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Why would an ICU patient be on Viagra BID (off label use?)

A client that my wife cared for in an ICU environment had Viagra prescribed BID. This was a post-op CABG scenario. Is there an off label use for the drug not in Davis where this would be appropriate?

nursej22, MSN, RN

Specializes in med/surg,CV. Has 30 years experience.

Viagra may be used for pulmonary hypertension, especially if coused by pulmonary fibrosis.

nurse4theplanet, RN

Specializes in Critical Care, Pediatrics, Geriatrics.

that makes sense because it was originally designed as a BP med and the most common side effect was an erection.

It is actually used on babies also in the ICU and other settings for pulmonary hypertension, what it was originally designed for. Comes is a liquid form.:)

I had a patient just the other night that was admitted for persistant hypotension that had scheduled Viagra. I had to go looking for information on it - the short of it is it works as a nitrate. (I didn't give it - pt was on a dopamine drip at the time)

A.W.

veronica butterfly, ADN, RN

Specializes in Med/Surg, Urg Care, LTC, Rehab. Has 10 years experience.

stupid question and not meant to be funny.....

do these patients get erections? and if so, isn't it uncomfortable for them if not "relieved"? or does viagra help someone with impotence only by allowing the body to function if the "mind is willing?"

sheesh, thanks.

TennNurse

Specializes in ER!.

stupid question and not meant to be funny.....

do these patients get erections? and if so, isn't it uncomfortable for them if not "relieved"? or does viagra help someone with impotence only by allowing the body to function if the "mind is willing?"

sheesh, thanks.

Good questions, all. I hope someone here can answer them; I'd like to know as well.

Anyone???

stupid question and not meant to be funny.....

do these patients get erections? and if so, isn't it uncomfortable for them if not "relieved"? or does viagra help someone with impotence only by allowing the body to function if the "mind is willing?"

sheesh, thanks.

In the beginning when it was first marketed a lot of people (lay) thought that. They would take the pill and waited expecting it to just pop up on its own. There must be sexual excitement. Viagra did not eliminate the need for foreplay. If no sexual excitement no erection.

Viagra allows an erection to happen in those who have physical difficulty in achieving and erection.

veronica butterfly, ADN, RN

Specializes in Med/Surg, Urg Care, LTC, Rehab. Has 10 years experience.

In the beginning when it was first marketed a lot of people (lay) thought that. They would take the pill and waited expecting it to just pop up on its own. There must be sexual excitement. Viagra did not eliminate the need for foreplay. If no sexual excitement no erection.

Viagra allows an erection to happen in those who have physical difficulty in achieving and erection.

Thanks, makes sense!!

Uptoherern, RN

Specializes in Emergency Room.

...............so they don't fall off the bed...........:rotfl:

Thanks, your information also raises another question. Why is it that Davis (and I'm going to go out out a limb and assume that Lippencott, Mosby et al are the same) don't mention the off label uses for Viagra? Is there a text (or website) that extensively covers the off label uses of various drugs? Also, I just did a Google search and found this article that discussed Viagra after a CABG to reduce the chance of graft blockage http://www.chestjournal.org/cgi/content/full/128/4/3065

The whole point of "off-label" use is that the drug has not been FDA approved as "safe & effective" for that other use. It's a v. grey area legally. The FDA forbids the pharmaceutical companies to promote off-label uses of their drugs; I imagine that the Rx drug reference books, which only cover FDA approved Rx drugs, may well feel that it would be inappropriate to discuss non-FDA-approved usages of Rx drugs.

That's just my best guess, though -- someone else may have a better answer.

babynurselsa, RN

Specializes in ER, NICU, NSY and some other stuff. Has 12 years experience.

http://en.wikipedia.org/wiki/Sildenafil

Check out the link. If you are looking it up as viagra you will find that it is marketed as an ED drug. If you look it up under the generic you will find tge original uses.

Hope this helps.

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

Good questions, all. I hope someone here can answer them; I'd like to know as well.

Anyone???

It is not a magic pill that, "Wallah! You have an erection!" Directions indicate that arousal must be used and even gives examples of "kissing and touching" in the directions. (We have free samples in the office, it is quite often that the doctor comes out asking for a sample of "the blue pills" as to not embarrass the patient.)

Just learned in class about a young man that thought he "would have a good time" and took four Viagra. He has an erection for 36 hours, but because he had the erection for so long, new blood was not entering the penis and the tissue died off. I guess it was kinda like a grand finale.:imbar

RazorbackRN, BSN, RN

Specializes in Pediatrics (Burn ICU, CVICU).

In the beginning when it was first marketed a lot of people (lay) thought that. They would take the pill and waited expecting it to just pop up on its own. There must be sexual excitement. Viagra did not eliminate the need for foreplay. If no sexual excitement no erection.

Viagra allows an erection to happen in those who have physical difficulty in achieving and erection.

I had a couple of ped's pts in the CVICU the other day that were both on Viarga for pulmonary HTN and they did have erections within a short time after receiving the drug. The nurse that was precepting me said that it was very common.

The whole point of "off-label" use is that the drug has not been FDA approved as "safe & effective" for that other use. It's a v. grey area legally. The FDA forbids the pharmaceutical companies to promote off-label uses of their drugs; I imagine that the Rx drug reference books, which only cover FDA approved Rx drugs, may well feel that it would be inappropriate to discuss non-FDA-approved usages of Rx drugs.

That's just my best guess, though -- someone else may have a better answer.

The thing is that Davis does include a section on "off label" uses however, in the case of Viagra none were referenced. My take is that if drugs are being used it is important for nurses to understand why whether or not the drug is FDA approved or being used in a nontraditional manner. Now if we can agree that it is important for nurses to understand even off label uses then most would probably also agree that there should be a standard reference which contains this information (understanding of course that off label uses are continually evolving and therefore no reference will ever be complete).

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

My take is that if drugs are being used it is important for nurses to understand why whether or not the drug is FDA approved or being used in a nontraditional manner.

There is, of course, simply asking the pt.'s MD about the ordered medication & getting insight into his/her thought process in ordering it.

jeepgirl, LPN, NP

Specializes in Pediatrics, Nursing Education. Has 4 years experience.

There is, of course, simply asking the pt.'s MD about the ordered medication & getting insight into his/her thought process in ordering it.

But, if you get a particularly mean doc on a particularly bad day... some can be downright abusive when questioning orders.

nurse4theplanet, RN

Specializes in Critical Care, Pediatrics, Geriatrics.

It is not a magic pill that, "Wallah! You have an erection!" Directions indicate that arousal must be used and even gives examples of "kissing and touching" in the directions. (We have free samples in the office, it is quite often that the doctor comes out asking for a sample of "the blue pills" as to not embarrass the patient.)

Just learned in class about a young man that thought he "would have a good time" and took four Viagra. He has an erection for 36 hours, but because he had the erection for so long, new blood was not entering the penis and the tissue died off. I guess it was kinda like a grand finale.:imbar

I remember several news casts when viagra was first introduced as an errectile dysfunction drug concerning teenagers who were taking it bc they believed it would work like ectasy and make sex better/last longer. Many times the kids died or suffered horrendous complications.

kurlykay

Specializes in Tele, ICU, CCU, teaching.

I worked on a tele/renal floor for a while and Viagra was sometimes given to renal patients. It was supposed to increase blood flow to the kidneys by vasodialating or something like that. Did you patient have CRF also?

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