Sildenafil in erectile dysfunction: a critical review
Salonia A, Rigatti P, Montorsi F.
Department of Urology,
University Vita-Salute San Raffaele, Milan, Italy.
Curr Med Res Opin. 2003;19(4):241-62


Sildenafil citrate (Viagra) is a potent orally active cGMP-specific phosphodiesterase type 5 (PDE5) inhibitor that is effective as a peripheral conditioner in the treatment of male erectile dysfunction (ED) of organic, psychogenic or mixed aetiology. Sildenafil is the first effective oral agent in the management of ED that has had a revolutionary impact on management of ED. The present review has been subdivided into five major sections. Based on the most recent peer-reviewed publications, the first section is aimed at critically evaluating PDE5 selectivity as well as the pharmacokinetics and pharmacodynamics of the drug, mainly to assess the best doses for each group of patients (i.e. adult and elderly men). Effectiveness in a broad spectrum ED population is the subject of the second section of the review, principally reporting post-marketing company-independent results. Safety and tolerability are the key concerns of the third section, with a broad consideration of the most commonly reported adverse events. Special attention has been paid to the cardiovascular safety of the drug, chiefly outlining the positive and potentially protective cardiac effects of sildenafil. Moreover, the impact of sildenafil in special patient populations is considered, namely in men complaining of diabetes mellitus, depression, neurological disorders, renal failure and those who have undergone a radical prostatectomy. Sildenafil and the ageing male has been especially underlined. Finally, the review covers a few new potential applications of sildenafil in ED patients with regard to high-dose treatment and combination therapy. The review ends with several considerations regarding the direct and/or indirect impact of sildenafil over quality of life and quality of partnership.

Coolidge effect
Viagra: review
Long-term Viagra
Viagra: mechanisms
The Viagra Revolution
Viagra: clinical efficacy
Semen as an antidepressant?
Yohimbine and sexual performance
The pharmacology of penile erection
Sexual side-effects of antidepressants
Drugs to promote female sexual desire
Viagra leaves fake aphrodisiacs flagging
Viagra v Levitra as recreational sex-drugs
Sildenafil (Viagra) and erectile dysfunction
Sexual health : drug combination therapies
Sildenafil (Viagra) for antidepressant-induced sexual dysfunction

and further reading

Future Opioids
BLTC Research
Utopian Surgery?
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World

The Good Drug Guide
The Good Drug Guide

The Responsible Parent's Guide
To Healthy Mood Boosters For All The Family