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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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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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