Transcript Erectile dysfunction

Erectile Dysfunction
Stephen Mark
Christchurch
Normal erectile function:
Physical and Psychological
factors
Erectile function is about performance
Erectile dysfunction is common
Causes of Erecitle dysfunction
Performance anxiety
Heart and Vascular disease
Depression
Diabetes
Drugs:
over 200 drugs
antihypertensives
heart medication
antidepressants
alcohol
smoking
Stopping smoking does improve erectile function
Effective treatment is available: at a cost…...
Reducing risk factors and psychological
treatment has little effect
Drug therapy: PDE5 Inhibitors
10 years since launch
NZ: 150,000 units ( 4 tablets) annually
61% market share
Background
Original drug developed for BP
Patented 1996
1999-2001 over $1 billion sales
First drug direct to patient
advertisement
Online prescription 10X
Off patent 2011
Viagra is effective!
…other uses…
Sports performance
Altitude sickness
Jet lag
Prevent plant wilting
Contraindications PDE5 Inhibitors
Recent MI/CVA
Patients on
nitrates
Unstable CV
disease
Liver disorders
Drug dosing
Initial dose 50 mg
Increase to 100mg if
not effective
By 4th dose standard
effect
Delayed absorption by
alcohol and fatty foods
Is Viagra effective in men without ED
Definitely safe
EAU 2008 Placebo
controlled
RCT in men without ED
Men have a “real” benefit
in quality and durability
of erections
Second generation PDE5 inhibitor
Cialis
Longer acting… up to
48 hours
Less effect with alcohol
and fat
31% market share
Marketing ED drugs
Controversial
Improved patient
awareness
More open
discussion
Intrusive
Levitra
Similar to Viagra
minimal marketing
7% market share
Online sales
Little info
significant
fraud
more than 10X
prescription
sales
Injectable agents
Alprostadil/Caverject or other
mixtures
direct vasodilators
over 80% effective
poor long term use
Post radical prostatectomy
Vacuum devices
Improves poor
quality erection
useful aid
uncomfortable
Penile Prosthesis
Expensive so low utilisation
Use: trauma, post radical
Excellent results
The End