From the Guidelines
Viagra (sildenafil) is generally considered safe for most patients with multiple sclerosis (MS) who experience erectile dysfunction, as indicated by a study published in the Annals of Internal Medicine 1. When considering the use of Viagra in MS patients, it's essential to weigh the potential benefits against the risks, prioritizing morbidity, mortality, and quality of life as outcomes.
- The study 1 mentions multiple sclerosis as one of the conditions where the effectiveness and safety of sildenafil have been evaluated, suggesting that it can be used in these patients.
- MS patients can typically take standard doses of Viagra, starting with 50mg taken approximately one hour before sexual activity, with adjustments made as needed based on response and tolerability, as the study 1 notes that improvement in erectile function was related to higher dose for sildenafil (50 mg vs. 25 mg but not 100 mg vs. 50 mg).
- However, patients with MS should consult their neurologist or primary care physician before starting Viagra, as individual circumstances may affect its safety, such as potential interactions with MS medications or certain cardiovascular conditions that sometimes accompany MS.
- The mechanism of action of Viagra, inhibiting phosphodiesterase type 5 (PDE5) to enhance blood flow to the penis, is particularly helpful for MS patients whose erectile dysfunction often stems from neurological damage affecting nerve pathways involved in sexual function, as suggested by the study's discussion on the effectiveness of PDE-5 inhibitors like sildenafil 1.
- For many MS patients, Viagra can effectively address erectile dysfunction and improve quality of life without worsening MS symptoms, aligning with the goal of prioritizing quality of life as an outcome.
From the Research
Safety of Viagra in Patients with MS
- The safety of Viagra (sildenafil) in patients with Multiple Sclerosis (MS) has been evaluated in several studies 2, 3, 4.
- A study published in 2012 found that sildenafil citrate was effective in improving erectile dysfunction in patients with MS, but noted that the evidence was limited and that further studies were needed to fully assess its safety and efficacy 3.
- Another study published in 2005 found that sildenafil citrate was effective and well-tolerated in men with MS and erectile dysfunction, with significant improvements in both general and disease-specific quality of life variables 4.
- A review of the literature on PDE-5 inhibitors, including sildenafil, vardenafil, and tadalafil, found that sildenafil had a proven track record of efficacy and safety, with a success rate of 82% in patients with erectile dysfunction and an organic underlying disease 5.
Efficacy of PDE-5 Inhibitors in Patients with MS
- Tadalafil, another PDE-5 inhibitor, has also been shown to be effective and safe in patients with MS and erectile dysfunction, with significant improvements in erectile function and overall sexual satisfaction 2, 6.
- A pilot study published in 2017 found that daily tadalafil improved lower urinary tract symptoms and erectile dysfunction in young men with MS, without any significant changes in urodynamic parameters 6.
Adverse Effects
- The most common adverse effects reported in studies of PDE-5 inhibitors in patients with MS include headache, flushing, rhinitis, visual disturbances, and dyspepsia 3, 4.
- Serious adverse events, such as coronary artery disease and cerebrovascular accidents, have been reported in some cases, but are rare 3.