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

Thadani, Udho; Smith, William B.; Nash, Stephen; Bittar, Neville; Glasser, Stephen P.; Narayan, Puneet; Stein, Richard A.; Larkin, Sharon; Mazzu, Arthur; Tota, Robert R.; Pomerantz, Kenneth B.; Sundaresan, P. R.

doi:10.1016/s0735-1097(02)02563-9

Cited by 134 publications

(74 citation statements)

References 23 publications

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“…37 As with sildenafil, exercise testing in men with stable coronary artery disease, showed that vardenafil at 10 mg did not impair the ability of 41 patients to exercise at levels equivalent or greater than attained during sexual intercourse. 38 At baseline (1 h after taking vardenafil or placebo), systolic and diastolic blood pressure was 6 and 5 mm Hg less, respectively, with vardenafil than placebo, and heart rate was 3 beats/min higher. 38 At peak exercise, vardenafil did not alter blood pressure or heart rate, relative to placebo.…”

Section: Vardenafil and Tadalafil Have Advantages Over Sildenafil S Dmentioning

confidence: 91%

“…38 At baseline (1 h after taking vardenafil or placebo), systolic and diastolic blood pressure was 6 and 5 mm Hg less, respectively, with vardenafil than placebo, and heart rate was 3 beats/min higher. 38 At peak exercise, vardenafil did not alter blood pressure or heart rate, relative to placebo. 38 There are no peerreviewed published studies of the interaction between vardenafil and the nitrates.…”

Section: Vardenafil and Tadalafil Have Advantages Over Sildenafil S Dmentioning

confidence: 91%

“…38 At peak exercise, vardenafil did not alter blood pressure or heart rate, relative to placebo. 38 There are no peerreviewed published studies of the interaction between vardenafil and the nitrates. The patient information sheet for vardenafil states that in 18 healthy subjects pretreated with vardenafil 20 mg, there was an additional reduction in blood pressure and increase in heart rate with nitroglycerin administration, and it is recommended that nitrates not be used until at least 24 h after vardenafil.…”

Section: Vardenafil and Tadalafil Have Advantages Over Sildenafil S Dmentioning

confidence: 92%

“…40 In healthy subjects, tadalafil caused very small changes in blood pressure that were not considered to be clinically relevant. 38 Tadalafil reduced mean standing blood pressure by À4.6 mm Hg in patients with hypertension, but this unlikely to be of major concern. 41 Tadalafil has no effect on the time to exercise treadmill test-induced myocardial ischaemia in patients with stable coronary artery disease.…”

Section: Vardenafil and Tadalafil Have Advantages Over Sildenafil S Dmentioning

confidence: 99%

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Do vardenafil and tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?

Doggrell

2006

Int J Impot Res

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Erectile dysfunction (ED) affects up to 50% of men between the ages of 40 and 70 years of age. Sildenafil, vardenafil and tadalafil have all been shown to be similarly effective in the treatment of men with ED of vary etiologies, to have similar adverse effects profiles, and to improve quality-oflife by similar amounts. As these phosphodiesterase 5 (PDE5) inhibitors all increase the hypotensive effects of nitrates, they are not suitable for use in patients taking nitrates for the treatment of ischaemic heart disease. All three inhibitors must be used with caution in patients taking a 1 -adrenoceptors antagonists for benign prostatic hyperplasia. Although nonarteritic anterior ischaemic neuropathy has been reported in some users of the PDE5 inhibitors, there is no conclusive evidence that PDE5 inhibitors cause this rare effect. Tadalafil has a longer half-life than sildenafil or vardenafil, and a longer duration of action than sildenafil and vardenafil. Most preference studies have shown tadalafil to be preferred, but there are serious limitations to some of these studies. One approach to treatment is to give each patient a short-and long-acting agent, and for individuals to decide their preference.

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Section: Vardenafil and Tadalafil Have Advantages Over Sildenafil S Dmentioning

confidence: 91%

Section: Vardenafil and Tadalafil Have Advantages Over Sildenafil S Dmentioning

confidence: 91%

Section: Vardenafil and Tadalafil Have Advantages Over Sildenafil S Dmentioning

confidence: 92%

Section: Vardenafil and Tadalafil Have Advantages Over Sildenafil S Dmentioning

confidence: 99%

See 2 more Smart Citations

Do vardenafil and tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?

