Talking With Your Patients About ED

Your patients with erectile dysfunction (ED) may be sensitive when it comes to discussing problems with sexual intimacy, but it is important to talk with your patients about their sexual health—both to address their erection problems and their overall health.¹ ED may be linked to common vascular conditions, such as cardiovascular disease. By evaluating your patients for ED, you may identify additional, undiagnosed medical conditions.²

Click on the links below for more information about:

Discussing ED
Involving your patient’s partner in discussions
Discussing your patient’s individual needs and expectations

Discussing ED

Patients may be reluctant to discuss ED with you. There could be many reasons it may be difficult for patients to open up regarding their sexual function.¹

To start a conversation about ED and help patients feel more comfortable, it is important to let them know that ED is a common condition that can be treated successfully in most men.^3,4 You may want to share some of the following ED facts with your patients:

ED is defined as the persistent inability to achieve and maintain an erection sufficient to permit satisfactory intercourse⁵
Estimates of the prevalence of ED in the United States range up to 18 million⁶
Incidence increases with age: the overall prevalence of ED in a cohort of men 40 to 70 years old was 52%; by age 70, the prevalence may be as high as 67%³
ED is treatable in most men, and more men have been seeking help because of improved treatments for ED⁴

Educating your patient regarding the common nature of ED may help to counteract some of the stigma associated with the condition. If your patient has diabetes or other ED-related condition, such as cardiovascular disease, you can discuss the association of these conditions with ED. Starting the conversation this way may put the patient at ease and allow him to share with you any erectile function problems he may be having.³

Involving your patient’s partner in discussions

Involving your patient’s partner in discussions can be a critical component of effective ED diagnosis and treatment.⁷

The importance of partner involvement is twofold. First, the failure of sexual advances caused by ED may lead some men to stop seeking sexual attention from their partners.¹ In addition, research shows that men tend to downplay the psychological and relationship issues that may be contributing to their ED, thus withholding key information relevant to the diagnosis and treatment of their condition.⁷ Clinical psychology guidebooks recommend discussing ED with the patient individually and with his partner, when possible. This may allow you to^1,7:

Obtain critical information that the patient may be withholding
Help the couple communicate about ED as a medical condition
Take into account the needs and expectations of both the patient and his partner when discussing treatment options
Discuss with the couple the potential challenges of re-initiating sexual intimacy after a prolonged period of abstinence due to ED
Identify any relationship issues that may warrant a referral to a marriage counselor or other mental health professional. It is important to emphasize to couples that ED treatments, such as CIALIS, will not treat any underlying issues in their relationship

When talking to a patient about ED, you may want to ask him to consider scheduling a separate visit for a discussion with both him and his partner. You can also ask your office staff to suggest partner participation when scheduling initial patient appointments.⁷

Discussing your patient’s individual needs and expectations

Before treating ED, it is important to consider the health status of the patient, the expectations he and his partner may have for treatment, and the impact of resuming sexual activity.⁷ You may want to ask the couple if they are looking for a treatment like CIALIS for once daily use that allows the man to attempt sex anytime, day or night.*

*Individual results may vary. Not studied for multiple attempts per dose.

Important Safety Information for CIALIS^® (tadalafil) tablets

CONTRAINDICATIONS

Nitrates: CIALIS is contraindicated in patients using any form of organic nitrate, either regularly and/or intermittently, as the combination could cause a sudden, unsafe drop in blood pressure.

Hypersensitivity Reactions: CIALIS is contraindicated in patients with a known serious hypersensitivity to CIALIS or ADCIRCA^® (tadalafil). Hypersensitivity reactions have been reported, including Stevens-Johnson syndrome and exfoliative dermatitis.

WARNINGS AND PRECAUTIONS

Cardiovascular: Physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity. Treatments for erectile dysfunction (ED), including CIALIS, should not be used in men for whom sexual activity is inadvisable as a result of their underlying cardiovascular status. Patients who experience symptoms upon initiation of sexual activity should be advised to refrain from further sexual activity and seek immediate medical attention.

PDE5 inhibitors, including CIALIS, are mild systemic vasodilators. While this effect should not be of consequence in most patients, physicians should consider this potential when prescribing CIALIS.

Patients with left ventricular outflow obstruction (e.g., aortic stenosis and idiopathic hypertrophic subaortic stenosis) can be sensitive to the action of vasodilators, including PDE5 inhibitors.

CIALIS was not studied and is not recommended in patients who have recently suffered a heart attack (within 90 days) or stroke (within 6 months), or patients with uncontrolled hypertension, hypotension, uncontrolled arrhythmias, heart failure (New York Heart Assocation [NYHA] ≥Class 2 in last 6 months), unstable angina or angina occurring during sexual activity.

