Evaluation of the Effects of Sildenafil Citrate (Viagra) on Vertebral Artery Blood Flow in Patients with Vertebro-Basilar Insufficiency

Zulkif Bozgeyik,Sait Berilgen,Huseyin Ozdemir,Aslan Tekatas,Erkin Ogur 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.6

Objective: To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). Materials and Methods: The study included 21 patients with VBI (aged 31-76; mean 61.0 ± 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Results: Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm2 to 10.80 cm2 at 45 minutes and 10.81 cm2 at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Conclusion: Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs. Objective: To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). Materials and Methods: The study included 21 patients with VBI (aged 31-76; mean 61.0 ± 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Results: Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm2 to 10.80 cm2 at 45 minutes and 10.81 cm2 at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Conclusion: Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs.

Sildenafil Citrate의 복용 후 발생한 양안의 안압 상승과 단안의 비동맥염성 앞허혈시신경병증 1예

이동익(Dong Ik Lee),이미연(Mee Yon Lee),문남주(Nam Ju Moon) 대한검안학회 2013 Annals of optometry and contact lens Vol.13 No.2

목적: Sildenafil citrate (Viagra??)의 복용 후 양안의 안압 상승 및 단안의 비동맥염성 앞허혈시신경병증이 동시에 발생한 증례 1예를 보고하고자 한다. 증례요약: 62세 남자 환자가 2개월 전 발생한 좌안의 시력저하로 타 병원에서 전원되었다. 환자는 증상 발생 하루 전 Sildenafil citrate 50 mg을 복용하였으며 아침에 일어난 직후 좌안의 통증과 시력저하를 느꼈다. 타병원에서의 안압은 우안 48 mmHg, 좌안50 mmHg였다. 안압 하강제를 사용하여 안압조절을 시행하였으며, 치료 후에도 시야협착이 호전되지 않아 본원으로 의뢰되었다. 본원에 첫 방문 시의 안압은 정상이었으나 좌측 시야의 전반적 결손 및 좌안 시신경유두의 창백 소견을 보였다. 좌안의 비동맥염성 앞허혈시신경병증 의심하 시력과 안압에 대한 정기적 추적관찰을 시행하였다. 3개월의 추적관찰기간 동안 안압은 안정적이었으나 시야의 호전은 없었다. 결론: Sildenafil의 복용이 안압상승 및 시신경병증의 발생에 영향을 미친다는 여러 보고들이 있다. 본 증례는 Sildenafil의 복용 후 안압상승과 그에 의한 것으로 추정되는 시신경병증이 발생한 국내의 첫 보고로, 상기 질환들의 위험인자가 있는 환자에게서 Sildenafil citrate의 복용을 주의해야 할 것이다. Purpose: To report a patient who simultaneously developed bilateral increased intraocular pressure and unilateral non-arteritic anterior ischemic optic neuropathy (NAION) after Sildenafil citrate (Viagra??) use. Case summary: 60-year-old male was referred from other hospital by decreased vision of his left eye. 2 month ago, he visited other hospital’s ophthalmologic department by pain and sudden decrease of vision in left eye and. He had taken Sildenafil citrate 50 mg one day before, and symptom was first recognized after wake up in the morning. At that hospital, intraocular pressure (IOP) was 48 mm Hg and 50 mm Hg in his right and left eye. IOP was controlled by topical IOP-lowering agent. However, visual field constriction was not improved after treatment, the patient was referred to our ophthalmologic clinic. IOP was normal at the first visit, but diffuse constriction of visual field and pale optic disk was observed in his left eye. With the impression of NAION, regular outpatient follow up was done. During 3 months follow up period, IOP was stable but visual field was not improved. Conclusions: There are several reports about increased intraocular pressure or development of NAION after Sildenafil use. To our best knowledge, this is the first case of developed increased intraocular pressure and unilateral NAION after Sildenafil use in Korea. Those who predisposed towards these diseases, special concern should be taken in using Sildenafil citrate.

