Author's Reply to “Reader's Response to ‘There Have Been Inadequate Warnings That Erectile Dysfunction Drugs Can Cause Blindness’”

To the Editor,

In addition to our study showing an 18-fold increased rate of reports to the FDA [US Food and Drug Administration] of nonarteritic anterior ischemic optic neuropathy (NAION) per million prescriptions with sildenafil (Viagra) compared with atorvastatin (Lipitor),[1] a recent case-control study found that for those men with either hypertension or a history of myocardial infarction (MI), the use of sildenafil or tadalafil (Cialis) conferred an increased risk for NAION, 10.7-fold increased risk and statistically significant for those with a history of MI and 6.9-fold increased risk but not quite statistically significant for those with hypertension.[2] Thus, in the face of increased cardiovascular risk, such as seen with hypertension or MI, there is an increased risk for NAION for those using these erectile dysfunction drugs.

If Dr. Stone[1] would read the book that he describes his patients as “clutching” Worst Pills, Best Pills (also available at worstpills.org), he would find that we do indeed describe why people with globally increased cardiovascular risk for strokes or heart attacks should be treated. But whenever we describe a drug as do not use, we always refer the patient to the pages in the book in which the safer, equally effective, and often less expensive alternative is described. With respect to our opportunity to educate the public, we will “use that position to responsibly educate the public in the future” as we have for the past 35 years.

Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eye only or for possible publication via email: glundberg@medscape.net