Currently, under the multiple influences of population aging, chronic cardiovascular and cerebrovascular diseases, and suboptimal health status, the health issues of middle-aged and elderly men are becoming increasingly serious. In particular, erectile dysfunction (ED), a common ailment among middle-aged and elderly men, has seen a significant rise in recent years. Sildenafil is one of the commonly used medications clinically for treating ED, and whether this medication causes dependence has been a topic of significant concern.
In clinical practice, when doctors are asked about the dependence potential of sildenafil by patients, they usually try earnestly to alleviate patients’ anxiety regarding oral medication. However, due to constraints such as time and environment, doctors may not be able to objectively analyze the question of “whether sildenafil causes dependence.” This is because the issue involves a considerable amount of professional knowledge and a wide range of clinical pharmacological concepts, making it difficult for doctors to explain the concept of dependence related to sildenafil in just a few sentences. This leads to many patients still feeling unfamiliar with the medication and lacking sufficient understanding of whether it causes dependence. Therefore, the focus of this article today is to delve into this issue and provide a detailed analysis, with a key emphasis on explaining how to discontinue the medication in a more scientific manner.
Does the need for repeated medication use indicate dependence on a drug?
In clinical practice, most male ED patients believe that “drug dependence” means a drug that cannot be discontinued and needs to be used repeatedly. For example, if sildenafil needs to be used frequently, or in cycles, and if the symptoms recur upon discontinuation, it is perceived as having dependence. In reality, the understanding of “drug dependence” is not straightforward; it has a precise and standardized definition.
The concept of “drug dependence” originates from the medical textbook “Clinical Pharmacology.” “Clinical Pharmacology” is a discipline included in the national “Eleventh Five-Year Plan” for higher education, the “Eleventh Five-Year Plan” of the Ministry of Health, and the planning textbooks of the National Higher Medical Education Textbook Construction Research Association. In simple terms, “Clinical Pharmacology” is a textbook used by professionals in basic, clinical, preventive, and oral medicine. In this textbook, a strict explanation of “drug dependence” is provided.
According to “Clinical Pharmacology,” the definition of “drug dependence” is a special toxicity of psychoactive drugs, indicating a unique mental and physical state formed by the interaction between the drug and the body under conditions of drug abuse. Drug dependence is mainly characterized by the regular or continuous compulsive use of the drug in order to experience its mental effects after use or to avoid severe physical discomfort and distress upon discontinuation of the drug. It can be seen that the clinical manifestations of drug dependence are very complex, but based on the displayed physical or mental states, it can be divided into physical dependence and psychological dependence.
Based on the definition of “drug dependence” in “Clinical Pharmacology,” sildenafil does not exhibit drug dependence
Based on the definition of “drug dependence” in “Clinical Pharmacology,” it is evident that the definition is rigorous. Drugs that meet the criteria for “drug dependence” cause dual harm to the body and mind. Whether it is physical dependence or psychological dependence, drugs meeting the criteria for “drug dependence” lead patients to psychologically and physically crave and accept the medication once used.
Applying the definition of “drug dependence” from “Clinical Pharmacology” to assess sildenafil, it is clear that sildenafil does not exhibit physical or psychological dependence. For example, regarding physical dependence, as mentioned earlier, a certain drug causing dependence will lead to the development of “withdrawal syndrome” upon cessation, but discontinuing sildenafil, although resulting in recurring symptoms, does not lead to other physical discomforts or exhibit symptoms of “withdrawal syndrome” such as palpitations, rhinorrhea, or diaphoresis.
Similarly, in terms of psychological dependence, if a drug exhibits dependence, discontinuation would induce a sense of “psychological craving.” However, for sildenafil, in reality, most patients tend to be resistant to the medication, both during its usage and post-discontinuation. Although some patients may resort to using sildenafil again after experiencing a recurrence of symptoms, it is mainly due to considering the therapeutic efficacy of the drug towards their condition. Hence, fundamentally, there is no psychological dependence when discontinuing sildenafil.
How to discontinue sildenafil more scientifically involves three main principles
First principle: Comprehensive medication principle. In clinical practice, the pathogenesis of ED is relatively complex, especially as most ED patients are middle-aged and elderly men, a demographic commonly characterized by vascular dysfunction, reduced hormone secretion, and decreased sensitivity in nerve conduction. Therefore, treating the disease becomes more challenging. In such situations, apart from using sildenafil, judiciously co-administering androgenic medications can address dysfunction caused by androgen insufficiency, while also using neurotrophic drugs to improve nerve conduction. Additionally, since vascular endothelial function is crucial for achieving an erection, combining medications that enhance endothelial function can ensure a more scientific discontinuation of sildenafil. Especially for patients with underlying cardiovascular and cerebrovascular diseases, actively treating the primary condition is crucial for effectively managing ED and is one of the key measures to reduce long-term sildenafil use.
Second principle: Low-dose medication principle. In clinical settings, the debate over whether low or high doses of oral sildenafil are more effective for ED patients has been ongoing. For doctors, recommending low doses offers fewer adverse effects, albeit with a lowering of drug efficacy. On the other hand, high doses increase drug efficacy but also come with more adverse reactions. Although both low and high doses have their dual effects on patient treatment, when considering discontinuation, it is advisable for patients to opt for low-dose sildenafil initially. This is because low-dose sildenafil results in lower blood concentration in the patient, avoiding the formation of “dose dependence.” Furthermore, if patients opt for high doses and suddenly discontinue, the large dose gap can lead to more frequent recurrence of symptoms.
Third principle: Gradual reduction principle. From a disease standpoint, there is a strong correlation between ED and male psychology. Ensuring the smooth discontinuation of medication and preventing patient anxiety, which can interfere with the discontinuation plan, are essential. In such cases, gradually decreasing the sildenafil dose is a reasonable approach for effective discontinuation. Gradually reducing the sildenafil dose not only aids in maintaining an effective blood concentration within the body, ensuring the basic drug efficacy but also boosts patient psychological self-confidence, reducing anxiety and transitioning more effectively from reducing drug use to complete discontinuation.
Conclusion
Currently, as society and the economy continue to develop, the aging population escalates, and suboptimal health conditions become more apparent, these factors are among the fundamental reasons leading to a significant increase in the incidence of male ED. For ED patients, to ensure a more scientifically sound discontinuation of medication, in addition to adhering to the three principles of comprehensive medication, low-dose medication, and gradual reduction, timely intervention to address the pathological causes of ED, effective elimination of high-risk factors contributing to ED, and implementing appropriate exercise, sufficient rest, balanced nutrition, and a healthy lifestyle are necessary to maximize the dual benefits of discontinuation and disease recovery.
