Sildenafil and Erectile Dysfunction

Mr. A was a 52-year-old male veteran with a long history of schizoaffective disorder and intermittent cocaine abuse who reported erectile dysfunction over the past 2 decades while he was taking neuroleptics, including perphenazine, trifluoperazine, fluphenazine, and haloperidol. Because of erectile dysfunction, he frequently discontinued the neuroleptics. Sexual functioning invariably improved after he stopped taking them. Mr. A had no other systemic diseases, including diabetes, hypertension, peripheral vascular disease, or alcoholism, that affected erectile functioning. His medications for the last 4 months included haloperidol decanoate, 150 mg i.m. every 4 weeks, and benztropine, 1 mg b.i.d. Mr. A reported difficulty attaining and maintaining erections. He could achieve only partial erections that lasted less than a minute. He was interested in having sex, although he felt frustrated by his inability to maintain erections. For his erectile difficulties, we prescribed sildenafil, 50 mg. With sildenafil therapy, he was able to attain a complete erection and experience intercourse without difficulty. In fact, the first time he took sildenafil, he experienced three erections in a 5-hour period. He has successfully used the same dose of sildenafil approximately 20 times with satisfactory results. He reported no side effects, such as headaches, gastrointestinal disturbance, priapism, or visual disturbances.