collins, MD, Hoover, AL; Ronald Castellanos, MD, Fort Myers, FL; Rafael Wurzel, MD, New Britain, CT; Robert Salant, MD, New York, NY; Samuel Axelrad, MD, Houston, TX; Stanley Brosman, MD, Marina Del Rey, CA; Fernando Borges, MD, St. Petersburg, FL; Robert Waldbaum, MD, Manhassett, NY; Laurence, Belkoff, DO, Bala Cynwyd, PA; William Jennings, MD, San Antonio, TX; William Monnig, MD, Cincinnati, OH; Walter Pittman, MD, Homewood, AL; Connie Abarikwu, MD, Phoenix, AZ; James Barada, MD, Albany, NY; Winston Barzell, MD, Sarasota, FL; Martin, Bastuba, MD, La Mesa, CA; Teresa, Beam, MD; Indianapolis, IN; Robert Brannigan, MD, Chicago, IL; Joseph Camps, MD, Tallahassee, FL; Stacy Childs, MD, Cheyenne, WY; James Cochran, MD, Dallas, TX; Ronald DeGuerre, MD, St. Louis, MO; Jules Deutsch, MD, Gretna, LA; Craig Donatucci, MD, Durham, NC; Robert Eastridge, MD, Palm Beach Gardens, FL; Robert Feldman, MD, Waterbury, CT; Floyd Freiden, MD, Kansas City, MO; Rene Frontera, MD, St. Clair Shores, MI; Louis Galdieri, MD, West Orange, NJ; Phillip Ginsberg, DO, Philadelphia, PA; Marc Gittelman, MD, Aventura, FL; William Glover, MD, Fairfax, VA; Kenneth Goldberg, Carrollton, TX; Abraham Hawatmeh, MD, St. Louis, MO; Wayne Hellstrom, MD, New Orleans, LA; Stanton Honig, MD, New Haven, CT; David Jablonski, MD, Orlando, FL; Joel Kaufman, MD, Aurora, CO; Ira Klimberg, MD, Ocala, FL; Dean Knoll, MD, Nashville, TN; Michael Lutz, MD, Southfield, MI; Myron Murdock, MD, Greenbelt, MD; Gregory Parr, MD, Port Orange, FL; Arthur Pinto, MD, Trumbull, CT; Steven Promisloff, MD, Hillsboro, OR; Stephen Sacks, MD, Los Angeles, CA; William Scaljon, MD, Atlanta, GA; Robert Sher, MD, Rockville, MD; Ned Stein, MD, Houston, TX; David Talley, MD, San Antonio, TX; William Terens, MD, Edison, NJ; Kevin Tomera, MD, Anchorage, AK; Frank Tortora, MD, Cary, NC; John Tuttle, MD, Lexington, KY; Larry Walker, MD, Memphis, TN; Douglas Ward, MD, Washington, DC; Michael Werner, MD, Purchase, NY; Kenneth Wiley, MD, New Orleans, LA.

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Authors and Affiliations

  1. Northeast Indiana Urology, Fort Wayne, IN, USA

    C P Steidle

  2. New York University School of Medicine, New York, NY, USA

    A R McCullough

  3. University Urological Associates, New York, NY, USA

    J C Kaminetsky

  4. Pfizer Inc., New York, NY, USA

    A R Crowley, R L Siegel, H deRiesthal & L-J Tseng

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  1. C P Steidle
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  2. A R McCullough
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  4. A R Crowley
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  5. R L Siegel
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  7. L-J Tseng
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Correspondence to C P Steidle.

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Steidle, C., McCullough, A., Kaminetsky, J. et al. Early sildenafil dose optimization and personalized instruction improves the frequency, flexibility, and success of sexual intercourse in men with erectile dysfunction. Int J Impot Res 19, 154–160 (2007). https://doi.org/10.1038/sj.ijir.3901498

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  • DOI: https://doi.org/10.1038/sj.ijir.3901498

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