Dmitriev D G, Gamidov S I, Mazo E B, Ovchinnikov R I
Ter Arkh. 2002;74(10):75-7.
To try combined treatment of erectile dysfunction with viagra and alprostadil in case of failure of their monotherapy; to compare effectiveness of viagra in dynamics of treatment, in various doses and dose adjustment.
82 patients with ED of different genesis received a course of intracavernous injections of alprostadil followed by a course of viagra; 25 patients received combined treatment with alprostadil and viagra. Each course lasted for 3 months. Viagra efficiency was also assessed in long-term use (12 months) and different initial doses (50 or 100 mg).
Monotherapy with alprostadil or viagra was effective in 73.2 and 75.6% patients, respectively. Their combination was more beneficial--88.0%. When used for a long time, viagra lost efficiency in psychogenic ED by 17.7%, in organic ED--by 16.9%. In an initial viagra dose 50 mg efficiency reached 70.3%, 100 mg--80.0%.
Combined treatment of ED is a method of choice in monotherapy failure and in severe ED. Lowering of viagra efficiency in long-term administration may be explained by disappearance of placebo effect.
在西地那非和前列地尔单一疗法失败的情况下，尝试二者联合治疗勃起功能障碍；比较西地那非在不同剂量及剂量调整的治疗过程中的有效性。
82例不同病因的勃起功能障碍患者接受了前列地尔海绵体内注射疗程，随后接受了西地那非疗程；25例患者接受了前列地尔与西地那非联合治疗。每个疗程持续3个月。还评估了西地那非长期使用（12个月）及不同初始剂量（50或100毫克）时的疗效。
前列地尔或西地那非单一疗法分别对73.2%和75.6%的患者有效。二者联合治疗效果更佳——有效率为88.0%。长期使用时，西地那非对心因性勃起功能障碍的疗效下降了17.7%，对器质性勃起功能障碍下降了16.9%。西地那非初始剂量为50毫克时，有效率达70.3%，100毫克时为80.0%。
勃起功能障碍的联合治疗是单一疗法失败及重度勃起功能障碍时的首选方法。长期服用西地那非疗效降低可能是由于安慰剂效应消失所致。
