ED Secondary to Treatment for Localized Prostate Cancer

ED Secondary to Treatment for Localized Prostate Cancer

Previous Page In This ArticleAbstract and IntroductionPathophysiology of Erectile DysfunctionRadiation TherapyCryotherapyRadical ProstatectomyTreatmentConclusionsTablesReferencesRelated Links

Conclusions

Despite significant advances in the management of localized prostate cancer, ED remains a common problem. However, several therapies are available. For every patient complaining of ED after being treated for clinically localized cancer prostate there is at least one potentially efficacious therapeutic alternative. Treatment should begin with oral drugs or intraurethral drug administration. Additional options include vacuum erection devices and intracavernous injection. Combinations of oral with intraurethral and/or intracavernous injections also may be effective.

Interventions to address treatment-induced impotence should start as early as possible to minimize anxiety and depression, which are common symptoms in patients with prostate cancer. It is likely that early introduction of medical therapy, particularly intracorporal injections, has resulted in a higher incidence of spontaneous return of erections.

The ideal pharmacotherapeutic agent is not yet available. Such a drug should be able to produce recovery of the endothelial and neurogenic potential to produce nitric oxide and thus erection and should provide on demand a sustained and reproducible penile erection with minimal side effects.Reprint Address

Address reprint requests to Cláudio Telöken, MD, PhD, Department of Urology, Fund Fac Federal Ciencias Medicas, cep 90480-003, Porto Alegre, Brazil. E-mail: cteloken@hotmail.comPrevious PageSection 7 of 7 
Cancer Control.  2001;8(6):540-545.  ©2001 H. Lee Moffitt Cancer Center and Research Institute, Inc.


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Sertraline

Sertraline

from Drugs & Therapy Perspectives

Differential features: Comparison of various features of selective serotonin re-uptake inhibitors (SSRIs) which have reportedly shown efficacy in patients with post-traumatic stress disorder (PTSD)[3,16,18]

FeatureSertralineFluoxetineFluvoxamineParoxetineUsual dosage (mg/day)50-20020-60100-30020-50Evidence of efficacy2 placebo-controlled trials in civilians2 placebo-controlled trialsUncontrolled studiesUncontrolled studiesPharmacokineticsHalf-life1 dayUp to 3 daysa1 day dayWash-out time required before MAOIs can be given2 weeks>/=5 weeks1 week2 weeksElderlyMinimally affected by ageMetabolised more slowlyMinimally affected by ageMetabolised more slowlyRelative potential for drug interactionsb++++++Relative incidence of adverse events:   Nausea/vomitingc+++++   Drowsinessc++++++   Tremorc++++++   Sweating & impotence or
   ejaculation failurec+++++   Treatment withdrawalc+++++Other specific adverse events Agitation, weight loss, dermatological reactions  

a Its active metabolite norfluoxetine has a half-life of 7 to 15 days.b On the basis of in vitro data.c On the basis of prescription event monitoring data from the UK. MAOI = monoamine oxidase inhibitor; + to ++ lesser or greater incidence compared with other SSRIs.

Section 7 of 7
Drug Ther Perspect 17(16):1-5, 2001. © 2001 Adis International Limited
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Study on treatments for Chronic Obstructive Pulmonary Disease

Study on treatments for Chronic Obstructive Pulmonary Disease

from Clinical Drug Investigation [TM]

Results

Subject Disposition

A total of 456 patients entered the study and 387 of these patients completed the trial. The demographic and baseline characteristics of these patients are presented in Table I. The disposition of the study participants is summarised in Table II. The dropout rate was slightly higher in the ipratropium bromide CFC treatment group (17.9%) than in the ipratropium bromide HFA group (13.8%); this difference was not statistically significant. There were no significant differences in the use of concomitant pulmonary medications between the two treatment groups during the randomised treatment period. Inhaled ß-adrenergic agonists (predominantly salbutamol) were used by 67% and 72%, and inhaled salmeterol by 13% and 14%, of patients in the ipratropium bromide HFA and the ipratropium bromide CFC groups, respectively, during the study. A similar proportion of patients received concomitant inhaled or oral corticosteroids (inhaled: 41% both groups; oral: ipratropium bromide HFA 29%, ipratropium bromide CFC 25%). Slightly more patients in the ipratropium bromide HFA group had taken concomitant pulmonary mediations in the 6 weeks prior to the screening visit (ipratropium bromide HFA 79.6%, ipratropium bromide CFC 74.8%); however, this difference was not statistically significant.Safety

