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Estudos clinicos mostraram eficacia estatisticamente superior ao placebo, dose-dependente, em homens com DE em populacao nao selecionada 17 ( A ) e nas seguintes subpopulacoes: de causa psicologica; com diabetes mellitus 18 ( A ); pos-prostatectomia radical.

Ate o presente momento, nao existem evidencias de maior eficacia de um desses medicamentos sobre outro. Os efeitos colaterais costumam ser transitorios e de leve intensidade. Os mais frequentes sao: cefaleia, rubor facial, epigastralgia e congestao nasal 17,19,20 ( A ) 21 ( B ) 22 ( D ). Dor lombar e mialgia sao mais frequentes com o uso da tadalafila 19 ( A ). Todos os tres medicamentos sao seguros do ponto de vista cardiovascular, nao apresentando efeitos negativos sobre a funcao cardiaca, nem piorando o quadro clinico de pacientes com insuficiencia coronariana estavel 23 ( A ) 24-27 ( B ).

Outrossim, as alteracoes no eletrocardiograma nao

foram

consideradas significantes 28 ( B ).

O uso de iF5 nao aumentou a incidencia de acidentes vasculares 29 ( D ).

Tambem nao causam alteracao significativa da pressao arterial sistolica e diastolica, nem na frequencia cardiaca 30 ( D ). Na insuficiencia cardiaca congestiva, sildenafila, alem de bem tolerada, aumentou a capacidade destes pacientes aos exercicios 31,32 ( sildenafil sandoz price B ).

A tadalafila apresenta alta seletividade para a fosfodiesterase tipo 11, existente nos testiculos e na hipofise 33 ( D ).

No entanto, o uso diario da tadalafila nao mostrou alteracao significativa na concentracao, morfologia ou motilidade dos espermatozoides. Tambem nao houve alteracao dos niveis plasmaticos de testosterona, LH e FSH 34 ( A ). Os iF5 sao metabolizados primariamente pela via do citocromo CYP3A4. Desta maneira, outras drogas metabolizadas por esta via, como cetonoconazol, inibidores da protease (ritonavir, saquinavir), que sao inibidores deste citocromo, retardam a metabolizacao desses medicamentos, aumentando seus niveis plasmaticos.

Ja a rifampicina, que e um indutor seletivo do CYP3A4, pode reduzir os niveis dos iF5 35 ( D ). O uso da iF5 concomitante com os alfabloqueadores pode produzir um efeito hipotensor sem, no entanto, contra-indicar sistematicamente a sua prescricao 36 ( B ).

A administracao de iF5 em pacientes em uso de um ou mais

anti-hipertensivos

nao traz alteracoes significantes dos niveis pressoricos 37 ( B ).

As unicas contra-indicacoes absolutas do iF5 sao sensibilidade a eles e uso concomitante com nitratos 1 ( B ).

O texto completo da diretriz " Disfuncao eretil: tratamento com drogas inibidoras da fosfodiesterase tipo 5" esta disponivel em www.projetodiretrizes.org.br . Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. Padma-Nathan H, Christ G, Adaikan G, Becher E, Brock G, Carson C, et al.

Sexual medicine: sexual dysfunctions in men and women In: Lue TF, Basson R, Rosen R, Giuliano F, Khoury S, Montorsi F, editors.

Porst H, Padma-Nathan H, Giuliano F, Anglin G, Varanese L, Rosen R.

Efficay of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after

dosing

: a randomized controlled trial. Sildenafil, a novel effective oral therapy for male erectile dysfunction. Onset and duration of action of sildenafil for the treatment of erectile dysfunction.

Valiquette L,Montorsi F, Hellstrom WJ, Giuliano F, Homering M, Taylor T, et al. Penetration and maintenance of erection with vardenafil: a time-from-dosing analysis. Vardenafil preclinical trial data: potency, pharmacodynamics, pharmacokinetics, and adverse events.

Fink HA,Mac Donald R, Rutks IR, Nelson DB, Wilt TJ.

Sildenafil for male erectile dysfunction: a systematic review and metaanalysis. Hussain IF, Brady CM, Swinn MJ, Mathias CJ, Fowler CJ.

Treatment

of erectile dysfunction with sildenafil (Viagra) in parkinsonism due to parkinson's disease or multiple system atrophy with observations on orthostatic hypotension.

Zhang Y, Guan DL, Ou TW, Wang Y, Chen X, Xing NZ, et al.

Sildenafil citrate treatment for erectile dysfunction after kidney transplantation.

The efficacy of sildenafil citrate following radiation therapy for prostate cancer: temporal considerations.

Seibel I, Poli de Figueiredo CE, Teloken C, Moraes JF. Efficacy of oral sildenafil in hemodialysis patients with erectile dysfunction. Giuliano F,Donatucci C, Montorsi F, Auerbach S, Karlin G, Norenberg C, et al.

