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by netaustin 1281 days ago
Off-label uses that appear to actually be effective include altitude sickness and prevention of SIPE (Swimming Induced Pulmonary Edema). I take it for the latter, and it's remarkable. No Sildenafil = I cough up blood after just a few minutes swimming in cold water (as in a triathlon). Sildeanfil = no ill effects whatsoever. I'm unclear how a vasodilator would impact a neurological disease.
2 comments
TrevorJ 1281 days ago
Asking because I am genuinely curious, if you are willing to share: What mindset do you have where you keep doing an activity that normally results in you coughing up blood? I know that sounds like a super disrespectful question, it's just the sort of thing I think about a lot due to having some health related activity restrictions that I've had to negotiate with myself. Always interested in what other people's journeys are in this space.
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netaustin 1281 days ago
Ha, fair. I love open water swimming and triathlon, and I can do it in not-cold water or a pool indefinitely, plus the Sildenafil entirely prevents it in cold water. Even without Sildenafil all I have to do is stop swimming and I'm fully better after an hour or so.
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TrevorJ 1280 days ago
Well that's good! I imagine the first time it happened must have been disturbing.
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netaustin 1280 days ago
Yes. The first time it happened was in the Hudson River in the NYC triathlon. I thought for sure that I'd just ingested some sludge, and I went on to complete the race, after which I was sent to the hospital (I walked). My pulse ox was 86. Most triathlon deaths occur during the swim portion of the race and are attributed to cardiac events, often SCD, but pulmonary edema may actually be the primary cause. A teeny bit of education (chest congestion? get out of the damn water!) could save lives, but nobody in the business of triathlon wants to scare off new participants, since the amateur fee-paying end of the sport is really the whole game.
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TrevorJ 1280 days ago
Wow, I had no idea. That would not have been on my list of potential dangers from long swims at all!
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teachrdan 1280 days ago
This off-label use of sildenafil for SIPE was part of a bigger scandal in the US Navy SEALs. Specifically, during the selection course for the SEALs, so many recruits suffered from SIPE it was common for many of them to surreptitiously take Viagra and keep training.

One soldier drowned as a result and another collapsed on land after a punishing swim and died.

https://www.nytimes.com/2022/08/30/us/navy-seal-training-dea...

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netaustin 1280 days ago
I participated in the clinical trial at Duke that's linked to from that story, which honestly was a blast. That the medics let this guy keep training is astonishing to me. If they measured his pulse ox and sent him back in anyways, that's criminal. Also, as I understand it, Sildenafil during dives is a bad idea (something about seizures) which might be why it's "banned" in SEAL training.

But who funded the Duke study that surfaced Sildenafil as a candidate drug? The Navy SEALs, of course.

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