On Friday, the FDA approved another – filÂ drug for erectile dysfunction (ED) – Avanafil (generic name),Â Stendra (trade name)
Stendra is produced by Mitsubishi Tanabe Pharma Corporation and licensed to Vivus Inc. in the US. This is now the fourth oral drug for ED. The others include:Â tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra – the king of ED drugs).
Avanafil, like the others , are PDE5 inhibitors. Supposedly, however, Avanafil works faster than its competitors.
Side effects of the drug includes headaches and flushing of the face and head – not any different from the others. As with other PDE5 inhibitors, Stendra should not be used by men who also take nitrates, commonly used to treat chest pain (angina), because the combination can cause a sudden drop in blood pressure.
And of course, the best side effect ever: “Men taking Stendra or other PDE5 inhibitors may get an erection lasting four hours or longer that will not go away (priapism). If this happens, patientsÂ seek immediate medical care.” This is a side effect most men wish they get, of course.
Priapism, however, is a “heart attack of the penis.” It can cause permanent ED. So be aware and take it seriously if this does happen.
My take on this:
Do we need another drug for ED? Probably not. Especially if the mechanism of action is the same as the others.
The claim that AvanafilÂ works faster than the others is a stretch. Such claim can only be proven in a head-to-head study whereÂ Avanafil is directly compared to any other PDE-5 inhibitor.
I don’t have a problem with PDE5 inhibitors. I think they bring great psychological benefit to men who have sexual inhibition. That’s right. I personally think the psychological benefits are greater than the physical. It gives a men a nice mental boost.
Some men, however,Â experience intolerable headaches from this class of drug. Others go through bad cases of flushing of the face. Cialis has induced back pain is some patients. Some reports have indicated blindness can be caused by PDE-5 inhibitors. I have never seen this in hundreds of patients I have seen with this ED.
So what should you do?
1. Always address the cause of ED. Obesity, heart disease and diabetes are major causes. The number one cause of ED , however maybe stress fatigue. This can be addressed by exercising and meditation. Also, take action – you may need to make a tough decision like addressing the issues with your partner or making employment modifications. Also, take Rhodiola. This is an herb that has shown to fight stress and inhibit stress fatigue in several randomized trials. (Darbinyan et al. 2000,Â Spasov et al. 2000,Â Olsson et al. 2008.Â Philip R. Muskin, MD, professor of clinical psychiatry at Columbia University has mentioned that Rhodiola enhances sexual function. This has been my experience as well. Rhodiola is at the top of my list of natural ED agents.
2. Think penile health first. Feed the arteries of the penis with nutrients and antioxidants. The best studied are pomegranate (Forest et al. 2007) and resveratrol ( Soner, et al 2010).
3. Arginine is good. L-Citrulline is better. Arginine he a precursor to Nitric Oxide (NO) a chemical produced in your arteries that help with dilation of the arteries. Dilated arteries in the penis is what produces an erection. The problem with arginine supplementation is that; 1. it take a lot of arginine to work, about 5000mg a day. 2. it is metabolized too quickly by the body so you need to take it often. Citrulline makes arginine in the kidney. In fact, you get more arginine in the body from oral intake of citrulline than oral arginine itself with a result of a firmer erection (Comio et al. 2011)
4. Try Epimedium, AKA Hornygoat weed. Epimedium contains a chemical called Icarrin which works as a PDE5 inhibitor (Shindel et al. 2010) but apparently does not produce the same side effects
The combination of Rhodiola, Epimedium, L-Citrulline, Resveratrol and Pomegranate extract can be magical if taken together in a formula. Well, this is exactly what’s in production right now. The name is XY VGR (as in male vigor) and I think it will revolutionize the natural male sexual industry. For the first time, there will be a natural supplement that addresses SEXUAL HEALTH and SEXUAL PERFORMANCE. There’s no hype or bull on this one. Just results.
Doggy bag message:
PDE-5 drugs work great. Bad side effects for some and Oh yes, almost forgot, the cost is about $10 a pill – health plans are not covering the cost. A natural supplement like XY VGR can safely be taken with a PDE-5Â forÂ SEXUAL HEALTHÂ or taken first (XY VGR) as a primary sexual aide and occasionally use a PDE-5′s. This approach can save you a couple of bucks.
More on XY VGR to come soon.
Darbinyan V, Kteyan A, Panossian A, et al. Rhodiola rosea in stress induced fatigueâ€”a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine. 2000;7:365-371.
Spasov AA, Wikman GK, Mandrikov VB, et al. A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen. Phytomedicine. 2000;7:85-89.
Olsson EM, von SchÃ©ele B, Panossian AG.A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 2009 Feb;75(2):105-12. Epub 2008 Nov 18.
Forest CP, Padma-Nathan H, Liker HR.; Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. Int J Impot Res. 2007 Nov-Dec;19(6):564-7. Epub 2007 Jun 14.
Soner, et al. Evaluation of vascular smooth muscle and corpus cavernosum on hypercholesterolemia. Is resveratrol promising on erectile dysfunction? Int. J Imp Res, Volume: 22 Â Â Issue: 4 Â Â Pages: 227-233 , JUL-AUG 2010
Cormio L, De Siati M, Lorusso F, Selvaggio O, Mirabella L, Sanguedolce F, Carrieri G; Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction. Source: Urology [0090-4295] Cormio yr:2011 vol:77 iss:1 pg:119 -22
Shindel, A. W., Xin, Z.-C., Lin, G., Fandel, T. M., Huang, Y.-C., Banie, L., Breyer, B. N., Garcia, M. M., Lin, C.-S. and Lue, T. F. (2010), Erectogenic and Neurotrophic Effects of Icariin, a Purified Extract of Horny Goat Weed (Epimedium spp.) In Vitro and In Vivo. The Journal of Sexual Medicine, 7:Â 1518â€“1528