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Patients who demonstrate hemodynamic instability on alpha-blocker therapy alone are at increased risk of symptomatic hypotension with concomitant use of PDE5 inhibitorsPatients should be stable on alpha-blocker therapy prior to initiating a PDE5 inhibitorIn those patients who are stable on alpha-blocker therapyPDE5 inhibitors should be initiated at the lowest dosesee DOSAGE AND ADMINISTRATIONIn those patients already taking an optimized dose of a PDE5 inhibitoralpha-blocker therapy should be initiated at the lowest doseStepwise increase in alpha-blocker dose may be associated with further lowering of blood pressure when taking a PDE5 inhibitorSafety of combined use of PDE5 inhibitors and alpha-blockers may be affected by other variablesincluding intravascular volume depletion and other anti-hypertensive drugs.

Across all trialsVIAGRA improved the erections of 43of radical prostatectomy patients compared to 15on placebo.

The physiologic mechanism of erection of the penis involves release of nitric oxideNOin the corpus cavernosum during sexual stimulationNO then activates the enzyme guanylate cyclasewhich results in increased levels of cyclic guanosine monophosphatecGMPproducing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood.

Viagra prevents cGMP from becoming degradedso the blood flow and the erection can continue.

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