Sildenafil Citrate Induces Migration of Mouse Aortic Endothelial Cells and Proteinase Secretion

Kim, Young-Il,Oh, In-Suk,Park, Seung-Moon,Kim, Hwan-Gyu The Korean Society for Biotechnology and Bioengine 2006 Biotechnology and Bioprocess Engineering Vol.11 No.5

Vascular endothelial cells release proteinases that degrade the extracellular matrix (ECM), thus enabling cell migration during angiogenesis and vasculogenesis. Sildenafil citrate stimulates the nitric oxide-cyclic guanosine monophosphate pathway through inhibition of phosphodiesterase type V (PDE5). In this report, we examined the mechanisms underlying sildenafil citrate-induced cell migration using cultured mouse aortic endothelial cells (MAECs). Sildenafil citrate induced migration and proteinase secretion by murine endothelial cells. Sildenafil citrate induced the secretion of matrix metalloproteinase-2 (MMP-2) and MMP-9, which is inhibited by $NF-{\kappa}B$ inhibitors. Sildenafil citrate also induced the secretion of plasmin, which is inhibited by PI 3'-kinase inhibitors. It is suggested that sildenafil citrate-induced migrating activity in endothelial cells may be accomplished by increased secretion of proteinases.

정상 젊은 성인 남성에서 Sildenafil Citrate가 자율신경계에 미치는 영향

박문호,고성범,김병조,박건우,이대희 大韓臨床藥理學會 2001 臨床藥理學會誌 Vol.9 No.2

실데나필 시트르산염 과다복용 후 발생한 색각이상 및 시야감소 1예

김패트릭,김소영 대한안과학회 2015 대한안과학회지 Vol.56 No.9

Purpose: Sildenafil citrate, is an oral tablet demonstrating efficacy for maintaining an erection in males with erectile dysfunction by inhibiting phosphodiesterase type 5 (PDE5). In the present study, we report 1 case of a transient color anomaly with visual field defect after an overdose of sildenafil citrate. Case summary: One patient, a 39-year-old female, with no significant medical history other than previous major depressive disorder,visited an outpatient department due to the visual field defect that began after taking 30 tablets of sildenafil citrate (50 mg)3 days earlier. A number of ophthalmologic tests were administered including visual acuity test, color vision test, fundus photography and the measurement of retinal structure with optical coherent tomography and her condition was monitored. The best corrected visual acuity was 1.0 in both right and left eyes in her first visit. The color anomaly and a central scotoma of both eyes were detected in the visual field test, while significant signs were not observed after evaluation using optical coherent tomography and fundus photography. After 5 weeks, the visual acuity was not affected, the color anomaly symptom disappeared and the focal visual field defect was present although improved. Conclusions: Transient color anomaly and persistent central scotoma caused by an overdose ingestion of sildenafil has not been reported in Korea, The related mechanisms may involve the inhibition of PDE5 on ganglion cells and bipolar cells in the retina and interruption of phosphodiesterase type 6 (PDE6) function in both rods and cones. 목적: Sildenafil citrate는 선택적으로 phosphodiesterase type 5 (PDE5)를 억제하여 발기를 지속시키는 경구용 발기부전 치료제로 널리 사용되는 약제이다. 본 저자는 sildenafil citrate 과다복용 이후에 발생한 색각이상 및 시야감소 1예를 보고하고자 한다. 증례요약: 특이 전신 질환이 없던 39세 여자 환자가 내원 3일 전 자살 목적으로 sildenafil citrate 50 mg 30알을 복용 후 시작된 시야감소를 주소로 내원하였다. 교정시력 우안(1.0), 좌안(1.0)이었으며 빛간섭단층촬영 및 안저검사상 특이소견은 발견되지 않았으나, 색각이상 및 시야검사에서 중심 암점이 관찰되었다. 경과관찰 5주간 시력변화는 없었으며 색각이상은 소실되었으나, 시야는 호전되는양상이지만 결손은 남아있었다. 결론: Sildenafil의 추천용량을 넘어서는 고용량을 한 번에 복용할 경우 일시적인 색각이상과 지속되는 중심 암점과 같은 시기능 저하가 나타날 수 있다.