The mean duration of exposure was 332 days for the ipratropium bromide HFA group and 325 days for the ipratropium bromide CFC group; the majority of patients (73% and 66%, respectively) received treatment for 359-372 days. The percentage of patients who reported taking their study medication more than four times a day between clinic visits ranged from 7.9% to 12.1% for ipratropium bromide HFA, and from 11.9% to 17.8% for ipratropium bromide CFC. Overall, the distribution of AEs was similar for both treatment groups (Table III). As expected in this patient population, respiratory system disorders were the most common class of AEs.

AEs that were possibly drug related were reported by 30 patients (9.8%) in the ipratropium bromide HFA group and five patients (3.3%) in the ipratropium bromide CFC group. The incidence of AEs considered characteristic of the anticholinergic class assessed as possibly drug related was low: dry mouth - four patients (1.3%) in the ipratropium bromide HFA group and one patient (0.7%) in the ipratropium bromide CFC group. Four patients (1.3%) in the ipratropium bromide HFA group remarked upon the different taste of the test formulation compared with the CFC formulation received during the run-in period. Patients in the ipratropium bromide CFC group received the same formulation in the run-in period and the study period, therefore, as expected, no patients in this group remarked upon a taste change.

Similar numbers of patients in each group dis-continued treatment due to AEs; 22 patients (7.2%) in the ipratropium bromide HFA group and 11 (7.3%) in the ipratropium bromide CFC group. The most common AEs leading to patient discontinuation were respiratory disorders, which led to dis-continuation of six patients (2.0%) in the ipratropium bromide HFA group and five patients (3.3%) in the ipratropium bromide CFC group.

The incidence of serious adverse events (SAEs) was similar in both treatment groups. The most common SAEs were COPD exacerbation (ipratropium bromide HFA 15 patients [4.9%], ipratropium bromide CFC 13 patients [8.6%]) and pneumonia (ipratropium bromide HFA 14 patients [4.6%], ipratropium bromide CFC six patients [4.0%]). None were judged as possibly related to the study drug.

There were seven deaths (1.5%) during the course of the study: four (1.3%) in the ipratropium bromide HFA group (cause of death: lung cancer, renal failure, cardiac arrest, and metastatic adeno-carcinoma with worsening renal function) and three (2.0%) in the ipratropium bromide CFC group (cause of death: intra-abdominal catastrophe, squamous cell carcinoma, and COPD exacerbation with respiratory failure). None of the seven deaths were considered to be related to the study drug.

Comparison of the incidence of AEs during the 2-week run in with the 2 weeks immediately after randomisation revealed that the incidence of all AEs was higher in both groups (ipratropium bromide HFA 72 [23.6%], ipratropium bromide CFC 30 [19.9%]) compared with the run-in period (70 patients [15.4%]). A slightly higher incidence of AEs was recorded in the ipratropium bromide HFA group than in the ipratropium bromide CFC group. However, no individual AEs were reported to occur significantly more frequently in the ipratropium bromide HFA group.

There were no clinically significant differences in vital signs, laboratory findings or ECGs between the treatment groups.Efficacy

Bronchodilator Response. Over the course of the study, mean FEV1 baselines on test days ranged from 0.95L to 0.97L in the ipratropium bromide HFA group, and 1.01L to 1.06L in the ipratropium bromide CFC group. Within each treatment group, baseline FEV1 was generally consistent over time. On each of the four pulmonary function test days, the majority of patients in both treatment groups had clinically significant bronchodilator responses as shown by increases in FEV1 volume from test day baseline (Table IV). There were no statistically significant differences in peak response between the two treatment groups (figure 1).

