Drugs used in erectile dysfunction



Drugs used in erectile dysfunction

Erectile dysfunction (impotence): A consistent inability to sustain an erection sufficient for sexual intercourse.

* Some common causes of erectile dysfunction (ED) include:

1. Aging 4. Low testosterone

2. Lifestyle (smoking, alcohol, obesity, etc.) 5. Atherosclerosis

3. Depression, anxiety 6. HT, DM, CVD

* Standard treatment (1st treatment) for ED include lifestyle changes, such as:

• Exercising

• Losing weight

• Stopping smoking

• Decrease alcohol intake

* Treatment:

1. Oral medication phosphodiesterase type 5 inhibitor (PDE5 inhibitor).

2. Other medications

• Alprostadil (PGE1)

• Testosterone replacement

3. Surgery.

* Phosphodiesterase type 5 inhibitor (PDE5 inhibitor)

PDE 5 inhibitor such as:

• Sildenafil (Viagra) 25mg, 50mg,100mg

• Tadalafil (Cialis) 10mg, 20mg

• Vardenafil (Levitra) 5mg, 10mg, 20mg

Mechanism of action:

Part of physiological process of erection involves the release of nitric oxide. Nitric oxide activates the enzyme guanylate cyclase which results in increased levels of cyclic guanosine monophosphate (cGMP) leading to smooth muscle relaxation and increased blood flow and an erection.

PDE5 inhibitors inhibit the degradation of cGMP by PDE 5, increasing blood flow to the penis during sexual stimulation.

Adverse effects:

PDE5 inhibitors can cause some side effects, including:

1. Headaches and migraines 5. A blocked or runny nose

2. Flushing 6. Back pain

3. Indigestion 7. Vision disturbances

4. Nausea & vomiting 8. Muscle pain

Contraindication:

• PDE5 inhibitors are contraindicated in those taking nitrate medication (because potentially life-threatening hypotension may occur).

• Sever hepatic impairment.

• Sever impairment in renal function.

• Hypotension.

• Recent stroke or heart attack.

• Drugs that interfere with metabolism of sildenafil include erythromycin and cimetidine, both of which can lead to prolonged plasma half-life levels.

• The use of sildenafil and an alpha blocker at the same time may lead to low blood pressure, but this effect does not occur if they are taken at least four hours apart.

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