Background: Men who use erectile dysfunction medications for recreational purposes may be at increased risk of becoming psychologically dependent, which in turn could lead to psychogenic-based erectile dysfunction symptoms. Sildenafil has become one of the most commonly prescribed and abused drugs available today. Objectives: This study aimed to describe the utilization pattern and associated factors of sildenafil citrate among its users visiting community pharmacies in Gondar, Ethiopia.
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Methods: A facility-based cross-sectional study was conducted from March 20, to May 10, , among male clients who visited community pharmacies in Gondar town, North West Ethiopia.
A self-administered, structured questionnaire was used to collect data from Sildenafil users older than 18 years, that started using the drug Sildenafil for at least 6 months before the data collection period.
Results: A total of 65 men participated in the study. Of the total study participants, The use of sildenafil for recreational purposes was Non-recreational use of sildenafil includes erectile problems associated with diabetes mellitus Conclusion: Most men who use sildenafil citrate do so for recreational purposes, and use of sildenafil citrate for 2 years or less was associated with recreational use.
There should be a collaborative effort among pharmacists, health professionals, and policymakers to improve the rational use of sildenafil.
Erectile dysfunction ED can be defined as a failure to attain or maintain an erection adequate for pleasing sexual activity. It is a relatively common medical problem and is estimated to affect million people worldwide, of whom 30 million live in Africa 1.
Its etiology can be organic, psychogenic, or most commonly, derived from a combination of the two 2.
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Medical risk factors for ED include diabetes mellitus, cardiovascular conditions e. Psychogenic causes can include depression and anxiety. Drugs used socially such as nicotine, alcohol in excess , and other recreational drugs also increase the prevalence of organic ED 2. Sildenafil, a selective inhibitor of phosphodiesterase type 5 PDE5 , is an effective oral medication for the treatment of erectile dysfunction.
During sexual stimulation, the cavernous nerves release nitric oxide NO , which induces cyclic guanosine monophosphate cGMP formation and smooth muscle relaxation in the corpus cavern sum.
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The lower 25mg strength of Sildenafil is often prescribed for men over the age of One Viagra Connect tablet should be swallowed whole with water approximately one hour before intended sexual activity.
Sildenafil facilitates the erectile process during sexual stimulation by inhibiting PDE5 and thus blocking the breakdown of cGMP 4. Sildenafil has become one of the most commonly prescribed and used pharmaceuticals available today.
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In the U. Similar results were also reported in other areas 7. The majority of recreational EDM users reported mixing EDMs with illicit drugs and particularly during risky sexual behaviors 8.
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In the Ethiopian context, due to the lack of strong regulations, sildenafil can be easily accessed from pharmacies without a prescription 1 , 9 — A qualitative study conducted in Addis Ababa, Ethiopia revealed that there was a widespread use of sildenafil citrate and the main reasons for the utilization were to gain sexual confidence and suppress anxieties associated with a feeling of loss of manhood Sildenafil use has also been associated with various adverse effects especially owing to its vasodilator properties.
Caution should be exercised in patients with one or more risk factors for cardiovascular or cerebrovascular disease, which include myocardial infarction, cardiac arrest, angina, ventricular tachycardia, hypertension, and other cardiac symptoms.
Concomitant use with organic nitrates e. More frequent EDM use was associated with decreased erectile confidence, which in turn showed negative relations with erectile function. Men who use EDMs for recreational purposes may be at increased risk of becoming psychologically dependent, which in turn could lead to psychogenic-based ED symptoms There are also case reports associating the use of Sildenafil with recurrent epistaxis.
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The number of similar cases might increase due to the diffusion of PDE-5 inhibitor overuse in recreational settings 15 , Case reports of type A and B aortic dissection have also been reported with sildenafil abuse In some cases, patients may experience vomiting, diarrhea, and abdominal pain shortly after the ingestion of sildenafil and may be found to have aortic dissection upon admission to a hospital It is allowed only in licensed pharmacies to be dispensed with legal prescriptions and even drug stores [Pharmacy retail outlets managed by pharmacy diploma holders known as druggists in Ethiopia ] are not allowed to hold these drugs.
However, the regulatory control is not stringent, and thus illegal drug marketing is very common which leads to difficulty in monitoring their utilization and improve their outcome 19 , Their easy accessibility may also predispose people who took other medications concomitantly and those with comorbid conditions to the adverse effects of these drugs 13 , 21 , Therefore, the current study aimed to assess the utilization pattern and associated factors of sildenafil citrate among its users visiting community pharmacies in Gondar, Ethiopia.
A facility-based cross-sectional study was conducted among male clients who visited community pharmacies in Gondar town, North West Ethiopia.
Gondar is located km away from Addis Ababa, the capital city of the country. At the time of the study, there were 20 pharmacies and 34 drug stores in the town. Based on a projection from the National Census conducted in , its population was estimated to be around , with the male to female ratio estimated to be around 1. The study was conducted from March 20, to May 10, All sildenafil citrate users that fulfilled the inclusion criteria and that were available visited the community pharmacies during the study period were included and thus no sample size calculation was needed.
