By
Tony Underwood
Overweight smokers in the ADF who drink too much or use illicit
drugs are more likely to receive counselling than a prescription
under the policy for erectile dysfunction (ED) medication just
published in a Defence Health Bulletin.
Certain job categories may be off-limits also for the two medications
currently approved for use in Australia - Viagra and Cialis -
at least when there’s a chance they can impair faculties
needed for Defence work.
They will not be prescribed for women.
And those who do receive a prescription from an MO are likely
to be limited to four doses per month.
“Risk factors for ED include age, medical conditions, medications
and lifestyle factors,” the Director-General Defence Health
Service, AIRCDRE Tony Austin said in the document addressing the
issue, Defence Health Bulletin No. 4/2003.
AIRCDRE Austin said an Australian survey in 1999 found that the
prevalence of impotence was about three per cent in 40-49 year
olds and 12 per cent in 50-59 year olds.
“Although the incidence of ED increases with age, it is not
an inevitable consequence of aging,” he said.
Medical conditions commonly associated with ED include diabetes,
mellitus, hypertension, heart disease, peripheral vascular disease,
multiple sclerosis, prostate surgery and trauma or fractures to
the pelvic area of spinal cord.
AIRCDRE Austin said however, that it is sometimes difficult to
distinguish between the effects of age and a predisposing medical
condition. Some medications, including those for blood pressure
and psychotropic medications are ‘also implicated’.
“Lifestyle factors such as cigarette smoking, chronic alcohol
abuse and obesity are associated,” he said. “Vigorous
exercise appears to have a protective effect against ED.”
Defence medical authorities will be looking carefully for the
possibility that ED medication can adversely affect the ability
of sailors, soldiers and airmen to carry out certain duties.
Pharmacological effects associated with Viagra and Cialis include
colour tingeing of the visual scene and decreased blue green colour
discrimination and generalised vasodilation associated with a
small decrease in blood pressure and dizziness.
As well as canvassing the dosages of the PDE5 (phosphodiesterase
type 5) drugs used to treat the condition, the Health Bulletin
mandates a thorough clinical assessment to identify contributory
medical conditions, medications, psychogenic or lifestyle factors
which could contribute to a patient’s impotence.
“If any underlying causes are present and able to be ameliorated,
an attempt must be made to do so,” AIRCDRE Austin said.
“Medications contributing to ED may be able to be discontinued
or alternatives prescribed.
“Psychosexual therapy, if indicated, may be used in conjunction
with other treatment.
“Counselling with regard to lifestyle factors such as obesity,
smoking, excessive alcohol or illicit drug use may be appropriate.”
The Health Bulletin adds that provision of PDE5 drugs is to be
limited to one packet of four tablets per person per month unless
the Senior Medical Officer (SMO) has approved provision of a larger
amount.
In terms of job descriptions which might be affected by the drugs,
the document says they are not to be prescribed for aircrew or
divers who are on active flying or diving status.
AIRCDRE Austin said underlying conditions for aircrew suffering
from ED may have ‘flying safety implications’.
But he said aircrew may be permitted to take the medication whilst
on active flying status provided they observe a 12-hour temporarily
unfit for flying (TMUFF) period after taking the medication.
The document said also the maximum period duration of provision
of PDE5 drugs is six months unless continuing treatment is prescribed
by the MO.