Sildenafil Citrate 복용 후 성관계 뒤 발생한 양안 급성폐쇄각녹내장 1예

이원준,성민철,Won June Lee,MD,Mincheol Seong,MD 대한안과학회 2011 대한안과학회지 Vol.52 No.9

Purpose: The authors of the present study report a case of bilateral simultaneous acute angle closure glaucoma following sildenafil citrate-aided sexual intercourse. Case summary: A 63-year-old man visited the emergency department with sudden onset of bilateral ocular pain and blurred vision. The patient had taken 50 mg sildenafil citrate followed by sexual intercourse. His visual acuity on presentation was 0.3 in the right eye and 0.5 in the left eye. Intraocular pressure (IOP) was 54 mm Hg and 46 mm Hg in the right and left eye, respectively. Anterior chamber depths were shallow and angles were closed on gonioscopy in both eyes. The patient was treated with ocular hypotensive medication and subsequently managed with bilateral YAG laser peripheral iridotomies. During the 13 months of follow-up, there was no recurrent angle closure attack and IOPs were well-controlled. Conclusions: The mechanism of bilateral angle closure glaucoma caused by sildenafil citrate is not proven. Those who are predisposed towards developing angle-closure glaucoma may be at risk when having sexual intercourse aided by sildenafil citrate. J Korean Ophthalmol Soc 2011;52(9):1123-1127

비아그라??복용 후 발생한 급성 심근경색증

유지영,왕순주,조성훈 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Erectile dysfunction(ED) is defined as the inability to achieve and/or maintain an erection which is sufficient for satisfactory sexual activity. Risk factors for ED include many of the same risk factors for cardiovascular disease: hypertension; lipid abnormalities, including low high-density lipoprotein cholesterol; diabetes; and smoking. Therefore, some patients with ED will have ischemic heart disease. Viagra□, an oral therapy for ED, is the citrate salt of sildenafil, a selective inhibitor of cyclic guanosine monophosphate(cOMP)-specific phosphodiesterase 5(PDE5). The adverse effects of sildenafil include headache, flushing, dyspepsia, nasal congestion, visual disturbance, and cardiovascular complications. A general impression exists that cardiovascular complications of sildenafil occur mainly when the drug is taken concomitantly with nitrate. We report the case of a 52-year-old man who developed an acute myocardial infarction shortly after taking one tablet of sildenafil without sexual activity. The patient had not been using nitrates. Physicians treating patients with chest pain should be aware of the potential consequences of giving nitrates to patients taking sildenafil. We suggest that before initiating therapy, the history of sildenafil ingestion be obtained from patients with suspected myocardial infarction.

Prolonged oral sildenafil use-induced Mondor disease: a case report

정한솔,문유호 영남대학교 의과대학 2022 Yeungnam University Journal of Medicine Vol.39 No.3

Penile Mondor disease (MD) is a palpable, painful, subcutaneous induration caused by superficial dorsal penile vein thrombosis. We report a case of penile MD that was suspected to be related to prolonged oral sildenafil use. A 46-year-old man visited our emergency department with sustained penile pain and swelling that began 7 hours after sexual intercourse. He had used oral sildenafil intermittently for 11 years and engaged in sexual intercourse the previous night after taking sildenafil. Examination revealed no evidence of intercourse-related trauma to the genital area or an increase in penile skin temperature. However, penile swelling and tenderness over the protruding dorsal penile vein were noted. A color Doppler ultrasound examination was performed immediately, which showed hyperechoic thrombosis in the right superficial dorsal penile vein that was dilated, with soft tissue swelling and no detectable flow signal in the thrombotic lesion. The patient was diagnosed as having penile MD. The patient was treated conservatively. Some reports have indicated the involvement of sildenafil in thrombogenesis. Physicians should be aware that prolonged oral sildenafil use may be associated with penile MD.

