AboutStephen W. Leslie, MD Expertise Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.
Experience Full time practicing urologist with 20 years experience. Assistant Clinical Professor of Urology at the Medical College of Ohio. Editor in Chief of eMedicine Urology internet textbook. Author of only book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.
Organizations American Urological Association, Ohio State Medical Association, Sexual Medicine Society
Publications Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.
Education/Credentials Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison
Awards and Honors Thirlby Award of the American Urological Association.
Question hi DR LESLIE,
my name is john ,and i am 38 years old.it has been 2 years now that my erections have become much softer and smaller,even with the use of viagra.and i already tried all 3 PDE5 inhibitors,with no good response,and i am pretty much frustrated,and i deeply need to restore my good quality erections.so,i need to ask you:
1)is it true(as i read on the net) that LOSARTAN (COZAAR)an angiotensin 2 antagonist,a drug used for the treatment of hypertension,has a very positive effect on erectile function? and,do u recommend that i take this drug in combination with viagra to see if it would make me have an optimal response to viagra?
2)to what extent is DOXAZOSIN,which is an a-blocker and an antihypertensive drug,is documented to have beneficial effect on erectile function? because it was stated on the net,that even patients who did not achieve an optimal response to intracavernosal alprostadil,the co-administration of doxazosin resulted in a significant improvement in the response to this prostaglandi E1 analogue?
3)is there any kind of an oral form of prostaglandin E1(alprostadil)such as tablets capsules etc.. and possibly effective in treating impotence..?
thank you,
Answer We do not recommend using either cozaar or doxazosin together with Viagra solely for the purpose of improving ED. The evidence suggests more that these agents are "less bad" than other anti-hypertensives. Doxazosin in particular can cause orthostatic hypotension and dizziness if taken with Viagra. There is no conclusive, double blinded study that shows a benefit to use of Doxazosin with prostaglandin E1 as an injection. In other words, there's not enough evidence to show it's safe and effective. There are other means.
There is no oral form of prostaglandin E1 but there is a gel. So far, just investigational.
Injection therapy would probably be the next step for you. Rather than mixing agents, you can try "trimix" instead of prostaglandin E1 if needed. Mixing Viagra with these agents can be even more effective but at the risk of problems such as Priapism. This type of mixing should only be done under the direction of a urologist experienced in ED therapies.