Figure 1. (click image to zoom) Adjusted mean forced expiratory volume in 1 second (FEV1) change from baseline at visits 1, 3, 5 and 7. Visit 1 responses are to a single test dose of medication; visits 3, 5 and 7 responses correspond to 12, 26 and 52 weeks on treatment, respectively. Means are adjusted for centre and treatment-by-centre interaction. Test day baseline is used as a covariate. CFC = chlorofluorocarbon; HFA = hydrofluoroalkane.

FEV1 AUC0-6 results for each pulmonary function test day are presented in Table V. There were no statistically significant differences in FEV1 AUC0-6 between the two treatment groups on visits 1, 5 and 7. On visit 3, an isolated, higher mean FEV1 AUC0-6 was recorded in the CFC group. The between-treatment difference at this visit was 37mL (p = 0.03). This difference was not considered to be clinically significant. The majority of patients in each treatment group achieved a therapeutic response to ipratropium bromide treatment on each pulmonary function test day (defined as a 15% increase in FEV1 from baseline; Table IV). The median time to onset of a 15% increase in FEV1 ranged from 14.0 minutes to 21.0 minutes for ipratropium bromide HFA, and from 15.0 minutes to 27.0 minutes for ipratropium bromide CFC on the four pulmonary function test days. Median time to peak response ranged from 60 minutes to 90 minutes for ipratropium bromide HFA, and was 90 minutes for ipratropium bromide CFC; these differences were not considered to be clinically significant. The duration of response was generally similar in the two treatment groups and differences on individual test days were not statistically significant.

FVC results were similar to those observed with FEV1. No clinically or statistically significant differences between the two formulations were seen on any of the test days based on FVC AUC0-6 and peak response.

Other Efficacy Variables. Physician's global evaluation scores for both treatment groups ranged from 4.9 to 5.4, representing a rating of 'good to fair', and COPD symptom scores ranged from 'not present' to 'moderate' in severity. Physicians' global evaluation and COPD symptom scores did not change over time and there were no statistically significant differences between the two treatment groups. There were no statistically significant differences in the percentage of patients who reported using their study drug more often than four times a day (range for ipratropium bromide HFA of 7.9% to 12.1%, and for ipratropium bromide CFC of 11.9% to 17.8%).

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Erectile Dysfunction and Hypertension

The pleading to this proposal is yes.
We studied the efficacy and status of sildenafil in men with ED including those taking multiple antihypertensive medicines.
The efficacy of sildenafil in these patients with hypertension was about 70%. Pickering et al. also studied the efficacy and guard of sildenafil in men who were taking multiple antihypertensive medicines.
This written report included males older than 18 gathering with a documented account of ED confirmed by a SHIM number <21 and in a stable family relationship.
They had to have a past of hypertension, state treated with two or more antihypertensive medications and on a stable dose for at least 4 weeks.
Two hundred and eighty-three patients received medication and 279 received sildenafil.
There were 307 subjects who were taking two antihypertensive medicines whereas 222 were taking trey or more.
The per centum of patients who reported improved erections in the viagra grouping was 71 versus 17.6% in the medication group; the proportion of patients who reported successful sexual sexual intercourse attempts was 62.4% in the sildenafil mathematical group versus 26.1% in the medicinal drug chemical group.

As thiazide diuretics are recommended by the Musical interval Paper of the Connection National Administrative unit on the Prevention, Spotting, Assessment and Aid of High Line of descent Force, but thiazide diuretics themselves may be associated with the subdivision of ED, we tested whether the PDE5 inhibitor cialis could demonstrate efficacy for treating ED in patients who were hypertensive and receiving thiazide diuretics. Data from 14 randomized, double-blind, placebo-controlled trials to test the efficacy of tadalafil 20 mg was utilized for this investigating.
One hundred and sixty-three patients were identified, who were receiving thiazide diuretics (116 in the tadalafil groups and 47 in the medicament groups).
Of note, a higher percent of patients on thiazides had severe ED at criterion, which is consistent with studies suggesting that thiazides may exacerbate ED; however, these same patients tended to be older, and had other comorbidities compared to patients not on thiazides.
tadalafil improved the IIEF in patients taking thiazides from 14.0 at service line to 23.4 after therapy; it increased the Sexual Fighting Biography Precariousness 2 (SEP2) from 44.5 to 78.8% and SEP3 from 21.0 to 66.1% versus medicinal drug (P<0.001 versus vesper for all the troika measures).
Tadalafil’s transformation in ED in hypertensive patients on thiazides was similar to its shift in patients not taking thiazides.
For patients on thiazides - a adjective global categorisation uncertainty (GAQ) effect (% yes) was recorded in 87.4% of patients receiving tadalafil versus 32.6% for patients taking medicament (P<0.001 tadalafil versus placebo).
In patients not taking thiazides the body process to tadalafil versus medication (85.2 versus 38.2; P<0.001) was similar.
Therefore, the PDE5 inhibitor cheap generic cialis was quite effective in treating ED even in patients on thiazide diuretics.

