Generics Blog|Medical-Care News

Since it came on the market in 1998, Viagra (sildenafil) has changed the manner in which erectile dysfunction (ED) is managed. Over 23 million men throughout the world have tried it, with a modicum of success. Even though it is the best known solution to ED, there are other options as well.

Erectile dysfunction can range from occasional to complete inability to achieve and maintain penile tumescence, or erection. An erection occurs when the nervous system activates increased blood flow to the male reproductive organ: Blood vessels relax and the influx of blood causes the tumescence. Once the sexual excitement comes to fruition, excess blood drains returning the organ to its non-erect state.

Most causes of ED are physical, including diabetes, high blood pressure, cardiovascular disease, and other conditions. It is also due to lifestyle choices such as smoking and lack of exercise. Taken together, any or all of these factors affect the blood flow to the pelvis. Other causes may include low libido and relationship or partner issues. Surgeries to treat cancers–for example, prostate cancer–and injuries to the pelvic area may result in ED. A wide array of pharmaceuticals can also lead to ED.

The three major medications to manage ED–sildenafil, verdanfil (Levitra) and tadalafil (Cialis)–are all inhibitors of an enzyme called phosphodiesterase 5 (PDES). They work by relaxing the smooth muscle cells, which increases the blood flow to the pelvic area and allows tumescence in response to sexual stimulation.

These agents are not free of side effects, however, especially for those with severe heart disease. As such, they are contraindicated for those who have recently suffered a stroke, or who take alpha-blockers for high blood pressure or voiding dysfunction. Importantly, PDE5 inhibitors should not be taken with nitrates (the heart drug nitroglycerine), because the combination can cause a potentially fatal drop in blood pressure. In addition, PDE5 inhibitors have also been linked to a rare form of blindness. All three of these inhibitors share certain side effects, including headache, nasal congestion, facial flushing, gastrointestinal distress, and, less commonly, vision changes.

Among alternatives to these PDE5 inhibitors are injectibles like Alprostadil (caverjet, Edex, MUSE). In addition, vacuum devices are used to trigger the blood flow to the penile tissue. These approaches, however, are marred by their awkwardness of use. It is for this reason that ED sufferers are increasingly turning to safer and natural alternatives. While a number of remedies are touted to be helpful, more often than not the claims fall far short of the promises.

Among the natural choices, the amino acid citrulline is one of the most effective agents to enhance blood flow without any metabolic inhibition, as is the case with PDE5 inhibitors. While PDE5 inhibitors inactivate the enzyme that breaks down nitric oxide (NO), the small molecule that induces vasodilation and increased blood flow, citrulline functions systemically to induce NO and, as a result, flush the pelvic flow with blood. Thus, by boosting the body’s ability to offset any loss in NO, citrulline is an entirely safe and effective long-term alternative for a healthy libido.

AKA: Panax ginseng, Asiatic ginseng, Korean ginseng, Korean red ginseng. Chinese ginseng

PART USED: Root

WHAT IT DOES BEST: Asian ginseng is used for a wide variety of conditions. However, the most scientifically supported uses are for male infertility and erectile dysfunction (ED).

THE BACKGROUND: The Chinese have used Asian ginseng for over 2,000 years as a tonic to improve mental acuity and vitality, enhance physical performance and memory, reduce fatigue and strengthen the immune system.

WHAT’S THE ACTIVE INGREDIENT?

The primary active ingredients are known collectively as ginsenosides. Other actives include panaxans, which may help stabilize blood sugar.

RECENT FINDINGS: According to a report in the November 2002 issue of Urology, Asian ginseng was found to be effective for ED in a double-blind human study. In a related commentary in the January 2003 issue of The Journal of Family Practice, doctors from the University of Virginia Health Sciences Center in Charlouesville noted that Asian ginseng is a safe, suitable alternative to sildenafil (Viagra).

In addition to increasing sex drive, ginseng may help improve male fertility. In a preliminary human study published in the December 1996 issue of Panminerva Medica, 66 men who took Asian ginseng experienced increased sperm count, sperm motility and testosterone levels.

Besides the above, animal studies suggest Asian ginseng may help reduce the effects of stress and fatigue and enhance immune function. Recently, a mice study published in me March 2005 issue of Archives of Pharmacal Research found that ginsenosides derived from Asian ginseng could enhance memory and reduce amnesia.

POSSIBLE SIDE EFFECTS AND PRECAUTIONS: When taken in the recommended dosages, Asian ginseng is considered safe; however, in rare cases it may cause insomnia and headaches and enhance the effects of caffeine. Allergic reactions are possible. Long-term use may contribute to menstrual irregularities and breast pain in some women.

People scheduled for surgery, on blood-thinning medications or with uncontrolled high blood pressure should not take Asian ginseng without first consulting a physician.

Ginseng may affect blood glucose levels; therefore people with diabetes should consult a health care practitioner before use.

IS IT SAFE TO TAKE WHILE PREGNANT OR NURSING?

Asian ginseng is not recommended for pregnant or nursing women.

ARE THERE ANY DRUG INTERACTIONS?

People taking warfarin (Coumadin) or other blood-thinning medications should consult with a physician before taking Asian ginseng.

WHICH TYPE AND HOW MUCH?

The root is dried, powdered and made into capsules, liquid alcohol (tinctures) and dried extracts. Asian ginseng root extract standardized to approximately 4-7 percent ginsenosides is the most researched form.

* For whole powdered root, studies have used 0.5-2g daily.
* For tinctures, 2-3ml three times daily is usually recommended.

