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Vision Loss Linked with Impotence Medications

Breaking News - June 2005 - Week 1

(Jun 1, 2005)

Healthcare in  the News

-- The US Food and Drug Administration (FDA) is investigating rare reports of vision loss among men using the impotence medications Viagra, Cialis, and Levitra.

Picture of a man's eye being examined

But, health experts caution, this type of vision loss also is linked to the same illnesses - such as diabetes and heart disease - that can lead to impotence.

An estimated 23 million American men take these impotence medications.

FDA Will Look at Concerns

Health officials at the FDA state that the agency had 43 reports of varying degrees of vision loss - including blindness - among 38 users of Viagra, four users of Cialis, and one user of Levitra, according to news reports.

FDA spokeswoman Susan Cruzan said the agency has no evidence yet that the medications are to blame for the reports of vision problems. But, she adds, "We take this seriously."

The vision problems seem to be linked to a condition called nonarteritic anterior ischemic optic neuropathy, or NAION, which causes sudden vision loss when blood flow to the optic nerve is blocked.

NAION is considered one of the most common causes of sudden vision loss in older Americans. Estimates suggest there are anywhere from 1,000 to 6,000 cases a year.

Risk factors for NAION include diabetes and heart disease - two of the leading causes of impotence. For that reason, it may be impossible for the FDA to determine whether the impotence drugs contribute to vision loss.

In the Journal of Neuro-Ophthalmology, Dr. Howard D. Pomeranz, an ophthalmologist at the University of Minnesota, reported on seven cases of NAION related to the use of Viagra.

According to that report, six patients had vision loss within 24 hours after taking the medication. Five patients had permanent vision loss in one eye and the other patient lost sight in both eyes.

All of these men had high blood pressure, diabetes, or high cholesterol - again, risk factors for vision loss.

"It's potentially a serious issue," says Dr. Robert Cykiert, an ophthalmologist at New York University Medical Center and a clinical associate professor at New York University School of Medicine. "There seems to be a clear association with the drugs."

The association is not unexpected, Dr. Cykiert says. "These drugs are known to have effects on the blood vessels in various parts of the body."

Viagra can cause blood pressure to drop, which may cause insufficient blood flow to the optic nerve, resulting in vision loss, he explains.

"Probably, patients need to be careful about using this drug," Dr. Cykiert advises. "If somebody has bad vascular disease, then they are at an increased risk of developing vision problems. The risk is low, but it is a possible risk factor."

But another expert thinks it is too early to blame these medications for what might be just a coincidence.

"Is this the kind of episode where there are 50 episodes in millions of men, and that is similar to what one would expect in men who have diabetes and cardiac disease?" asks Dr. Natan Bar Chama, a urologist at Mount Sinai Medical Center in New York City.

Dr. Bar Chama notes that the potential vision problems cited on the labels of these medications refer to temporary blurred vision or a temporary blue haze, not the permanent effects the FDA is investigating.

More Study Needed to Determine Connection

Despite the FDA investigation, Dr. Bar Chama is not convinced that the findings should worry patients.

"At this point in time, there are 23 million men using these drugs. These are 50 cases. The significance of this report is still unclear," he says.

Word of the possible link between vision problems and the impotence medications comes at a time when the drug industry is under criticism for not disclosing serious side effects associated with certain drugs, such as the medications Vioxx and Bextra.

Always consult your physician for more information.


For more information on health and wellness, please visit health information modules on this Web site.


Erectile Dysfunction and Therapies

Impotence, or erectile dysfunction (ED), may result from the total inability to achieve an erection, an inconsistent ability to achieve an erection, or the ability to only sustain a brief erection.

According to the National Institutes of Health (NIH), 15 million to 30 million men are affected by ED, depending on the definition used.

Although in the past it was commonly believed to be due to psychological problems, it is now known that 80 percent to 90 percent of impotence is caused by physical problems, usually related to the blood supply of the penis.

Many advances have occurred in both diagnosis and treatment of ED.

Some of the medical treatments available for ED include the following:

sildenafil citrate (Viagra®)
Viagra is a prescription medication taken orally for the treatment of ED. Viagra does not directly cause penile erection, but affects the response to sexual stimulation.

vardenafil citrate (Levitra®)
In clinical studies, Levitra has been shown to work quickly and improve sexual function in men the first time they take the medication. It has been shown to work well in men of all ages, in men with diabetes, and in men who have had the surgical procedure called radical prostatectomy.

tadalafil citrate (Cialis®)
Studies have indicated that Cialis stays in the body longer than other medications in its class. Most men who take this medication find that an erection occurs within 30 minutes and the medication's effectsmay last up to 36 hours.

The US Food and Drug Administration (FDA) recommends that men follow general precautions before taking a medication for ED. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use Viagra, Levitra, or Cialis.

Taking nitrates with one of these medications can lower blood pressure too much. In addition, men who take Levitra or Cialis should not use alpha blockers as they could result in hypotension (abnormally low blood pressure).

Experts recommend that men have a complete medical history and physical examination to determine the cause of ED. Men should tell their physician about all the medications they are taking - including over-the-counter medications.

In addition, men should not take these medications if they have a history of heart attack or stroke, or if they have a bleeding disorder or stomach ulcers.

Men with medical conditions that may cause a sustained erection such as sickle cell anemia, leukemia or multiple myeloma, or a man who has an abnormally shaped penis may not be able to benefit from these medications. Also, men with liver diseases or a disease of the retina, such as macular degeneration or retinitis pigmentosa, may not be able to take these medications, or may need to take the lowest dosage.

hormone replacement therapy
Testosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone.

penile implants
There are three types of implants used to treat ED. With a hydraulic pump, two cylinders are placed within the erection chambers of the penis which causes an erection by releasing a saline solution; it can also remove the solution to deflate the penis. With a prosthesis, two semi-rigid but bendable rods are placed within the erection chambers of the penis which allows manipulation into an erect or non-erect position. Another therapy includes interlocking soft plastic blocks that are placed within the erection chambers of the penis and can be inflated or deflated using a cable that passes through them.

Always consult your physician for a diagnosis.

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