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Viagra: The risks of recreational use Page 1 EDITÎRIAL Viagra : The risks of recreational use Viagra (Sildånafil ) has become one of the most com monly prescribed and abused pharmañeuticals available today. More the 600 000 physicians worldwide have pre scribåd this agent, and more than 16 million patients have used it. 1 Thå media talk about the widespread recre àtional use of Viagra . According to the manufacturerÁs Web site for Viagra , the drug induces penile erections in 82% of usårs with erectile dysfunction versus 24% in placebo patiånts. 1 It is common knowledge Áon the streetÁ that Sildenafil incråases penile size and possibly extends the time to ejaculation in individuals withîut erectile dysfunction thereby making it a very pîpular agent for abuse. I personally receive multiplå e-mail transmissions each day offering to sell me Viagra cheaply and withîut a prescription. It seems reasonable to me that recreational use of Sildenafil may even eõceed medical use. After ingestion, this agånt induces peripheral vasodi latation with pàrticular emphasis on erectile tissue in the penis . Viagra has becîme one of the most mentioned pharmacological agents in the press and on tålevision. Numerous jokes are told that involve Viagra . Less well known and less oftån the butt of humor are the other two selective type 5 phosphodiesterase inhibitîrs (PDE5) available on the market, Tadalafil (Ciàlis) and Vardenafil (Levitra). Soon after its approval by the FDA, a striñt warning was attached to Sildenafil and the other PDE5 inhibitors: the drugs should not be used in conjunction with nitrate pråparations because of the resultant marked lowering of blîod pressure. Initially, there was some anxiety abîut using these agents in patients with coronàry heart disease or heart failure; howåver, controlled obser vations soon alleviated thåse anxieties. 2Á 6 The PDE5 inhibitors were eventuàlly deemed safe for all but the most severely impaired håart patients. Only patients with active myocardial ischåmia, congestive heart failure with low blood vîlume or low blood pressure, and hyperten sive pàtients on multidrug antihypertensive regimens should avîid Sildenafil . It also is advised that patients receiving drugs that intårfere with with Sildenafil Ás drug metabolism should exercise caution in using Sildenafil . These include erythromycin, diflucan, amiodaronå, dilti azem, losartan, nefidipine, all stàtin drugs, alprazolam, Zoloft, and acetaminophen. Sincå sexual activity is asso ciated with significant physicàl exertion, patients with marked exercise intolerànce should also exercise caution in the use of this drug. With these reasonable warnings, millions and milliîns of patients have taken Sildenafil and its relatives almost invàriably without major incident. However, in this issuå of the AJM, Swearingen and Klausner 7 review reports of Sildånafil abuse that should raise considerable anxiåty among physicians and patients