Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Vardenafil (Levitra) was the second oral medicine approved by the U.S.
FDA for the treatment of erectile dysfunction. Like sildenafil (Viagra),
vardenafil (Levitra) inhibits PDE5 which
destroys cGMP (as discussed earlier).
How effective is vardenafil (Levitra)?
Vardenafil was evaluated in four multicenter, randomized, placebo-controlled
trials involving more than 2,400 men (78% white, 7% black, 2% Asian, 3% Hispanic)
with erectile dysfunction. Two of these trials were conducted in special
erectile dysfunction populations; one in men with diabetes mellitus, another in
men who developed erectile dysfunction after prostate surgery. The doses of
vardenafil in the four studies were 5 mg, 10 mg, and 20 mg.
In all four studies, vardenafil was significantly better than placebo in
improving men's ability to achieve and maintain erections in all age
categories (less than 45, 45-65, and greater than 65 years of age) and in all
races.
How should vardenafil (Levitra) be administered?
The recommended starting dose of vardenafil is 10 mg taken orally
approximately one hour before sexual activity. The dose may be adjusted higher or
lower depending on efficacy and side effects. The maximum recommended dose is 20
mg, and the maximum recommended dosing frequency is no more than once per day.
Vardenafil can be taken with or without food.
What are the side effects of vardenafil (Levitra)?
Vardenafil is generally well tolerated with only mild side effects. These
side effects include headache, flushing, nasal congestion, dyspepsia, body
aches, dizziness, nausea, and increased blood levels of the muscle enzyme
creatine kinase.
There have been rare reports of priapism (prolonged and painful erections
lasting more than six hours) with the use of oral PDE5 inhibitors such as
vardenafil, sildenafil, and tadalafil.
Men with blood cell diseases such as
sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks
of developing priapism.
Untreated priapism can cause injury to the penis tissue and lead to
permanent loss of potency. If there is prolonged erection (longer than four hours),
immediate medical assistance should be sought.
Who should not use vardenafil (Levitra)?
Vardenafil (Levitra) can cause hypotension (abnormally low blood pressure,
which can lead to fainting and even shock) when given to patients who are taking
nitrates. People taking nitrates daily should not take vardenafil. Most commonly used nitrates are medications to relieve angina (chest pain due to insufficient blood supply to heart muscle because of narrowing of the coronary arteries). These include nitroglycerine tablets, patches, ointments, sprays, pastes, and isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate are found in some recreational drugs called "poppers."
Vardenafil should not be used with alpha-blockers, medicines used to treat
high blood pressure and benign prostate hypertrophy (BPH), because the
combination of vardenafil and an alpha-blocker may lower the blood pressure
greatly and lead to dizziness and fainting. Examples of alpha-blockers include
tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin
(Uroxatral), and prazosin (Minipress).
Men with a rare heart condition known as long QT syndrome should not take
vardenafil since this may lead to abnormal heart rhythms. The QT interval is the
time it takes for the heart's muscle to recover after it has contracted. The
QT interval is measured with an electrocardiogram (EKG). Some people have longer than normal QT
intervals, and they may develop potentially life-threatening abnormal heart
rhythms, especially when given certain medications. Since long QT syndrome can
be inherited, men with a family history of long QT syndrome should not take
vardenafil. Furthermore, vardenafil is not recommended for men who are taking
medications that can affect the QT interval such as quinidine (Quinaglute,
Quinidex), procainamide (Pronestyl; Procan-SR; Procanbid), amiodarone
(Cordarone), and sotalol (Betapace).
There is insufficient information on the safety of vardenafil in men with the
following conditions:
unstable angina (chest pain due to coronary artery
disease that occurs at rest or with minimal physical exertion),
low blood pressure (a resting systolic blood pressure
less than 90mm Hg),
uncontrolled high blood pressure (greater than
170/110 mm Hg),
recent stroke or heart attack
(within six months),
severe heart failure or disease of the heart's valves, for example,
aortic stenosis,
retinitis pigmentosa.
Therefore, men with these conditions should not use vardenafil without having
these conditions evaluated and stabilized first. For example, men with
uncontrolled high blood pressure should have their blood pressure controlled; and
men with potentially life-threatening abnormal heart rhythms should have these
rhythms controlled.
When there is angina or heart failure, the doctor may need to determine
whether the heart has enough reserve to safely carry out the work necessary for
sexual activity by performing cardiac treadmill stress testing.
What precautions should be taken when using vardenafil (Levitra)?
Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease,
and concurrent use of certain medications (such as erythromycin, ketoconazole
[Nizoral],
and protease inhibitors). Slowed breakdown allows vardenafil to accumulate in
the body and potentially increase the risk for side effects. Therefore, in men
over 65 years of age, with liver dysfunction, or who are also taking medication(s) that can
slow the breakdown of vardenafil, the doctor will initiate vardenafil at low
doses to avoid its accumulation. For example:
Men taking erythromycin or ketoconazole should not
take more than 5 mg of vardenafil in a 24-hour period.
Men taking high doses of ketoconazole (Nizoral)
should not take more than 2.5 mg of vardenafil in a 24-hour period.
Men with moderately severe liver disease also should
not take more than a 5 mg dose of vardenafil in a 24-hour period.
Men
taking the protease inhibitor (for the treatment of HIV/AIDS) indinavir (Crixivan) should not take more than 2.5 mg of vardenafil in a 24-hour period.
Men taking another
protease inhibitor ritonavir (Norvir) should not take more than 2.5 mg of
vardenafil every 72 hours.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Testicular pain, or pain in the testicle or testicles are caused by a variety of diseases or conditions such as testicular trauma, testicular torsion, testicular cancer, epididymitis, and orchitis. Common symptoms of pain in the testicle or testicles are abdominal pain, urinary pain or incontinence, fever, nausea, vomiting, and pain in the scrotum or testicle. Treatment depends on the cause of the testicular pain or pain in the testicles.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Male sexual dysfunction can be caused by physical or psychological problems. Common sexual problems in men include erectile dysfunction (impotence or ED), premature ejaculation and loss of libido. Treatment for sexual dysfunction in men may involve medication, hormone therapy, psychological therapy, and the use of mechanical aids.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Penis disorders (male reproductive problems) include priapism, Peyronie's disease, balanitis, phimosis, paraphimosis, and penile cancer. Read on for causes, symptoms, diagnosis, and treatment. These disorders can affect a man's fertility and sexual functioning. A variety of treatments are available for these disorders.
Prolactinoma is an adenoma (benign tumor) of the pituitary gland. Causes of many prolactinomas are unknown. Symptoms in women include changes in menstruation and infertility, decreased libido, or painful intercourse due to vaginal dryness. The most common symptom in men is impotence (erectile dysfunction). Treatment of prolactinomas are medication or surgery.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
Peyronie's disease is a condition characterized by a hard lump, or plaque, that forms within the penis. Symptoms of Peyronie's disease range from mild to severe. Treatment for Peyronie's disease includes medication, and often surgery.
Men's health is an important component to a happy lifestyle and healthy relationships. Eating healthy, exercise, managing stress, and knowing when to have medical tests for a particular age is key to disease prevention in men.
Having diabetes can mean early onset and increased severity of bladder symptoms (urinary incontinence and urinary tract infections) and changes in sexual function. Men may have erectile dysfunction; and women may have problems with sexual response and vaginal lubrication. Keep your diabetes under control, and you can lower your risk of sexual and urologic problems.
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