Erectile dysfunction drug-induced

Drug-induced sexual dysfunction Ejaculation disorders Decreased libido, erectile dysfunction, ejaculation disorders... 

If the patient is started on a 5a-reductase inhibitor, monitor the patient for drug-induced decreased libido, erectile dysfunction, or ejaculation disorders. If severe, discontinue the drug. 

There is a higher incidence of impaired sexual function in men who take finasteride compared with placebo (58,59). The incidence of erectile dysfunction has been estimated at 5% (60), but it is difficult to estimate, since in many users of the drug other causes are present, including advanced age, heart disease, diabetes, hypertension, smoking, and hypercholesterolemia. Benign prostatic hyperplasia itself can also aggravate or even induce erectile dysfunction. A questionnaire study in New Jersey... 

Neuroleptic drug-induced sexual dysfunction, including erectile and ejaculatory dysfunction and changes in libido and the quality of orgasm, appear to be reversible on withdrawal. 

Soderdahl DW, Thrasher JB, Hansberry KL. Intracavemosal drug-induced erection therapy versus external vacuum devices i n the treatment of erectile dysfunction. Br J Urol 1997 79 952-957. 

Erectile dysfunction has been reported in 3% to 5% of patients. It may be secondary to ejaculation disorders, or may be due to drug-induced inhibition of nitric oxide synthase (which is needed for producing nitric oxide, a vasodUatory substance) in cavemosal tissue. The role of 5a-reductase inhibitors in causing erectile dysfunction is not clear, as elderly men with BPH commonly develop erectile dysfunction as they age, or have concurrent medical illnesses or concomitant drug therapies that may predispose to the development of sexual dysfunction. ... 

Other intracorporal agents used to induce penile erections include papaverine, a drug with a relaxant effect on smooth muscle, and phentolamine, an a-adrenergic receptor blocker. Yohimbine, an a2-adrenoreceptor antagonist, enhances noradrenergic neurotransmission and may improve erectile dysfunction via adrenergic system activation. 

There appear to be no published reports of adverse interactions between intracavemous alprostadil (prostaglandin E,) and other drugs used for erectile dysfunction, but some manufacturers say that smooth muscle re-laxants such as papaverine and other drugs used to induce erections such as alpha-blocking drugs [e.g. intracavernosal phentolamine] should not be used concurrently because of the risks of priapism (painful prolonged abnormal erection). ... 

In place of intracavernosal injection to examine patients with erectile dysfunction intraurethral instillation of prostaglandin El at the dose of 0.5 mg has been proposed as an alternative method to reduce the distress connected to the direct injection (Tam et al. 1998). Although the urethral mucosa is not the best route of drug transfer, its anatomical structure with numerous submucosal veins that communicate between the corpus spongiosum and the corpora cavernosa can be considered an alternative way to induce erection. Color Doppler parameters and specifically peak systolic velocity (PSV) measured the increase statistically, and in about 65% erections sufficient for intercourse were obtained. The transurethral administration of prostaglandin El has shown a positive effect in the treatment of a substantial proportion of men with chronic erectile dysfunction, but the procedure is not suitable to define the nature and the severity of it (Padma-Nathan et al. 1997). 

Shanmugam, K., Holmquist, L., Steele, M., Stuchhury, G., Berbaum, K., Schulz, O., and Mtlnch, G. 2008. Plant-derived polyphenols attenuate lipopolysaccharide-induced nitric oxide and tumour necrosis factor production in murine microglia and macrophages. Molecular Nutrition Food Research, 52(4), 427-438. Shiri, R., Koskirndki, J., Hakldnen, X, Auvinen, A., Tam-mela, T.L.J., and Hakama, M. 2007. Cardiovascular drug use and the incidence of erectile dysfunction. InternationalJournal of Impotence Research, 19(2), 208-212. 

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