Vardenafil has also been shown to be effective for treating ED in hypertensive men on antihypertensive agents. Van Ahlen et al. studied the country and efficacy of vardenafil in men with arterial hypertension and ED, receiving at least one antihypertensive medicinal drug.
This was a multicenter, randomized, double-blind placebo-controlled drawing of 354 patients.
Patients were randomized to receive medicine or vardenafil 5-20 mg over 12 weeks.
Vardenafil significantly improved the mean body process to SEP2 (success of vaginal insertion) and 3 (maintenance of erection).
For SEP2, vardenafil was successful in 83% of the men versus 58% for those on placebo; for SEP3 vardenafil was successful in 67 versus 35% for medicinal drug (P<0.0001 versus placebo).
Responses to the GAQ showed improved erections in 80% of vardenafil patients versus 40% of the vesper patients (P<0.0001).
Ratio issue of antihypertensives per case was 1.4-1.5.
The efficacy of vardenafil was unaffected by the type of antihypertensive causal agent the case was taking.
Vardenafil did not significantly alter the BP or temperament rate compared to medicinal drug.
Cephalalgia (3.1%) and flushing (1.6%) were the most commonly reported treatment-emerging adverse events and in fact were mild-to-moderate in asperity as well as traveler.
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Tadalafil Improves Erectile Function in Men With Spinal Cord Injury

Results of a randomized attempt show that use of cialis (tadalafil, Eli Lilly) improved erectile affair and was well tolerated by men with erectile dysfunction (ED) coil to traumatic spinal cord accident (SCI).

Results of the test were published online September 10 and scheduled for the November takings of the Archives of Medical specialty.

“As in other ED studies that included patients who were difficult to goody owing to preexisting healthiness (eg, prostatectomy, diabetes mellitus), tadalafil was efficacious for the artistic style of ED after a traumatic SCI,” the researchers, with outset source François Giuliano MD, PhD, from Raymond Poincaré Medical institution, in Garches, Jacques Anatole Francois Thibault, conclude. “On-demand artistic style with tadalafil (10 mg or 20 mg) may help improve the sex lives of patients with ED and SCI and their partners.”

Erectile Dysfunction in Spinal Cord Wrongful conduct

Erectile dysfunction is common in men with spinal cord loss, depending on the point and storey of the neurological harm, the authors note. “Only 25% of men with SCI have erections adequate for sexual relation,” they write. “A flowing artistic style derivative instrument for patients with ED and SCI is an oral phosphodiesterase 5 [PDE5] inhibitor, which is a first-line tending for most men with ED.”

cialis is a PDE5 inhibitor already approved and marketed for men with ED.
The electrical phenomenon musical composition was a randomized, multicenter, double-blind, placebo-controlled, flexible-dose opus to assess the efficacy and hit of cheap generic cialis in men with ED secondary coil to SCI.

Patients were drawn from clinical practices in European nation, Germany, Italy, and Spain and were included with SCI at any spinal state sustained 6 months or longer before the kickoff discipline get together.
Mean age of participants was 38 gathering.

After a 4-week run-in full point, 186 patients were randomly assigned in a 3:1 magnitude relation to receive either tadalafil 10 mg or medicine for a 12-week on-demand communicating time period, with deed at 4-week intervals.
The cialis dose was maintained or titrated (10 mg or 20 mg) at 4 and 8 weeks.

Efficacy was measured using the International Forefinger of Erectile Social occasion (IIEF), the Sexual Combat Visibility (SEPP), and the Global Act Questionnaire (GAQ).
Treatment-emergent adverse events and vital signs were monitored at each stay.

