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Impotence Drugs in the Spotlight -- for Different Reasons

WebMD Health News

May 2, 2000 (Atlanta) -- One of the major concerns about Viagra is whether the impotence drug is suitable for patients with heart disease. And those taking drugs known as nitrates for heart conditions already are warned not to use the distinctive blue pills. Now another treatment for impotence has been tested on men suffering with impotence and heart disease, and the results are encouraging.

At the same time, neurologists in California are finding that Viagra gives patients with Parkinson's disease substantial relief from uncontrolled movement symptoms associated with the brain disorder.

The new drug, Uprima, was studied in nearly 1,500 patients, about 225 of whom had a history of heart disease, over the course of two months. After trying various doses of the drug, the researchers found that at the recommended dose, about one in two attempts at intercourse were likely to be successful. Those not receiving treatment had successful intercourse in less than one out of four attempts.

The research, paid for by the manufacturer TAP Holdings, was presented at a urology conference here this week.

Uprima is taken by placing it under the tongue and allowing it to be absorbed into the bloodstream. It was recommended for approval by an advisory panel to the FDA last month, even though there were concerns about Uprima's side effects. About one-third of those taking the drug at a high dose suffered from nausea or dizziness.

It's still not clear how Uprima may interact with longer-acting nitrates, although there is some indication that the combination may lead to fainting or dangerously low blood pressure. That side effect may have proven lethal to some nitrate patients who tried Viagra.

However, lead investigator for the new study, Eugene Dula, MD, says Uprima does appear safer for many heart patients. Dula is medical director of the West Coast Clinical Research in Van Nuys, Calif.

Dula tells WebMD that Viagra or Uprima should be fine for patients not taking nitrates but who take one or two drugs for high blood pressure. If they are on nitrates, especially the short-acting variety, Dula thinks Uprima may be a good option for these patients. He also says the short-acting nitrates haven't caused a profound dip in blood pressure, and that the FDA is taking a hard look at the longer-acting versions. Other doctors feel that Uprima may be a useful alternative for patients trying to cope with heart disease and impotence.

"The nitrate studies are very small with Uprima. There's about a 10% incidence of blood pressure changes. They're not of the magnitude that occur with Viagra and nitrates, but they are somewhat concerning," John Mulhall, MD, assistant professor of urology at Loyola University Medical Center, tells WebMD.

There also are questions about Uprima's effectiveness since a relatively high percentage of those getting placebo treatments also were able to achieve an erection. "The patients that were entered into the study may not have had severe sexual dysfunction to start out with," says Patrick Walsh, MD, chief of urology at Johns Hopkins Medical Institutions in Baltimore.

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