February 2007

Acupuncture for Depression: Missing the Point
Depression-specific acupuncture was no better than nonspecific acupuncture for patients with major depression.

Adjunctive Galantamine in Schizophrenia
Galantamine (formerly Reminyl, currently Razadyne) added to risperidone (Risperdal) treatment for schizophrenia patients offered some benefits.

Adverse Effects of Erectile Dysfunction Drugs
Drugs for erectile dysfunction, such as sildenafil (Viagra) and vardenafil (Levitra), may worsen sleep apnea and can cause seizures.

Deep brain stimulation decreased obsessive compulsive symptoms in 10 patients.

Clozapine for Treatment-Resistant Schizophrenia
Clozapine (Clozaril and others) was superior to other second-generation antipsychotics for treatment-resistant patients with schizophrenia.

In Brief
Rasagiline Approved for Treatment of Parkinson's Disease; Paliperidone Approved for Treatment of Schizophrenia; PCOS Reversed When Valproate Discontinued.

Antipsychotics and New MIs
A large study suggests that antipsychotic drugs do not increase the risk of a new myocardial infarction (heart attack).

Take Ziprasidone with Food
Adequate absorption of ziprasidone is promoted by taking it with a meal that contains at least 30% fat.

Adverse Effects of Erectile Dysfunction Drugs

February 2007

Several phosphodiesterase type 5 (PDE-5) inhibitors are available to treat erectile dysfunction. Although these drugs require a prescription, many patients purchase them via the Internet. Psychiatrists sometimes prescribe them to alleviate sexual dysfunction caused by antidepressant drugs. Two recent articles point out potential adverse effects of PDE-5 inhibitors.

Roizenblatt and others randomly assigned 14 men with severe obstructive sleep apnea to receive either sildenafil (Viagra) or placebo.1 Subjects were then monitored withall-night polysomnography. On a second night, men who had received sildenafil took placebo and vice versa.

Measures of sleep apnea were significantly worse after the men took sildenafil compared with placebo. The number of episodes of reduced oxygen per hour increased and mean arterial oxygen saturation decreased to a statistically significant extent. The investigators opine that sildenafil might impair respiratory function by promoting upper airway congestion, relaxing pharyngeal muscles, and causing pulmonary vasodilatation. They recommend sildenafil be used with caution when patients have a pre-existing sleep-related breathing disorder.

In separate work, Striano and coauthors point out that epileptic seizures can result from high doses of vardenafil (Levitra).2 They describe a healthy 60-year-old man who took 10 mg po for sexual dysfunction. When he found the effect insufficient, the patient increased his dose to 40 mg. Three hours later he had a tonic-clonic seizure. Doctors told him to stop vardenafil, but 2 months later he took another 30 mg and had a second seizure. Eight months later, having taken no additional doses, he remained seizure-free without treatment. All neurologic tests were negative.

PDE-5 inhibitors increase nitric oxide, which could affect the seizure threshold. The authors cite another recent case in which a 78-year-old man had a partial seizure after taking 10 mg of vardenafil.3 Sildenafil also has been associated with seizures.4

Drugs for the treatment of erectile dysfunction have become popular in recent years. Highly effective but not benign, they have widespread pharmacologic actions, some of which can be adverse.

1Roizenblatt S, Guilleminault C, Poyares D, Cintra F, Kauati A, Tufik S: A double-blind, placebo-controlled, crossover study of sildenafil in obstructive sleep apnea. Arch Intern Med 2006;166:1763-1767.

2Striano P, Zara F, Minetti C, Striano S: Epileptic seizures can follow high doses of oral vardenafil. BMJ 2006;333:785.

3Koussa S, Hage Chahine S, Tohme A, Riachi M: Epileptic seizures and vardenafil. Rev Neurol (Paris) 2006;162:651-652.

4Gilad R, Lampl Y, Eshel Y, Sadeh M: Tonic-clonic seizures in patients taking sildenafil. BMJ 2002:325:869.