Sildenafil Citrate 복용 후 발생한 하직근 비대 1예

정윤혜,이나영,임혜빈,Youn Hea Jung,MD,Na Young Lee,MD,PhD,Hye Bin Yim,MD,PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.2

Purpose: Sildenafil citrate was developed to treat angina, but was found to also inhibit PDE in the corpus callosum and is now widely used to treat impotence. We report a case of enlargement of the inferior rectus muscle after sildenafil citrate ingestion. Case summary: A 58-year-old male presented with binocular diplopia which started 2 weeks prior. He had no underlying disease. The patient had taken sildenafil citrate on 3 different occasions 2 weeks prior, and 2 days after his first ingestion, his right conjunctiva was injected and binocular diplopia started. On the first visit, he showed 16 PD hypotropia of the right eye with limitation of motion at upgaze. The MRI scan showed enlargement and enhancement of the inferior rectus muscle, and 50 mg of prednisone was prescribed. The amount of hypotropia decreased to 8 PD 2 weeks later. Conclusions: Enlargement of extraocular muscle caused by sildenafil citrate ingestion has not been reported in Korea, and related mechanisms are yet to be researched. Additional case reports and research are necessary in the future.

실데나필 시트르산염 과다복용 후 발생한 시야이상을 동반한 빛간섭단층촬영 변화

박효송,양종윤,이제훈 대한안과학회 2018 대한안과학회지 Vol.59 No.3

Purpose: A case of a transient visual field defect and a change in spectral-domain optical coherence tomography (SD-OCT) after an overdose of sildenafil citrate is described. Case summary: A 67-year-old male with no previous medical history presented with a bluish tinge and visual field defect in both eyes. He had consumed eight tablets of sildenafil citrate (800 mg) 3 days before the visit. His best-corrected visual acuity was 14/20 in the right eye and 20/20 in the left eye. No specific finding was noted on slit-lamp examination. Fundus examination and fundus photography revealed focal foveal hypopigmentation in both eyes. He underwent SD-OCT imaging with the Cirrus HD-OCT (Carl Zeiss Meditec, Oberkochen, Germany), and thickening of the ellipsoid zone and choroid was revealed by SD-OCT scans. He was advised not to take any more sildenafil citrate and was followed for 1 week after the first visit. Central scotomas of both eyes were revealed by a visual field test, and thickening of the ellipsoid zone and choroid remained. His eyes were re-evaluated 1 and 3 months after the first visit, and although the symptoms nearly disappeared, abnormalities in the visual field test and on SD-OCT remained, albeit with some degree of improvement. He revisited us 4 months after the first visit, at which time the visual field test and SD-OCT scans showed results within normal ranges. Conclusions: Sildenafil citrate overdose can result in a color anomaly (bluish tinge), visual field defects, and thickening of the ellipsoid zone and choroid on SD-OCT scans. 목적: 실데나필 시트르산염 과다복용 후 발생한 시야이상을 동반한 빛간섭단층촬영 변화 1예를 보고하고자 한다. 증례요약: 특이 전신질환 없는 67세 남자가 내원 3일 전 실데나필 시트르산염 제제 8정(800 mg)을 복용한 후 발생한 시야장애 및 푸르게 보이는 증상을 주소로 내원하였다. 내원 시 측정한 교정 시력은 우안 0.7 좌안 1.0이었으며, 세극등을 이용한 전안부 검사상 특이 소견은 없었다. 안저촬영상 황반부의 국소적인 저색소 침착 외에 특이 소견은 없었으며, 빛간섭단층촬영 결과 양안 모두 망막 중심와 부위 ellipsoid zone에서 신호가 증가하고 불규칙하게 두꺼워지며, 맥락막의 두께가 정상보다 두꺼워진 소견이 확인되어 실데나필 시트르산염 제제 복용을 중단하도록 하였다. 1주일 후 재내원 시 푸르게 보이는 증상이 호전되었고 양안 모두 교정시력 1.0으로 호전을 보였다. 하지만 시야검사상 양안 중심부 암점이 관찰되었으며, 빛간섭단층촬영에서의 이상 소견은 지속되었다. 4개월 후 실시한 시야검사에서 중심 암점은 완전히 호전되었으며, 빛간섭단층촬영에서도 ellipsoid zone 신호 강도가 정상화되고 맥락막 울혈이 호전되었다. 결론: 추천 용량을 넘는 실데나필을 복용할 경우 본 증례에서와 같은 푸르게 보이는 색각이상, 중심 암점과 함께 빛간섭단층촬영에서 ellipsoid zone에서 신호가 증가하고 불규칙하게 두꺼워지는 변화가 나타날 수 있다.