Phosphodiesterase 5 inhibitors in the treatment of erectile dysfunction

被引:49
作者
Aversa, Antonio [1 ]
Bruzziches, Roberto [1 ]
Pili, Marcello [1 ]
Spera, Giovanni [1 ]
机构
[1] Univ Roma La Sapienza, Dept Med Pathophysiol, Chair Internal Med, I-00161 Rome, Italy
关键词
phosphodiesterase; 5; inhibitors; erection; cardiovascular disease; endothelium; efficacy; safety;
D O I
10.2174/138161206778343046
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Erectile dysfunction (ED) has multifactor pathogenesis, with neurological, vascular, endocrinological and psychogenic components described. However, about 50-85% of ED population report the presence of one or more comorbidities i.e. hypertension, diabetes, cardiovascular disease, dyslipidemia which all impair endothelial function and, erection is a basically vascular event that necessitates an intact endothelium to occur. Hence, ED may be mostly considered as the clinical manifestation of a disease affecting penile circulation as a part of a generalized vascular disorder due to atherosclerosis. Orally active drugs, i.e. phosphodiesterase type-5 inhibitors (PDE5-i), are a group of on-demand drugs licensed for ED treatment and appear to offer advantages over past therapies in terms of ease of administration and cost, and they are now widely advocated as first-line therapy. The recent discovery that chronic not on-demand administration of these drugs may improve erectile and endothelial response in men previously unresponding to on-demand regimes, opens a new scenario in the treatment of men with ED and comorbidities. Finally, the recent approval of PDE5-i sildenafil for the treatment of pulmonary arterial hypertension represents the new challenge for these class of drugs. Aim of this article will be to provide an update on the pathophysiology of ED and how to use of different available PDE5-i in approaching sexual dysfunctional men, pointing out on their characteristic of efficacy and safety and different indications in special sub-populations.
引用
收藏
页码:3467 / 3484
页数:18
相关论文
共 163 条
  • [11] A rationale for the use of testosterone "salvage" in treatment of men with erectile dysfunction failing phosphodiesterase inhibitors
    Aversa, A
    Bruzziches, R
    Spera, G
    [J]. ENDOCRINOLOGIST, 2005, 15 (02) : 99 - 105
  • [12] Hormonal supplementation and erectile dysfunction
    Aversa, A
    Isidori, AM
    Greco, EA
    Giannetta, E
    Gianfrilli, D
    Spera, E
    Fabbri, A
    [J]. EUROPEAN UROLOGY, 2004, 45 (05) : 535 - 538
  • [13] Erectile dysfunction: Expectations beyond phosphodiesterase Type 5 inhibition
    Aversa, A
    Pili, M
    Fabbri, A
    Spera, E
    Spera, G
    [J]. JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 2004, 27 (02) : 192 - 206
  • [14] Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction
    Aversa, A
    Isidori, AM
    Spera, G
    Lenzi, A
    Fabbri, A
    [J]. CLINICAL ENDOCRINOLOGY, 2003, 58 (05) : 632 - 638
  • [15] Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction
    Aversa, A
    Isidori, AM
    De Martino, MU
    Caprio, M
    Fabbrini, E
    Rocchietti-March, M
    Frajese, G
    Fabbri, A
    [J]. CLINICAL ENDOCRINOLOGY, 2000, 53 (04) : 517 - 522
  • [16] Aversa A, 2001, ASIAN J ANDROL, V3, P175
  • [17] Anxiety-induced failure in erectile response to intracorporeal prostaglandin-E(1) in non-organic male impotence: A new diagnostic approach
    Aversa, A
    RocchiettiMarch, M
    Caprio, M
    Giannini, D
    Isidori, A
    Fabbri, A
    [J]. INTERNATIONAL JOURNAL OF ANDROLOGY, 1996, 19 (05): : 307 - 313
  • [18] Aytac IA, 1999, BJU INT, V84, P50
  • [19] Effects of sildenafil on the relaxation of human corpus cavernosum tissue in vitro and on the activities of cyclic nucleotide phosphodiesterase isozymes
    Ballard, SA
    Gingell, CJ
    Tang, K
    Turner, LA
    Price, ME
    Naylor, AM
    [J]. JOURNAL OF UROLOGY, 1998, 159 (06) : 2164 - 2171
  • [20] New treatment options for erectile dysfunction in patients with diabetes mellitus
    Basu, A
    Ryder, REJ
    [J]. DRUGS, 2004, 64 (23) : 2667 - 2688