DEAR DR. ROACH: Short of sounding like a conspiracy theorist, why hasn't the Food and Drug Administration approved sildenafil in a set dosage for blood pressure medication? I saw a decrease from 150/90 to 115/70 in a reading about an hour after taking a 20-mg tablet. That's a far superior result compared with the medications I am on. -- J.I.C.
ANSWER: Sildenafil (Viagra) does have a blood-pressure-lowering effect in many men. However, the average effect is only about 8 points systolic and 6 points diastolic, far less than the 35 and 15 point drop you saw. Further, the blood pressure effect is gone in less than 8 hours. The goal for blood pressure medicine is continuous lowering without big ups and downs.
I'm not a big believer in conspiracy theories. If the medication were truly safe and effective for blood pressure control, you can be sure it would be marketed as a blood pressure pill with additional benefits for some people, just as tadalafil (Cialis) is marketed as a treatment for benign prostate enlargement, in addition to its proven role in treating erectile dysfunction. Tadalafil is also being studied as a potential benefit in heart failure treatment.
DEAR DR. ROACH: I happened to be using a topical steroid for a bug bite when I got a sunburn on the area. To my surprise, the area that had the steroid on it had no redness or pain. Are topical steroids effective sunblocks? If so, why don't we use them? -- W.R.R.
ANSWER: High-potency steroids are powerful anti-inflammatory drugs. Although they do not prevent the damage done to the skin by the sun, they do prevent the inflammatory reaction that shows up as redness and warmth on the skin. That reaction appears for hours or days after sun damage, depending on the degree of the sun exposure and the individual's protective skin pigment.
Broad-spectrum sunscreens do partially protect a person's DNA against the sun. In addition to avoiding excess sun by staying out of it, especially during the most dangerous time of the day, other strategies to reduce risk of sun damage and skin cancer include wearing sun-protective clothing and the regular, repeated and liberal use of UVA and UVB sunscreens.
High-potency topical steroids are not proven to and probably don't reduce the risk of skin cancer. More importantly, they have far too many side effects to use on a large area of the body. I don't recommend steroids in prevention nor treatment of sunburn.
DEAR DR. ROACH: What are your views on the safety and effectiveness of glucocorticoid nasal sprays, instead of, and in addition to, oral antihistamines and decongestants, for managing allergic rhinitis? -- P.L.V.
ANSWER: My experience, backed up by the research, is that more people will get relief with regular use of nasal corticosteroids, such as fluticasone (Flonase) or triamcinolone (Nasacort), than with oral antihistamines or decongestants. All three classes are generally safe. However, nasal steroids cause nosebleeds in some people; decongestants can raise blood pressure, occasionally strikingly; and some antihistamines are sedating. Older men can have prostate problems with either decongestants or antihistamines.
Some people may prefer one or the other just for convenience. Some of my patients just cannot stand nasal sprays, even newer ones that have much less sensation upon spraying. Other people don't like pills. The combination of the two has more potent effects than either by itself.
Before taking medications, it may certainly be wise to consider how to reduce contact with substances that trigger one's symptoms. It may be impossible to avoid triggers entirely.