Q: I underwent a bypass surgery 4 years ago. Now I am exercising regularly and am on a low fat and low sweet diet. Within 15 days of the surgery I had melena due to heavy doses of pain killers. I am on Repace AF for hypertension, Eltroxin for hypothyroidism, which is normal now. I also take Pentocid 40 mg because I take ecosprin 150 mg. I also take Simcard 5 for cholesterol. My lipid profile is better after my surgery. Cholesterol - 157 mg/dl, triglycerides - 107 mg/dl, HDL - 52 mg/dl and LDL - 97 mg/dl. My main problem is that I am not able to sustain my erection to my wife's expectations. I can sustain it only when I take ayurvedic medicines for it. I take 2 tablets of Recharge. Can I take Tadalafil after having so many problems? What are the side effects of this medicine? Will it clash with the medicines I am taking already? I am facing this problem from the past 2 years.

A:Hypertension itself is a cause of erectile dysfunction. Many medicines meant for control of blood pressure make the disorder worse. Therefore great caution needs to be taken while prescribing anti-hypertensive drugs to sexually active males. It is known that losartan (Repace) reduces libido. Enalapril (sold under the trade names of BQL, Enam etc) is the drug of choice since it does not adversely affect the sexual potency and/or libido. The usual dose is 5-10mg 1-2 times daily. The first dose should be no more than 5mg. Patients of hypothyroidism often tend to have high lipid levels but the answer lies in treating the disease adequately. Only when the lipids rise to unacceptable levels, does it become necessary to give lipid lowering agents. It is known that simvastatin (Simcard) can lower male sex hormone - testosterone - levels. In any case with your lipid profile you do not need simvastatin. For many years, in fact over a decade, it was believed that aspirin is useful in patients of ischaemic disease of both heart and brain because it is a blood thinner. To our great surprise a very large study done in the US has just come up with surprising results: aspirin actually increases the risk of haemorrhagic stroke in men while it reduces it in women. In any case you can safely reduce the dose to 75 or at the most 100mg of aspirin since its blood thinning property remains the same as of 150mg. This reduction will help reduce its side effects. You can safely use Pantodac for aspirin-related hyperacidity. There is no prohibition on the use of tadalafil (sold under the brand name of Zydalis) in your case since you are not consuming nitrates/nitrites and your blood pressure is on the higher side. The use of Zydalis is prohibited by people who are taking nitrates such as Sorbitrate etc. The normal dose of Zydalis is 10mg and its effect remains for up to 24 hours. The dose can be increased to 20 mg.