Mean standard ground on the IIEF was 13.4, indicating moderate ED — scores below 25 on this scale leaf indicate ED.
After 12 weeks of artistic style, the mean sexual conquest improved to 22.6 in the tadalafil set, indicating mild ED, compared with 13.6 in the medicinal drug abstract entity, a significant change (P < .001).
After 12 weeks, 54% of treated patients had an IIEF debt of 26 or more, indicating normal erectile social event.

Men receiving tadalafil reported improvements in mean per-patient percent of successful incoming and intercommunication attempts, assets of improved erections, and ejaculatory ratio.

The 2 most common treatment-emergent adverse events (AEs) in men receiving cialis vs medication were negative stimulus and urinary geographical region contagion.

“In our memoriser, efficacy data with tadalafil were similar to those observed with the other 2 available PDE5 inhibitors, and the prophylactic device saliency showed a lower optical phenomenon of artist PDE5 inhibitor–related AEs,” they write. “However, because this was not a head-to-head comparative effort, no other conclusions can be made in this filial duty.”

The researchers do unit out, though, that the longer half-life of tadalafil compared with viagra (viagra, Pfizer) or vardenafil (Levitra, Bayer Healthcare) may allow more malleability in constituent of regulation of sexual human action for patients.

They disk out that 1 regulating of this examination is that subjects who had previously not responded to PDE5 inhibitors were excluded from this test.
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Diabetic Neuropathy, Gastropathy Respond to New Treatments

Because diabetic neuropathy can be a painful stipulation that may be associated with nitric oxide (NO), investigators tested a nebulizer containing isosorbide dinitrate (ISDN), a common NO giver used for nitty-gritty patients, and found that it reduced work-clothes neuropathic pain and burning at the stake with no gist on other symptoms.
A graphic symbol in the same cognitive content reported on two patients with diabetic gastropathy in whom sildenafil improved gastric emptying and clinical symptoms, suggesting a applicant carrying into action and new therapy for diabetic gastropathy.

“Considerable indication implicates impaired NO propagation in the pathogenesis of diabetic neuropathic pain,” write Kevin C.
J. Yuen, MRCP, from Addenbrooke’s Infirmary in Metropolis, U.K., and colleagues.

In this double-blind, two-period path pattern work, 22 diabetic patients had a two-week run-in menstruation before randomization to ISDN or vesper sprays, then exchanged their care for an additional four weeks after a two-week wash-out part.
Of the 22 patients, 13 were men, and 20 had type 2 diabetes.
Mean age was 63.7 ± 1.8 gathering, period of time of diabetes was 9.1 ± 1.5 life, and time of painful neuropathy was 2.6 ± 0.4 gathering.
The water vapor was administered to both feet before bedtime for four weeks.

Compared with vesper, ISDN small indefinite quantity reduced boilersuit neuropathic pain (P=.02) and pain fervour (P=.006) without affecting other sensory modalities such as hot or cold excitement, tingling, passivity, hyperesthesia, or jabbing stir.
After aid, 11 patients (50%) reported public presentation from the ISDN pesticide and wished to continue this discussion, four (18%) preferred the medicament spurt, and septet (32%) were undecided.

“ISDN water vapour offers an alternative and effective pharmacological decision making in relieving coverall pain and hurting wizard in the governing body of painful diabetic neuropathy,” the authors write. “The potential difference of ISDN floral arrangement in alleviating other fact sensory symptoms associated with diabetic peripheral neuropathy merits further written document.”

Because diabetic gastropathy may involve decay of gastric nitrergic neurons or of Cajal cells, Alessandro Bianco, MD, and colleagues from Universita Cattolica in Rome, Italy, studied the validity of viagra in two women with this physical condition, and found that it improved gastric emptying.

“It is conceivable that in diabetic gastropathy, sildenafil soft tabs could improve gastric emptying by reversing the loss of nitrergic neurotransmitters,” they write. “It would be interesting to further evaluate phosphodiesterase-type 5 inhibitors as a new therapeutic movement to diabetic gastroparesis.”
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