There were no cases of priapism in any of the studies. Blood pressure and heart rate were unaffected. Here we have some well-conducted and large randomised trials which show good efficacy for important outcomes, together with a sensible portrayal of possible harm. The evidence so far is that sildenafil is effective, and safe. The obvious missing group was men with spinal injuries, though abstracts of as-yet unpublished studies indicate that sildenafil is just as effective in them.
Adverse effects are different.
Because sildenafil's mode of action potentiation of hypotensive effects of nitrates is expected, and apparently was demonstrated in early studies. Use of sildenafil in men using organic nitrates is therefore contraindicated. Clearly the advent of several new and effective treatments for male erectile dysfunction poses some difficult questions about who gets what treatment and when. Sildenafil, a novel effective oral therapy for male erectile dysfunction. I Goldstein, TF Lue, H Padma-Nathan et al.