Betty here is another answer to your question..
Viagra and Muse urodoc_17305
Jun 10 1998
12:55PM EDT
Having just read the report on the deaths in patients who had taken Viagra, it is clear that the prescribing physicians must be far more careful to be sure that the patient is not also taking or liable to be taking any nitrate medication.
The list of such medications include but is not limited to the following:
NITROGLYCERINES
Deponit, Minitran, Nitrek, Nitro-Bid, Nitrodisc, Nitro-Dur, Nitrogard, Nitroglyn, Nitrolingual Spray, Nitrol Ointment, Nitrong, Nitro-Par, Nitrostat, Nitro-Time, Transderm-Nitro
ISOSORBIDE MONONITRATES
Imdur, Ismo, Monoket
ISOSORBIDE DINITRATES
Dilatrate-SR, Isordil, Sorbitrate
ERYTHATYL TETRANITRATE
PENTAERYTHRITOL TETRANITRATE
SODIUM NITROPRUSSIDE
AMYL NITRITE (poppers)
Viagra works well in patients with psychogenic and mild organic impotency. It does not work well in patients with moderate or severe organic impotency.
MUSE works in at least 25% of these more difficult cases. If patient selection is done to eliminate those for whom an active sex life would be a detriment to their health, the 25% figure rises to over 50%.
It appears that the first line of treatment in appropriate cases is Viagra and when Viagra is ineffective, MUSE is prescribed.
There may even be a number of patients who may require both Viagra and MUSE
Both medications are quite good and each has its use.
Sexual Stress with Viagra vs MUSE urodoc_17305
Jun 11 1998
7:39PM EDT
Dear Betty,
Thank you for one of the too few intelligent messages on this thread.
Please refer to the first message I have written # 10173 for a listing of the medications which are contraindicated if Viagra is to be prescribed. Actually, it's the Viagra which is contraindicated when any of the medications on the list are being used or even might be used by the patient for up to 5 days before and extending 5 days after the use of Viagra.
I am a practising urologist as well as an investor. I am long in Vivus and have no PFE stock.
Nontheless, my first approach to an impotent patient with a normal serum testosterone level who has no medical contraindication to resuming his coital activity is to prescribe Viagra in the 50 mg doseage. If 50 mg Viagra does not relieve his impotency, the dose is raised to 100 mg. If that still doesn't relieve the problem, I prescribe MUSE.
Although many patients unresponsive to Viagra do respond to MUSE, I have not yet seen a case unresponsive to MUSE which did respond to Viagra.
At the present time, I have a number of patients unresponsive to both Viagra and MUSE and I have prescribed the combination of both drugs, first having the patienrt take the Viagra and then using the MUSE an hour later. This far I have no feedback on the combination.
Much of the problems with MUSE are related to the doctor not taking the time and trouble to show the patient in the office how to use the medication. Vivus has supplied us with video tapes to give to the patients showing how to use MUSE but its not the same as watching a patient try to learn how to use it first hand. That way, the errors can be corrected and the learning curve shortened considerably.
As for your question regarding whether sexual activity is more life threatening using Viagra or using MUSE, you are perfectly correct in that the risk of the sex act to the persons cardiovascular system is the same regardless of the source of erection.
What I worry about with Viagra is some patient who has had success with Viagra and who gets the pills from his drug plan offers his friend a Viagra pill without realizing that his friend is taking Imdur or Ismo or Isordil or any other nitrate with catastrophic consequences.
Another scenario, equally horrifying is the man walking down the street after a wonderful night thanks to his Viagra when he suddenly faints from any number of unrelated causes. When the EMS arrives, he complains of chest pain, they pop a nitroglycerine under his tongue and goodby.
I hope I have shed some light in the hopes of answering your questions. Both products are excellent but each for a different patient set. The Viagra best for psychogenic and mild organic impotency and the MUSE best for moderate and severe organic impotency.
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