Potential Drug Interactions: CIALIS can potentiate the hypotensive effects of alpha-blockers, antihypertensives or substantial amounts of alcohol (≥5 units). CIALIS is not recommended in combination with alpha-blockers for the treatment of benign prostatic hyperplasia (BPH) symptoms because efficacy of the combination has not been adequately studied and due to the risk of blood pressure lowering. Caution is advised when CIALIS is used as a treatment for ED in men taking alpha-blockers. CIALIS for once daily use provides continuous plasma tadalafil levels. Physicians should consider this when evaluating the potential for interactions.

Combination with other PDE5 inhibitors: CIALIS is also marketed as ADCIRCA for the treatment of pulmonary arterial hypertension. Instruct patients not to take CIALIS in combination with ADCIRCA or other PDE5 inhibitors.

Potent inhibitors of CYP3A4: For patients taking potent inhibitors of CYP3A4, dose should be adjusted: CIALIS for use as needed: 10 mg no more than once every 72 hours. CIALIS for once daily use: the maximum recommended dose is 2.5 mg.

Prolonged Erection: There have been rare reports of priapism with this class of compounds. Patients should be advised to seek immediate medical attention should this occur. Use CIALIS with caution in patients who have conditions that might predispose them to priapism.

Vision/Hearing: The following events have been reported in men taking PDE5 inhibitors including CIALIS: (1) sudden decrease or loss of vision in one or both eyes; (2) sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness. It is not possible to determine whether these events are related directly to the medicines, other health conditions, or to a combination of these. If a patient experiences a sudden decrease or loss in vision or hearing he should stop taking CIALIS, and call a healthcare provider right away. Patients with known hereditary degenerative retinal disorders, including retinitis pigmentosa, were not included in the clinical trials, and use in these patients is not recommended.

Specific Populations: Creatinine clearance less than 30 mL/min or on hemodialysis: CIALIS for daily use is not recommended; CIALIS for use as needed- 5 mg not more than once every 72 hours. Creatinine clearance 30 to 50 mL/min: For CIALIS for daily use treatment of BPH or ED/BPH, start dosing at 2.5 mg and increase to 5 mg based upon individual response. CIALIS for use as needed- 5 mg not more than once per day with maximum dose 10 mg not more than once every 48 hours. Severe hepatic impairment: Use of CIALIS is not recommended. Mild or moderate hepatic impairment: CIALIS has not been extensively evaluated in patients with mild or moderate hepatic impairment; caution is advised if CIALIS is prescribed to these patients. With CIALIS for use as needed, dose should not exceed 10 mg. Additional dose adjustments may be required for patients with other concomitant medications. See full Prescribing Information for complete dosing instructions.

Sexually Transmitted Diseases: The use of CIALIS offers no protection against sexually transmitted diseases. Counseling patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.

Consideration of Other Urological Conditions Prior to Initiating Treatment for BPH: Prior to initiating treatment with CIALIS for BPH, consideration should be given to other urological conditions that may cause similar symptoms. In addition, prostate cancer and BPH may coexist.

ADVERSE REACTIONS

Most common adverse reactions (≥2%) with CIALIS for once daily use vs placebo, respectively, include:

In ED (2.5 and 5 mg): headache (3% and 6% vs 5%), dyspepsia (4% and 5% vs 2%), nasal congestion (2% and 2% vs 0%), flushing (1% and 3% vs 1%), and pain in extremity (1% and 2% vs 0%). Back pain (3% and 3% vs 1%) and myalgia (2% and 2% vs 1%) were also reported, sometimes with delayed onset.

In BPH and ED/BPH (5 mg): headache (4.1% vs 2.3%), dyspepsia (2.4% vs 0.2%), nasopharyngitis (2.1% vs 1.6%). Back pain (2.4% vs 1.4%) was also reported, sometimes with delayed onset.

Most common adverse reactions (≥2%) with CIALIS for use as needed in ED (5 mg, 10 mg, and 20 mg) vs placebo, respectively, include: headache (11%, 11%, and 15% vs 5%), dyspepsia (4%, 8%, and 10% vs 1%), nasal congestion (2%, 3%, and 3% vs 1%), flushing (2%, 3%, and 3% vs 1%), and pain in limb (1%, 3%, and 3% vs 1%). Back pain (3%, 5%, and 6% vs 3%) and myalgia (1%, 4%, and 3% vs 1%) were also reported, sometimes with delayed onset.

For more complete information, please see full Prescribing Information and Patient Information.

TD HCP ISI 24JAN2012

References

DiMeo PJ. Psychosocial and relationship issues in men with erectile dysfunction. Urol Nurs. 2006;26:442-446.
Hatzichristou D, Hatzimouratidis K, Bekas M, Apostolidis A, Tzortzis V, Yannakoyorgos K. Diagnostic steps in the evaluation of patients with erectile dysfunction. J Urol. 2002;168:615-620.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151:54-61.
Wespes E, Amar E, Hatzichristou D, et al. EAU Guidelines on erectile dysfunction: an update. Eur Urol. 2006;49:806-815.
NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270:83-90.
Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007;120:151-157.
Dunn ME. Restoration of couple's intimacy and relationship vital to reestablishing erectile function. JAOA. 2004;104(suppl 4):S6-S10.

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