Doggrell

2006

Int J Impot Res

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“…None of the PDE5 inhibitors worsened ischemia or caused coronary vasoconstriction; [33][34][35][36][37] in some studies, there were actually improvements, in time, to ischemia and improved coronary vasodilator reserve. 33,35,37 Vardenafil slightly increases the QTc on the electrocardiogram and is not recommended in patients with congenital prolonged QT interval or in patients taking type 1A antiarrhythmic agents (such as quinidine or procainamide) or type three antiarrhythmics (such as sotalol or amiodarone). 23,38 As the PDE5 inhibitors are all mild vasodilators they may on their own cause small reductions in systolic and diastolic blood pressure, which, in general, are not considered clinically significant.…”

Section: Next Stepmentioning

confidence: 99%

A case of erectile dysfunction and risk factors for coronary artery disease

Kloner

2005

Int J Impot Res

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The hypothetical case of a man with erectile dysfunction and multiple cardiovascular risk factors is presented to illustrate the use of the second Princeton Consensus Conference Guidelines. Methods to optimize efficacy of the phosphodiesterase inhibitors are described. The overall cardiovascular safety of the phosphodiesterase inhibitors and their interaction with organic nitrates and alpha blockers are discussed. International Journal of Impotence Research (2005) 17, S7-S11. doi:10.1038/sj.ijir.3901423Keywords: erectile dysfunction; cardiovascular risk factors; hypertension; angina pectoris; Princeton Consensus Conference Guidelines; phosphodiesterase inhibitors; sildenafil; vardenafil; tadalafil The caseA hypothetical 58-y-old male presents to his physician with the complaint of erectile dysfunction (ED) for about 1 y. He reports that sexual desire is present but that he has a lack of ability to achieve and maintain erection. He notes that he has avoided physical affection with his wife in order to avoid the embarrassment of 'not being able to perform.' He often falls asleep early so that he may avoid initiation of sexual contact. The man is overweight and has a 5-y history of hypertension, which is being treated with a thiazide diuretic and calcium channel blocker. He has a history of smoking one pack of cigarettes every few days for at least 30 y. He does not exercise and occasionally notes cramps in his legs when he walks more than four blocks.Had this patient presented with the same story 20 or 30 y ago to a physician, he might have been told that the ED was psychological and that probably very little could have been done to help him.Today this patient's history is rather typical. He presents with ED and has multiple risk factors for atherosclerotic vascular disease-age, gender, smoking, hypertension, and sedentary lifestyle. [1][2][3] It is now well recognized that cardiovascular risk factors, the same factors associated with the development of endothelial dysfunction, 4-6 are also risk factors for ED. These include treatable risk factors such as smoking, hypertension, lipid abnormalities, diabetes, and sedentary lifestyle. [1][2][3][4][5][6] In addition, this patient is taking a thiazide diuretic for hypertension. Several medicines have been associated with ED, including certain antihypertensives. Thiazide diuretics and beta blockers are the two antihypertensive agents most likely to cause ED. 7,8 Calcium channel blockers and angiotensin converting enzyme inhibitors are less likely to have this effect and there are even a few small reports suggesting that angiotensin receptor blockers are protective against ED. 9 Physical examination of the patient reveals a moderately obese male in no acute distress. Eye examination shows mild arteriolar narrowing. His heart rate is 80 beats per minute and blood pressure is 138/86 mmHg; hence although he has been on antihypertensive medicines his blood pressure is in the prehypertension level. Lungs reveal scattered rhonci and wheezes consistent with chronic obstructive...

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A 66-Year-Old Man With Sexual Dysfunction

Morgentaler¹

2004

JAMA

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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

Abstract: Vardenafil 10 mg did not impair the ability of patients with stable CAD to exercise at levels equivalent or greater than that attained during sexual intercourse (average of 2.5 to 3.3 METS).

Cited by 134 publications

References 23 publications

Do vardenafil and tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?

Do vardenafil and tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?

A case of erectile dysfunction and risk factors for coronary artery disease

A 66-Year-Old Man With Sexual Dysfunction

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