Better health and a better sex life

·         According to one Harvard study, just 30 minutes of walking a day was linked with a 41% drop in risk for erectile dysfunction (ED).

·         Moderate exercise can help restore sexual performance in obese middle-aged men with ED.

·         In the Massachusetts Male Aging Study, eating a diet rich in natural foods like fruit, vegetables, whole grains, and fish — with fewer red and processed meat and refined grains — decreased the likelihood of ED.

·         High blood pressure, high blood sugar, high cholesterol, and high triglycerides can all damage arteries in the heart (causing heart attack), in the brain (causing stroke) and leading to the penis (causing ED). An expanding waistline also contributes.

·         A man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist.  Losing weight can help fight erectile dysfunction

·         Obesity raises risks for vascular disease and diabetes, two major causes of ED.

·         Excess fat interferes with several hormones that may be part of the problem as well.

·         A strong pelvic floor enhances rigidity during erections and helps keep blood from leaving the penis by pressing on a key vein.

·         In a British trial, three months of twice-daily sets of Kegel exercises (which strengthen these muscles), combined with biofeedback and advice on lifestyle changes — quitting smoking, losing weight, limiting alcohol — worked far better than just advice on lifestyle changes. 

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Building consensus on off-label uses of sildenafil

We are building consensus on the off-label uses of sildenafil. The current indications approved by DCGI are as follows:

Drug Name	Indication	Date of Approval
Sildenafil citrate film coated 25/50/100 mg	By urologist, psychiatrist, endocrinologist in erectile dysfunction in men.	08/01/2001	Cardiologists decide about contraindications but cannot prescribe.
Sildenafil Citrate Orally Disintegrating Strips: 25mg / 50mg	Erectile dysfunction.	05.07.13	Quick acting. Does not mention about restrictions of prescribers. 100 mg will be off label use.
Sildenafil Citrate 20mg	Pulmonary arterial hypertension (WHO group I) to improve exercise ability.	23.01.07	Approved only for primary PPH. For others it will be off label use. Does not mention about prescribing restrictions.
Sildenafil Citrate Injection 0.8mg/ml	Pulmonary arterial hypertension (PAH) (WHO Group-1) to improve exercise ability and delay clinical worsening.	05.12.12

 (Source: New Drugs Approved by CDSCO at https://cdscoonline.gov.in/CDSCO/Drugs)

Sildenafil can be prescribed by all. This discrepancy in indications should be taken out.

The responses received so far for off label use of tadalafil are as below:

·                     Dr Pai: Insert in the vagina before or after embryo transfer and continue it for 15 days till pregnancy test is done, to find out whether patient is pregnant. Sildenafil is used in patients with poor endometrial growth or with recurrent IVF failures.

·                     Dr Prashant Tanna: Newborn in persistent pulmonary hypertension

·                     Dr Gian Chand Rana: Only by MBBS

·                     Viraj Suvarna: Sildenafil with nintedanib versus nintedanib alone is currently being examined in severe idiopathic pulmonary fibrosis. Earlier study where sildenafil was tried in such patients and while it did not improve the 6-minute walk test (primary endpoint), it did improve certain QOL measures (secondary endpoints) - the STEP trial.

o    Women with clitoral erectile dysfunction.

o    Hypoactive sexual desire disorder

o    All types of pulmonary hypertension (like tadalafil is approved)

Drug Name	Indication	Date of Approval
Tadalafil Tablet2.5mg/5mg	1. Erectile dysfunction. 2. Erectile dysfunction with benign prostatic hyperplasia	27.02.13
Tadalafil tablet 20 mg(Additional Indication)	Pulmonary arterial hypertension	14.11.09
Tadalafil Orally Disintegrating Strip10mg & 20mg (Additional dosage form)	Erectile dysfunction	30.07.14
Tadalafil 10mg/20mgTablets	Erectile dysfunction in adult men	11/09/2003

 (Source: New Drugs Approved by CDSCO at https://cdscoonline.gov.in/CDSCO/Drugs)

Off label use of tadalafil

·     Benign prostatic hyperplasia (BPH) without erectile dysfunction

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Smoking can cause Erectile Dysfunction

One reason for a man or a woman not to smoke is that a man is likely to end up with erectile dysfunction and the woman with premature aging with wrinkles on face, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India.

It has been shown that men who smoke more than 20 cigarettes a day have 60% higher risk of erectile dysfunction as compared to those who never smoke. Fifteen percent of past and present smokers experience erectile dysfunction. Men, who are current smokers or are former smokers, are 30% more likely to suffer from erectile dysfunction. Among men who never smoke, only 12% end up with erectile dysfunction.
Smoking increases the risk of erectile dysfunction by more than 50% in men in the 30–40 year age group. Diabetes, high blood pressure and high cholesterol are other important risk factors for erectile dysfunction.
Apart from erectile dysfunction, smoking also causes reduced volume of ejaculation, low sperm count, sperm shape etc.

In women, smoking leads to premature aging with formation of wrinkles on the face.
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