All of the available community pharmacies in the town were approached, but only seven of them were volunteer to allow the data collectors to meet with patients collect data. Drug stores were not included in the study as it is illegal for them to sell phosphodiesterase inhibitors such as sildenafil in Ethiopia, though there were rumors that claim these drugs are sold illegally in these outlets.
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All men sildenafil users of at least 18 years of age that were volunteer to participate in the study. The dependent variable was the use of sildenafil citrate for recreational purposes and this was analyzed against the independent variables; socio-demographic factors age, marital status, partner status, educational status, occupation, religion and other factors such as illicit substance use, and duration of sildenafil use. A structured, self-administered questionnaire was used to collect data.
The questionnaire was composed of 36 questions that were divided into three major parts.
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The first part asked about the socio-demographic age, marital status, partner status, educational status, occupation, religion… and clinical characteristics of the study participants. The second and third parts were focused on the participant's general perception and utilization pattern of sildenafil citrate. The data was collected by two data collectors who were well aware of the questionnaire as well as the purpose of the study.
The data collectors were given 1 day of training on the purpose of the study and the data collection procedures.
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A pretest was carried out on 5 sildenafil users that came to two randomly selected pharmacies in the town. The collected data were checked for completeness and consistency each day before entering into the software for analysis.
Descriptive analysis was conducted and results were presented using tables. Binary logistic and multi-variable logistic regression analyses were conducted to determine the association between the dependent and independent variables.
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Recreational use: Use of a drug to advance certain activity sexual performance without a definite need or any medical condition. Before the data collection, the purpose of the study and the proceedings were provided to each study participant and verbal consent was obtained. No personal identifiers were included in the questionnaire and confidentiality of the information was assured in such a way that no disclosure of the collected data was made apart from the study purpose.
A total of 65 men had participated in the study. The mean age of the participants was 37 years range 22— More than half Regarding occupational status, about 24 The majority of the study participants The respondents also reported the use of alcohol and multiple illicit drugs with sildenafil in which more than half of the respondents reported that they use alcohol Regarding the source of information about sildenafil, some of the respondents reported multiple sources though the main source for the majority of them were their friends Regarding the source of the medication itself sildenafil some of the respondents also obtained it through multiple routes with the majority In the current study, 43 participants Multiple answers were also reported concerning the timing of taking the drug sildenafil in which 40 About In the duration of use, 33 Most of the participants Regarding information provision, The most common side-effect experienced by the users due to the use of sildenafil was dizziness Binary and Multi-variable logistic regression analyses were conducted to determine if there was an association between the various independent variables and the recreational use of sildenafil by taking the medical use of sildenafil as constant.
Those significant variables were then analyzed in the multivariable logistic regression. Table 3.
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Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of Viagra. But they may be more severe than usual if caused by overdose. Whether you're looking for answers for yourself or for someone you love, we're here to give you the best information available. Depending on the dose for ED, you can use it as needed before sexual activity, or you may take 2.
Sildenafil is meant to be taken before having sex, with the understanding that its effects last only a few hours. This medication can be used to treat pulmonary hypertension PH that happens in your arteries of your lungs pulmonary arterial hypertension or PH that happens due to a blood clot in your lungs. As the same review notes, some animal studies suggest that Viagra could reduce the risk of heart disease.
Factors associated with recreational use of sildenafil in Gondar town, On the other hand, some of the users also took sildenafil for medical purposes in which diabetes mellitus In the current study, it was found that there was a widespread use of sildenafil citrate for non-medical recreational purposes in the younger community. The result was consistent with similar studies conducted in other countries in which the majority of the younger participants use PDE5Is for recreational purposes 1 , 6.
This could be convincing because ED is usually common in older age and chronic diseases such as hypertension and type II diabetes. PDE5Is reduce systemic and pulmonary arterial pressures and cardiac output thereby having vasodilator effects to increase blood flow to the penis to help a man get and keep an erection. However, these diseases are usually not common at a younger age and thus younger men will usually tend to use sildenafil to impress or satisfy their partner rather than treat ED.
In the present study, the recreational use of sildenafil was also more prevalent in participants who had multiple sexual partners. Similar findings were also reported in a study conducted in Brazil 6 , and this could be because men with multiple sexual partners may be attempting to impress their partners with prolonged sexual periods 7 , 8. It could also be attributed to a low level of self-esteem in men who had multiple sexual partners.
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In the current study, most of the participants reported that they got information about sildenafil primarily from their friends. Similar results were reported in other studies in which friends, the internet, and sex shops were the primary source of information 6.
The recreational use of sildenafil was also associated with vision changes A remarkable issue evident in the current study and other similar studies was the level of acquisition of sildenafil without a medical prescription.
In the present study, most of the respondents get sildenafil without a prescription as an OTC medication. Similar findings were reported in Ethiopia and a web-based observational study conducted in the United Kingdom, Germany, and Italy 1 , 9.
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The latter revealed that embarrassment to speak to a physician and the perception that this would be the cheapest way to get the medicine was the major predictive factors for obtaining PDE5Is without prior health care professional consultation 9.
The non-prescription availability of PDE5Is could lead to the inappropriate utilization of the medication and an increased rate of adverse effects as well as increased probability of addiction to the drug The most common reasons to use sildenafil in the present study were to increase erectile sensation and penile rigidity.