Vardenafil is effective and well tolerated for treating erectile dysfunction in a broad population of men, irrespective of age.

Efficacy and tolerability of vardenafil for treatment of erectile dysfunction in patient subgroups. Nehra A,

Grantmyre

J, Nadel A, Thibonnier M, Brock G.

Vardenafil improved patient satisfaction with erectile hardness, orgasmic function and sexual experience in men with erectile dysfunction following nerve sparing radical prostatectomy.

Goldstein I, Young JM, Fischer J, Bangerter K, Segerson T, Taylor T. Vardenafil, a new PDE5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Eardley I, Gentile V, Austoni E, Hackett G, Lembo D, Wang C, et al. Efficacy and safety of tadalafil in Western European population of men with erectile dysfunction. Effect of tadalafil on erectile dysfunction in men with diabetes. Skoumal R, Chen J,Kula K, Breza J, Calomfirescu N, Basson BR, et al.

Efficacy and treatment satisfaction with on-demand tadalafil (Cialis) in men with erectile dysfunction. Nehra A, Grantmyre J, Nadel A, Thibonnier M, Brock G.

Vardenafil improved patient satisfaction with erectile hardness, orgasmic function and sexual experience in men with erectile dysfunction following nerve sparing radical prostatectomy.

Deveci S, Peskircioglu L, Aygun C, Tekin MI,

Dirim

A, Ozkardes H.

Sublingual sildenafil sandoz buy sildenafil at walgreens price sildenafil in the treatment of erectile dysfunction: faster onset of action with less dose. Padma-Nathan H, Eardley I, Kloner RA, Laties AM, Montorsi F.

A 4-tear update on the safety of sildenafil citrate (Viagra).

DeBusk RF, Pepine CJ, Glasser DB, Shpilsky A, DeRiesthal H, Sweeney M. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease.

Thadani U, Smith W, Nash S, Bittar N, Glasser S, Narayan P, et al.

The effect of vardenafil, a potent and highly selective phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, on the cardiovascular response to exercise in patients with coronary artery disease. Rosano GM, Marazzi G,

Patrizi

R, Cerquetani E, Vitale C, Volterrani M, et al. Comparison of trimetazidine plus sildenafil to chronic nitrates in the control of myocardial ischemia during sexual activity in patients with coronary artery disease.

Efficacy and safety of sildenafil citrate for the treatment of erectile dysfunction in men with cardiovascular disease.

Rosano GM, Aversa A, Vitale C, Fabbri A, Fini M, Spera G.

Chronic treatment with tadalafil improves endothelial function in men with increased cardiovascular risk. Sildenafil citrate does not affect QT intervals and QT dispersion: an important observation for drug safety.

Shakir SA, Wilton LV, Boshier A, Layton D, Heeley E.

Cardiovascular events in users of sildenafil: results form first phase of prescription event monitoring in England.

Cardiovascular effects of the 3 phosphodiesterase-5 inhibitors approved for the treatment of erectile dysfunction.

Bocchi EA, Guimaraes G, Mocelin A, Bacal F, Belloti G, Ramires JF.

Sildenafil effects on exercise, neurohormonal activation, and erectile dysfunction in congestive heart failure: a double-blind, placebo-controlled, randomized study followed by a prospective treatment for erectile dysfunction.

Use of sildenafil for safe improvement of erectile function and quality of life in men with New York Heart Association classes II and III congestive heart failure: a prospective, placebocontrolled, double-blind crossover trial.

Phosphodiesterase 11 (PDE11): is it a player in human testicular function?

Hellstrom W, Overstreet J, Yu A, Saikalik, Shen W, Beastey C, et al. Tadalafil has no detrimental effect on human spermatogenesis or reproductive hormones.

The clinical pharmacokinetics of phosphodiesterase-5 inhibitors for erectile dysfunction. Kloner RA, Jackson G, Emmick JT, Mitchell MI, Bedding A, Warner MR, et al.

Interaction between

the

phosphodiesterase 5 inhibitor, tadalafil and 2 alphablockers, doxazosin and tamsulosin in healthy normotensive men. Effect of sildenafil citrate on blood pressure and heart rate in men with erectile dysfunction taking concomitant antihypertensive medication. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.

Sao Carlos do Pinhal, 324 01333-903 Sao Paulo SP - Brazil Tel: +55 11 3178-6800 Fax: +55 11 3178-6816. Vardenafil relaxes muscles of the blood vessels and increases blood flow to particular areas of the body.

Vardenafil is used to treat erectile dysfunction (impotence).

Vardenafil may also be used

for

purposes not listed in this medication guide. What is the most important information I should know about Levitra ?

You should not use vardenafil if you are allergic to it, or if you take other medicines to treat pulmonary arterial hypertension, such as riociguat (Adempas). Vardenafil is not approved for men younger than 18 years old. Do not take vardenafil if you are also using a nitrate drug for chest pain or heart problems.

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