There has been concern about the use of sildenafil (Viagra; Pfizer) for the treatment of erectile dysfunction (ED), particularly with regard to its possible role in the reported deaths and other serious cardiovascular events. Although sildenafil attracted considerable free media publicity in its debut in Australia and ranks as the most publicised new product this decade,1,2 consumer interest has been subdued and partly overshadowed by reports of 130 deaths involving sildenafil users in the United States between late March and mid-November 1998.3
Correspondence:
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- Anderson M, Nicholson B, Louie E, Mulhall JP. An analysis ofvasculogenic erectile dysfunction as a potential predictor ofoccult cardiac disease. J Urol 1998; 159 Suppl 5: 30 abstract118.
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- Greenstein A, Chen J, Miller H, et al. Does severity of ischaemiccoronary disease correlate with erectile function? Int J ImpotRes 1997; 9: 123-126.
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- Morales A, Gingell G, Collins M, et al. Clinical safety ofsildenafil citrate (Viagra) in the treatment of erectiledysfunction. Int J Impot Res 1998; 10: 69-74.
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- Viagra -- approved product information. Pfizer, 1998.
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- Boolell M, Allen MJ, Ballard SA, et al. Sildenafil: an orallyactive type 5 cyclic GMP-specific phosphodiesterase inhibitor forthe treatment of penile erectile dysfunction. Int J Impot Res1996; 8: 47-52.
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- Zusman RM, editor. Cardiovascular data on sildenafilcitrate. Am J Cardiol 1999; 83(5A).
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- Feenstra J, van Drie-Pierik RJHM, Lacle CF, Stricker BHC. Acutemyocardial infarction associated with sildenafil. Lancet1998; 352: 957-958.
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- Viagra is here! Australian Adverse Drug ReactionsBulletin 1998; 17(4).
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- Hellerstein HK, Friedman EH. Sexual activity and thepostcoronary patient. Arch Intern Med 1970; 125: 987-999.
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- Bohlen Y, Held JP, Sanderson MO, Paterson RP. Heart rate,rate-pressure product, and oxygen uptake during four sexualactivities. Arch Intern Med 1974; 144: 1745-1748.
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- Willich SN, Klatt S, Arntz HR. Circadian variation and triggers ofacute coronary syndromes. Eur Heart J 1998; 19 Suppl C:C12-23.
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- Nalbangtil I, Yigitbasi O, Kiliccioglu B. Sudden death in sexualactivity. Am Heart J 1976; 91: 405-406.
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- Ueno M. The so-called coital death. Jpn J Legal Med 1963;17: 330-340.
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- Lecomte D, Fornes P, Nicolas G. Stressful events as a trigger ofsudden death: a study of 43 medico-legal autopsy cases. ForensicSci Int 1996; 79: 1-10.
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- Muller JE, Mittleman MA, Maclure M, et al. Triggering myocardialinfarction by sexual activity. JAMA 1996; 275: 1405-1409.
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- Johnston BL, Fletcher GF. Dynamic electrocardiographicrecording during sexual activity in recent post-myocardialinfarction and revascularization patients. Am Heart J 1979;98: 736-741.
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- Drory Y, Shapira I, Fisman EZ, Pines A. Myocardial ischaemiaduring sexual activity in patients with coronary artery disease.Am J Cardiol 1995; 75: 835-837.
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- Kavanagh T, Shephard RJ. Sexual activity after myocardialinfarction CMAJ 1977; 116: 1250-1253.
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- Health United States. 1998. Hyattsville, Maryland: US NationalCenter for Health Statistics, 1998.
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- Australian Institute of Health and Welfare. Heart, stroke andvascular diseases, Australian facts. Canberra: AIHW and the HeartFoundation of Australia, 1999. (Cardiovascular Disease Series No.10. AIHW Cat. No. CVD 7.)
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- Australian Bureau of Statistics. Causes of death, Australia.Canberra: ABS, 1997. (Cat No. 3303.0.)
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- Cardiac rehabilitation: sex after a heart attack. In: Zaret BL,Moser M, Cohen LS, editors. Yale University School of Medicine HeartBook. New York: Hearst Books, 1992; 351.
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- Tardif GS. Sexual activity after a myocardial infarction.Arch Phys Med Rehabil 1989; 70: 763-766.
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- Summary statement of the American College of Cardiology and theAmerican Heart Association on the use of sildenafil (Viagra) inpatients at clinical risk from cardiovascular effects. 10 August1998. <http://www.americanheart.org/Whats_News/AHA_Science_Advisories/viagra.html>. Accessed18 February 2000.
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- Fact sheet for prevention of myocardial infarction. NationalHeart Foundation of Australia. Curr Ther 1999; 39: 52.
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- Fact sheet for angina. National Heart Foundation of Australia.Curr Ther 1999; 39: 63.
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- Grundy SM, Balady GJ, Criqui MH, et al. Guide to primary preventionof cardiovascular diseases. A statement for healthcareprofessionals from the Task Force on Risk Reduction. Circulation1997; 95: 2329-2331.
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- Heart Foundation of Australia. Guide for the use of lipid loweringdrugs in adults. Canberra: Heart Foundation of Australia, 1999.Available at <http://www.heartfoundation.com.au/include/defaultStory.asp?OwnerUID=200&ContentType=tblcategory>.
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- Mitka M. Some men who take Viagra die -- why? [news]. JAMA2000; 283(5).<http://jama.ama-assn.org/issues/v283n5/full/jmn0202-2.html>.Accessed 18 February 2000.
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