Erectile dysfunction drug-related

A 58-year-old man with a history of angina for which he occasionally takes isosorbide dinitrate is having erectile dysfunction. He confides in a colleague who suggests that sildenafil might help and gives him three tablets from his own prescription. The potentially lethal combination of these drugs relates to... 

Keene LC and Davies PH. Drug-related erectile dysfunction. Adverse Drug React Toxicol Rev 1999 18 5-24. 

Yohimbine (4.43) is an antagonist. Yohimbine, an indole alkaloid closely related to reserpine—an a antagonist—has been evaluated as a potential treatment for male erectile dysfunction. Naphazoline (4.46) and other a-agonist imidazoline compounds are nasal decongestants, used by inhalation to decrease swelling of the nasal mucosa. Overdependence on and overuse of these drugs can lead to rebound swelling. 

Intracavernosal alprostadil was effective and well tolerated in the treatment of erectile dysfunction, according to the results of a 6-month study (funded by Pharmacia Upjohn) in 848 men (mean age 52 years) with at least a 4-month history of erectile dysfunction (12). This is provided that the individual dose is established by titration and patients receive training in injection techniques and periodic supervision during treatment. An initial dose was established for each patient and the patients then administered the alprostadil themselves at home. Of 727 evaluable patients, 682 (94%) had at least one erectile response after the injection of alprostadil, and 88% of injections lead to a satisfactory sexual response. The most commonly reported adverse event was penile pain, reported by 44% of patients, but only after 8% of injections. In just over half of the patients who had penile pain, the condition was reported as mild. Prolonged erection, penile fibrosis, and priapism occurred in 8,4, and 0.9% of patients respectively. Treatment was withdrawn because of medical events in 4% of patients, and drug-related events accounted for treatment withdrawal in 2% of patients. 

In the presence of sexual stimulation and in doses of 25 to 100 mg, sildenafil produces satisfactory erections in 56% to 82% of patients, independent of the etiology of erectile dysfunction. Similar values are documented in the product labeliug for the other two agents in this class (65% to 80% for vardenafll and 62% to 77% for tadalafil). Response rates for sUdenafll in the lower range have been documented in patients following radical prostatectomy, probably due to postoperative nerve damage. The drugs effectiveness appears to be dose related. °... 

Sexual fimction Beta-blockade is one of the leading causes of drug-related erectile dysfunction, although differences between different agents have not been assessed. In 1007 patients, mean age 58 years, who had taken any beta-blocker for at least 6 months, the prevalence of any category of erectile dysfunction was 71%. Erectile dysfunction... 

---