Stockjet and others interested in the pharmacology,
First of all, many medications cause impotence, either fully or to some degree(more common). The ssri antidepressants are among the most notorious, although also including anorgasmia and decreased libido. However, to say that impotence isn't generally as common as the other problems reflects a lack of knowledge about these medications, based on my clinical experiences on a large scale. Also, as someone mentioned, there are other medicines also commonly involved with these types of problems, such as certain antihypertensive medications(which incidentally can sometimes cause depression). The concern about the route of metabolism is an important one, as the interaction risks can be huge, such as with seldane and hismanal in the past, leading to seldane removal from the market with the advent of allegra. Seldane wouldn't be metabolized and a deadly arrhythmia called torsades de point could develop, generally as a result of a large buildup of seldane in the system, even though only taking a normal dose. The 3A4 pathway of the cytochrome p450 system of the liver is responsibe for many similar interactions, such as not being able to use propulcid, the digestion medicine, along with antidepressants such as luvox, prozac, and serzone. Since I still haven't read all of the psychopharmacology involved with sildenafil, I can only say that if metabolism is through 3A4, there is the possibility of risk with the above mentioned antidepressants(luvox and prozac are among the 4 ssri antidepressants. Serzone is typically without the sexual side effect risk.) This would mean that paxil and zoloft would be among the safer antidepressants to combine viagra with potentially, but I would need to read more about the pharmacology involved to comment fully, let along the risks with decreased metabolism with a 3A4 med, vs. simply giving a lower dose.
Regarding the grapefruit juice issue, this usually is a concern with the dose of medicine itself more than anything else. In other words, you shouldn't take luvox for instance with a glass of grapefruit juice. Usually if later on in the day, it is unlikely to be much of a problem. Now if you were to be a grapefruit junkie I can't say that I know the details as to the risks.
Regarding the comments by the alien guy, maybe it's time to return to the home planet. I have refused to buy stock in any pharmaceutical company involved with psychiatric meds for some time, knowing their potentials, given the ethics to me of having a conflict of interest in determination of the proper med to use. I don't give a darn either way frankly, as if I think the best med to be used is from a company I don't own or don't like, I don't care...I'll prescribe it anyway. I spend literally hours every day on the phone or filling out extra paper work to make sure that meds which are declined by third party payers are fought for in the best interests of patients, even though I don't really have the time during the day to do this. I guess you have a real problem with doctors though, causing you to be the same set of problems you attribute to physicians. If you didn't care for the joke of how many meds pfizer makes being able to be used one time, that's not my problem. I can promise you that I would only joke, never using the meds unless I truly felt it was best for the patient. However, there are still many people who feel that drs. are out to get them, and as such complain if I don't see them even if they come 20 minutes late for a 15 minute appt when another person is scheduled, or upset about having to pay a 6 or 10$ copay with their hmo. Luckily, this is not most people, as I still believe that most people appreciate medical care, even though the current environment rots. Considering your response to my last(which was my first) post on this thread, I have to assume that the judgmental and hyping one is actually you. If using a medicine to help combat side effects of a primary medicine which is needed bothers you, you are welcome not to read my comments or utilize such treatments if the need were ever to arise. I say it would be malpractice for me to withhold necessary and available care which improves quality of life however.
Enough rambling. Have a good week all.
Marshall |
