HEALTH: Popular erectile dysfunction drug eases symptoms of lung disease

You may be sur­prised to learn that the drug Silde­nafil, bet­ter known by the brand name Via­gra, has oth­er med­ical uses besides treat­ing erec­tile dys­func­tion in men. It can also be used to treat lung dis­ease, which often has a poor prognosis.

Silde­nafil works by inhibit­ing an enzyme called phosphodiesterase.

Silde­nafil works through a com­plex path­way involv­ing oth­er mol­e­cules, ulti­mate­ly relax­ing smooth mus­cle and dilat­ing blood ves­sels. The lat­ter effect is known as vasodilation.

Vasodi­la­tion results in increased blood flow to organs, both the penis and the lungs.

Vasodi­la­tion by silde­nafil may be ben­e­fi­cial in pul­monary dis­eases such as pul­monary arte­r­i­al hyper­ten­sion (PAH) and idio­path­ic pul­monary fibro­sis (IPF).

Peo­ple with PAH and IPF have pro­gres­sive short­ness of breath and chron­ic cough. Besides the lungs, PAHs and IPFs can affect many oth­er organ systems.

PAH is a dis­ease in which high pres­sure is applied to the arter­ies of the lungs, which are nor­mal­ly designed for low­er pres­sure, caus­ing breath­ing dif­fi­cul­ties and heart strain. For­tu­nate­ly, it is a rare dis­ease that affects 1–2 peo­ple per mil­lion peo­ple each year.

IPF is the more com­mon lung dis­ease, with an esti­mat­ed inci­dence of 2 to 29 cas­es per 100,000 peo­ple per year. It is a chron­ic, repeat­ed thick­en­ing, hard­en­ing, and scar­ring (fibro­sis) of the lungs.

The eti­ol­o­gy of both dis­eases is often unclear, and doc­tors and researchers do not ful­ly under­stand why these dis­eases devel­op and progress.

Both dis­eases are incur­able and often get worse over time despite the best treat­ments. Cur­rent­ly, there are few effec­tive treat­ments and their dis­cov­ery is of con­stant interest.

The use of silde­nafil in PAH is now well estab­lished, effec­tive, and approved in Cana­da. There are sev­er­al high-qual­i­ty ran­dom­ized con­trolled clin­i­cal tri­als that have shown effi­ca­cy in improv­ing exer­cise capac­i­ty and symp­tom burden.

Silde­nafil is often called Reva­tio (rather than Via­gra for erec­tile dys­func­tion) in PAH, but there is a dif­fer­ence between Via­gra and Reva­tio, except that patients often take Reva­tio three times a day in small dos­es. , makes lit­tle difference.

Our recent­ly pub­lished paper inte­grates the evi­dence for mul­ti­ple treat­ments for PAH. The results exam­ined the com­bi­na­tion of drugs in the same class, such as silde­nafil, tadalafil (trade name Cialis), and var­de­nafil (trade name Lev­i­t­ra), with oth­er com­mon­ly used PAH drugs.

Results showed a 12.7% reduc­tion in clin­i­cal adverse events such as dis­ease pro­gres­sion and hos­pi­tal­iza­tion com­pared to place­bo. In addi­tion, the exer­cise per­for­mance index mea­sured by the 6‑minute walk test improved by near­ly 50m.

The use of silde­nafil in IPF is less cer­tain as few ran­dom­ized con­trolled tri­als, the gold stan­dard of evi­dence, have been conducted.

Only four tri­als have been con­sid­ered for use in IPF. This small num­ber of meta-analy­ses approached sta­tis­ti­cal sig­nif­i­cance, sug­gest­ing that effects will become appar­ent as more tri­als are completed.

The lat­est Euro­pean Res­pi­ra­to­ry Society/American Tho­racic Soci­ety guide­lines address­ing this issue rec­om­mend against the use of silde­nafil in IPF due to lack of data.

Recent­ly, how­ev­er, a drug with a sim­i­lar effect to silde­nafil (tre­pros­tinil) has shown promise for patients with inter­sti­tial lung dis­ease (a gener­ic term for lung dis­eases includ­ing IPF) and pul­monary hyper­ten­sion. The great­est ben­e­fit was seen in patients diag­nosed with inter­sti­tial lung disease.

This fur­ther demon­strates the promise of agents like silde­nafil and sim­i­lar vasodila­to­ry mech­a­nisms in the treat­ment of IPF.

For intractable dis­eases such as PAH and IPF, there are ben­e­fits to reusing drugs like sildenafil.

On the oth­er hand, devel­op­ing new drugs is very expen­sive. On the oth­er hand, when it comes to the safe­ty of new drugs, like Via­gra, which is wide­ly used, its side effect pro­file is well known in the med­ical community.

For exam­ple, silde­nafil is known to low­er blood pres­sure and should be avoid­ed by peo­ple who are prone to hypoten­sion or who are tak­ing cer­tain anti­hy­per­ten­sive drugs. Oth­er com­mon side effects include hot flash­es, headaches, and changes in vision.

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