Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station. Today I'd like to share with you a little bit about Viagra. Viagra is obviously a medication that we all know about, but we often don't talk about it. It comes up from time to time in my office as I'm speaking with people. And I will not infrequently ask individuals about whether they're having issues with intimacy or sexual dysfunction, particularly after a major heart event, because I think there are psychological issues that can really impact. So how about a little bit of background on Viagra? Well, the technical description of the sort of drug it is, that it is a phosphodiesterase number five inhibitor and that probably doesn't mean a lot to you but it simply means that by taking this drug an enzyme system is altered such that an agent called nitrous oxide is increased in the blood vessels and that nitrous oxide NO is a relaxant of blood vessels and by creating relaxation increasing blood flow in fact to the penis but also to the lungs well so viagra known generically as sildenafil is a phosphodiesterase inhibitor and that by blocking phosphodiesterase 5 increases blood flow to the penis and the lungs. Well that's how it does in fact support erectile function. The drug was discovered by the huge drug company called Pfizer in about 1989 and in fact at the time they were looking for potential anti-anginal medications and for want of a better term stumbled across this agent somewhat serendipitously. There are a number of other agents on the market that have similar properties, other phosphodiesterase 5 inhibitors, and you may have heard of them. One is called Levitra. This is considered to work more rapidly than Viagra, and so there's their marketing edge. There's one called Cialis, which seems to have a longer half-life, and there is their marketing edge. These are produced by other drug companies. Well, how do you get Viagra at the moment? Well, in Australia, you can get it by script. That's the only way I know about it, but I'm sure you could jump on the internet and search it in various different ways. And I'm sure you'd be able to find some preparation, whether it was authentic or rigididge, I don't know. But if you quickly Google Viagra, as I just did in preparation for this presentation, you can find that you're able to buy four, 100 milligram tablets from Chemist Warehouse online for about $14, which makes each tablet just a little bit under $4. Those 100 milligram tablets, of course, could be split. So it is possible. If you think about it when the preparation of Viagra is available in a 25 milligram, a 50 milligram and a 100 milligram and each of those preparations come in a four tablet lot and each of those four tablet lots cost approximately the same then you actually get your best bang for your buck buying four 100 milligram tablets at 14 odd dollars and about 10 dollars for a pill cutter to cut up into halves. quarters or eights, depending on your requirement. Well, the use for Viagra, of course, is for erectile dysfunction, but really not erectile dysfunction in the setting of major organic problems. If there are lack of blood flow issues from diseased arteries, for example, then Viagra may not be as effective if there's been trauma. or damage to nerves vagra may not be as effective so before consideration of using this agent there needs to be some certainty that if there is any erectile dysfunction it's not from an important organic cause that may need to be reversed with specialist input so you would need to really discuss that and probably go through a formal examination with your doctor to be sure that you're using this preparation in the right space It's reasonable to think that it might be used in some situations as individuals age or fatigue or age and fatigue and perhaps use alcohol where sexual performance is reduced. And it might be in that particular situation that some men may find an eighth or a quarter or a half of Viagra, depending on their response to the medication, uh erectile support for erectile function and therefore sex and intimacy the other role for viagra can be with pulmonary hypertension so i mentioned early on that the phosphodiesterase inhibitors can increase blood flow to the penis but also to the lungs and there can be a change in blood flow to the lungs that may help individuals who have high blood pressure within their lungs. This is called pulmonary, pulmonary being within the lungs, hyper, increased tension, pulmonary hypertension or increased blood pressure in the lungs. And there are situations where individuals are actually prescribed Viagra for this distressing lung condition and it is beneficial. The use of Viagra is recommended to be taken about half an hour before it's perceived to be likely used. It can last for two to four hours subsequently. There are some warnings and it can lead to prolonged erection and that is called priapus and can be a problem of its own. If you were to be using Viagra for the first time, you would be using a very small dose as a tester and building up from there. You wouldn't start off with a 100 milligram tablet in case you really did create this situation of a prolonged problematic erection, which is called Priapus and needs to be corrected at a hospital. I do note that there's been issues with vision and even hearing with the use of Viagra and it does cause other areas to vasodilete. So people get facial flushing. Well, the biggest warnings that are commonly associated with Viagra are in regard to the medications that you cannot take it with. And this is really important for heart patients. we have a group of agents which are based off glycerol trinitrate or tnt dynamite if you like nitroglycerine those glycerol trinitrate based preparations are the spray under the tongue or the tablet under the tongue called gtn but we've also got tablets like isosorbide mononitrate which is known as monogeo and we've got a related agent which is pretty similar called nicarandol or icaril and these agents all actually work through a similar nitrous oxide pathway well here's the warning you can't combine viagra or viagra type preparations with these nitrate type preparations or you can be confronted with profound blood pressure lowering and that can be very dangerous this is particularly important in fact if for example a patient has taken a viagra tablet for example a heart patient has taken a viagra tablet for an evening of intimacy and develops chest pain appropriately the ambulance is called the ambulance first response will often be to spray sublingual GTN under the tongue my strong recommendation is if you have in fact used vitamin V on that evening and the ambulance has come out please don't be embarrassed please fess up and let them know that you've taken it because you may go from someone whose blood pressure is pretty acceptable to someone whose blood pressure is through the floor and that could cause major problems so openness and frankness in that situation is really important please be aware of that i'm pretty well to the end of my uh chat on vagra but i did come across something that made me laugh and i'm going to share that with you as a wrap up it was that in 2007 Viagra was featured in the Ig Nobel Prize. So not the Nobel Prize, the Ig Nobel Prize. And the Ig Nobel Prize is the satirical mirror image to the Nobel Prize. And in this particular situation, it's science awards given to bits of trivia or scientific research, which grab the imagination and perhaps give people a laugh. Well it turned out in 2007 an Argentinian research group demonstrated that Viagra could reduce jet lag in hamsters and for that they won the Ig Nobel Prize that year. Well I'm going to wrap up on Viagra. It is a phosphodiesterase inhibitor. We've talked about how it increases blood flow. We've talked about how you can access it. If it is a medication that may be important for you please speak with your doctor about it so up there i will invite you to drop me any questions at info at dr Warrick bishop online if you've got any suggestions for future podcasts then of course please let us know as always thank you so much for joining in and i hope you found This presentation, interesting. Till next time, of course, I wish you the very best and please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
