Dear Dr. Roach: My husband had a small stroke last spring, causing a small loss of vision in his left eye. He is 81 and an otherwise active man. He has even been told by several doctors that he can drive. One doctor told him to stop using meclizine and Viagra. Another physician said that he didn’t see a problem with taking the meds. Both physicians are very skilled. Whose advice should he follow?
M.M.
A stroke is caused by the death of brain cells, most commonly due to poor blood flow in the brain, and it’s critical to avoid any medication that will increase the risk of stroke. Meclizine is an antihistamine medicine most commonly used for motion sickness and sometimes used for vertigo. Although it has been reported to cause blurry vision, the risk of a person with a history of a stroke taking meclizine is minimal.
The situation with Viagra is more complex. A rare side effect of Viagra is nonarteritic anterior ischemic optic neuropathy (NAION), affecting one person in every 10,000 persons over 50. A person with a history of NAION should not take Viagra.
There isn’t good evidence that Viagra is dangerous for a person who had a stroke. One trial suggested there was benefit of reducing the size of a stroke with Viagra. However, Viagra does lower blood pressure by a few points, so if your husband’s blood pressure is on the borderline, that might be an issue.
I can’t give you a definitive answer, but most authorities say that a man who is stable, has good blood pressure and is more than six months out from his stroke does need not stop Viagra.
Dear Dr. Roach: At 75, I developed stress urinary incontinence, but in the past two years, it has become more uncomfortable. My urogynecologist has recommended a urethral bulking agent called Bulkamid. Are you familiar with this procedure? Can you give any insight on the pros and cons?
M.F.
My preferred treatment for female stress incontinence are pelvic floor exercises, ideally with the help of a pelvic floor physical therapist, as this has a very high patient-satisfaction rate without the risk of medication or surgery. Unfortunately, they don’t work for everyone. In women well past menopause, I look carefully for evidence of vulvovaginal atrophy and consider topical estrogen.
If these low-risk therapies are ineffective, then a visit to the urologist or urogynecologist is in order. The most common treatments include surgery, such as the minimally invasive sling surgery, and also the injection of a bulking agent into the urethra, like Bulkamid. Comparing the two, surgery tends to have higher patient-satisfaction rates, but the injection is less invasive and still has a good result for most women, although sometimes additional injections are necessary (about 25% in a large study).
For younger women, especially those with fewer medical problems, the surgical treatment is often recommended. For older women or those who aren’t in good medical shape (or who just want to avoid surgery), the Bulkamid injection is a good option. Your urogynecologist can explain why they recommended Bulkamid over a urethral sling procedure.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
