Dear Dr. Roach: Short of sounding like a conspiracy theorist, why hasnt the Food and Drug Administration approved sildenafil in a set dosage for blood pressure medication? I saw a decrease from 150/90 to 115/70 in a reading about an hour after taking a 20-mg tablet. Thats a far superior result compared with the medications I am on. J.I.C.
Answer: Sildenafil (Viagra) does have a blood-pressure-lowering effect in many men. However, the average effect is only about 8 points systolic and 6 points diastolic, far less than the 35 and 15 point drop you saw. Further, the blood pressure effect is gone in less than 8 hours. The goal for blood pressure medicine is continuous lowering without big ups and downs.
Im not a big believer in conspiracy theories. If the medication were truly safe and effective for blood pressure control, you can be sure it would be marketed as a blood pressure pill with additional benefits for some people, just as tadalafil (Cialis) is marketed as a treatment for benign prostate enlargement, in addition to its proven role in treating erectile dysfunction. Tadalafil is also being studied as a potential benefit in heart failure treatment.
Dear Dr. Roach: What are your views on the safety and effectiveness of glucocorticoid nasal sprays, instead of, and in addition to, oral antihistamines and decongestants, for managing allergic rhinitis? P.L.V.
Answer: My experience, backed up by the research, is that more people will get relief with regular use of nasal corticosteroids, such as fluticasone (Flonase) or triamcinolone (Nasacort), than with oral antihistamines or decongestants. All three classes are generally safe. However, nasal steroids cause nosebleeds in some people; decongestants can raise blood pressure, occasionally strikingly; and some antihistamines are sedating. Older men can have prostate problems with either decongestants or antihistamines.
Some people may prefer one or the other just for convenience. Some of my patients just cannot stand nasal sprays, even newer ones that have much less sensation upon spraying. Other people dont like pills. The combination of the two has more potent effects than either by itself.
Before taking medications, it may certainly be wise to consider how to reduce contact with substances that trigger ones symptoms. It may be impossible to avoid triggers entirely.