Yet another reason for men to exercise caution in the use non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief: These drugs may cause erectile dysfunction (ED).

Finnish researchers surveyed close to 1,100 men between the ages of 50 to 70 about their use of non-steroidal anti-inflammatory drugs, which include most over-the-counter pain relievers, such as aspirin, ibuprofen (generic: Advil, Motrin IB) and naproxen (generic: Aleve). They also asked how often the men had experienced ED, the inability to achieve and sustain penile engorgement.

The men who were taking NSAIDs were twice as likely to have ED as the non-users. This outcome was statistically adjusted to account for various medical conditions that could confound the results.

The researchers speculated that NSAIDs may reduce the body’s release of nitric oxide (NO), a compound that is critical in ensuring optimal blood flow to the penile tissue. In fact, ED drugs on the market–Viagra, Cilais, and Levitra–all work by releasing NO.

This side effect of NSAIDs is in addition to others that have been known for quite some times, such as high blood pressure, heart attacks, stomach bleeding, and potential kidney and liver damage. Even though acetaminophen (generic: Tylenol, Panadol) may be a first choice for mild-to-moderate pain, but it may damage the liver as well.

Men who experience ED should consult their physicians to exclude an underlying disorder that could be causing the problem–for example, diabetes, hypertension or cardiovascular disease.

Here’s a brief look at a few of maca’s healthy attributes — and some reasons you may want to try it.
multitalented

Maca is used primarily for enhancing libido and fertility, and treating erectile dysfunction (ED). The herb is lately being suggested for easing PMS and menopause symptoms, such as night sweats, hot flashes and low libido.

ancient Healer of the Andes

The first recorded use of maca as an herbal medicine dates back to the 17th century in South America, where it was believed to enhance fertility, sexual desire, strength and endurance. Native to the Peruvian Andes, this tuber, related to turnips and radishes, has been consumed by locals for approximately 2,000 years. Maca contains vitamins, minerals, protein, carbohydrates, fiber, amino acids and fatty acids.

Clinically Studied

Preliminary human research suggests maca may enhance both libido and fertility in men without affecting testosterone or other hormone levels.

While there are no human studies on maca and women, animal research suggests that maca has estrogenlike effects, and that it may also enhance female fertility and help prevent menopause problems related to low estrogen, such as osteoporosis. Maca’s ability to mimic estrogen in a positive way may explain its growing popularity as a PMS remedy.

Maca may also be helpful for arthritis. According to a test-tube study on human cartilage, maca promoted nitric oxide (NO) production in cartilage. NO, which results from a natural bodily process, is thought to help decrease inflammation and increase circulation. Researchers theorize that maca improves ED by boosting NO production to the penis.

a Mustard Family Member

Like other members of the mustard family, maca contains glucosinolates, which are responsible for the pungent taste and odor. Glucosinolates, taken in excess along with a low-iodine diet, can lead to the development of goiter, when the thyroid gland is enlarged and thyroid hormone production decreases. However, there are no known reports of maca causing goiter.

Maca’s safety has not been established, although it is considered to have little (if any) toxicity, as it has been a staple in Peru for thousands of years. According to research, maca not only is nontoxic to the liver, but appears to have a liver-protective effect.

THE DOSAGE YOU NEED

A typical dosage for maca is 500-1000mg 3 times daily of the dried root powder. There are no known drug interactions, Avoid if you are pregnant or nursing.

QUICK TIP: Fend off fatigue

Latin American doctors often recommend maca to patients complaining of general fatigue. Tired? Give the herb a try and see if it affects your energy levels.

• If you’re about to start a family, think twice before taking an erectile-dysfunction drug. Viagra can harm sperm and reduce your fertility, report British scientists. In a test-tube study, researchers discovered that a typical dosage of the drug doubled premature damage to sperm heads compared to swimmers that weren’t treated. The scientists explain that Viagra, Levitra, and Cialis are part of a class of drugs called PDE inhibitors, which cause the outer layer of the sperm head to break down before it reaches the female egg, preventing penetration. Consult a urologist for an ED therapy that doesn’t affect fertility.

• Nothing says “I love you” like finishing the bathroom tile. Researchers at the University of Nevada at Reno recently determined that following through on promises is the best way to show her how you feel. In the survey of 121 couples, women rated specific actions — for instance, completing home-improvement projects and being on time — as significantly more telling than verbal professions of passion. “Women can see continued small acts of irresponsibility as red flags signaling that you mentally have one foot out the door,” says the study author, Dan Weigel. Ph.D. Another finding: Women rated gift giving at the bottom of the commitment scale.

The singles scene can seem like a minefield. That’s because just kissing can lead to three types of sexually transmitted diseases. Our advice: Get tested for STDs every 3 to 6 months, and ask your partner if she’s been tested, too.

Do you know that more women than men die of heart disease each year? Chances are, neither does your physician. A recent study found that fewer than one in five doctors knew it. This may explain why women are six times less likely to be prescribed Stettins, aspirin, and beta blockers than men are, say Rush University scientists. The meds can have side effects, but the researchers found that the risk of harm is equal for men and women.

• You don’t need to last for hours to please her. Just 8 minutes of sex is enough, states a survey of sex therapists out of Pennsylvania State University. While it was most desirable for intercourse to last between 7 and 13 minutes, making love for 10-plus minutes was often considered too long. “Past that point, the woman may feel inadequate because she can’t make you climax, which decreases her enjoyment,” says Eric Corty, Ph.D., the study author.