勃起功能障碍的口服药物治疗进展

阴茎勃起功能障碍 (ED)目前有多种治疗方法可供选择 ,其中口服药物治疗因方便、有效而被医生和患者广为接受。第一届国际勃起功能障碍咨询委员会达成共识 ,以枸橼酸西地那非 (万艾可 )为代表的口服药物是ED的一线治疗[1] 。口服药作用部位可为神经中枢或阴茎局部 ,作用机制可为诱导或增强阴茎勃起 ,例如中枢诱导剂阿朴吗啡、局部诱导剂甲磺酸酚妥拉明、局部增强剂PDE5抑制剂西地那非等[2 ] 。一、枸橼酸西地那非西地那非上市前在全球范围内进行了多项临床试验 ,近 5 0 0 0例受试者参加 ,其中 30 0 0余例ED患者参加了双盲安慰剂对照试验…     

他达拉非:ED患者及其配偶的选择偏爱?

勃起功能障碍(erectile dysfunction,ED)是男性常见疾病,直接影响患者及其配偶的生活质量。PDE5抑制剂是治疗ED的首选药物。尽管临床主要有3种PDE5抑制剂(西地那非、伐地那非和他达拉非)可供选择,但是患者及其配偶在选择PDE5抑制剂上是否有偏好,以及影响其选择的因素又有哪些本文简要地综述了最近的研究进展。     

磷酸二酯酶5抑制剂西地那非和伐地那非治疗勃起功能障碍患者心血管参数改变的研究

西地那非是勃起功能障碍(ED)患者最常用的口服处方药。伐地那非是由美国FDA去年批准应用治疗各种原因引起的ED的一种新型的磷酸二酯酶5(PDE5)型抑制剂。这两种PDE5抑制剂通过一氧化氮环磷酸鸟苷途径舒张血管,影响血压(BP)。为了观察这两种PDE5抑制剂对血压正常的ED患者血压和心率(HR)     

PDE5抑制剂治疗ED研究进展

勃起功能障碍(ED)是中老年人的常见疾病。自1998年西地那非用于临床治疗ED以来,ED的治疗进入了一个新阶段。西地那非以其疗效确切、安全性高成为首选治疗。近年来新的PDE5抑制剂伐地那非和他达拉非相继问世,为口服药治疗ED提供了更多选择。本文就PDE5抑制剂的基础与临床研究成果作一综述,以期为临床医生选择使用提供参考。     

他达拉非每日一次在勃起功能障碍中的应用:来自患者及其性伴侣的观点

勃起功能障碍(ED)是一种影响男性健康并危害两性关系的常见疾病.5型磷酸二酯酶(PDE5)抑制剂的诞生,使这些患者家庭的性生活质量获得了显著改善.这类药物被公认为大多数ED患者的一线用药.目前,有3种PDE5抑制剂--西地那非、他达拉非和伐地那非被批准在有性行为需求时使用,但其中只有他达拉获批可以每日服用1次.本综述总结了ED患者及其性伴侣对PDE5抑制剂的观点,并通过与他达拉非按需服用以及其他PDE5抑制剂类药物进行比较,明确了他达拉非每日1次的治疗方案是否有助于改善ED患者的心理状况(譬如性自信心、性行为自发性和时间顾虑).     

同期内使用3种PDE5抑制剂治疗ED的经验

目的:观察与比较同期内使用3种PDE5抑制剂治疗ED患者的疗效,满意情况和不良反应。分析影响患者疗效、接受度、倾向性的因素。方法:11个月在门诊应用3种PDE5抑制剂治疗ED患者331例。使用西地那非134例,他达拉非88例,及伐地那非109例。医师详细指导药物的应用,注意事项,观察的内容等,并互留电话,列表登记、随访。结果:复诊或电话随访时间,结果为:①获得良好的疗效及满意率为西地那非72例(79.12%),他达拉非52例(78.78%),伐地那非63例(81.81%)。②PDE5抑制剂单纯或交叉应用的资料分析显示:青年患者或新婚者,偏好伐地那非;③中青年患者倾向于他达拉非;中老年及较长期应用PDE5抑制剂的患者多选用西地那非。3种PDE5抑制剂用于早泄均有一定疗效。④对不能继续用此类药治疗ED的原因进行了分析,分别为:价高,不治本,效果差,耽心不良反应。结论:①同期3种PDE5抑制剂治疗ED的疗效基本相近。亦各有一些优势和特点。②3种PDE5抑制剂的安全性均好,一般、轻度不良反应相近,中度、特殊的不良反应少,严重不良反应均无发生。③PDE5抑制剂的疗效观察,目前众多的问卷、量表实际均仍以主观的感受为主。对同一个人以相同形式、相同问题、繁简一致阐述,获得的有关疗效满意情况、感受等简易回答是有可比性、可信度和实用性的。     

磷酸二酯酶抑制剂：有效性和新用途

van Driel MF等人对磷酸二酯酶5(PDE5)抑制剂进行了一项综述性研究。目前有3种不同的PDE5抑制剂被用于治疗男性勃起功能障碍(ED),包括西地那非、伐地那非和他达拉非。     

PDE5抑制剂，治疗输尿管绞痛的新选择？

Gratzke C等人进行了一项研究。背景:PDE5抑制剂是治疗勃起功能障碍(ED)的金标准。其在泌尿外科新的适应症(如治疗输尿管绞痛)已经有了可喜的成果。本研究的目的是评价PDE5抑制剂西地那非     

展望5型磷酸二酯酶抑制剂的未来

<正>5型磷酸二酯酶(PDE5)抑制剂起先被研究用于心血管疾病,而后则被研发并获准用于按需治疗勃起功能障碍(ED)。数年以前,西地那非被批准用于治疗肺动脉高压,因此重新引起了研究者对PDE5抑制剂治疗心血管疾病的兴趣。而且他达拉非每日一次的治疗方案也被用于治疗ED。鉴于PDE5在人体内的广泛分布并涉及多种生理功能,PDE5抑制剂未来的发展前景又将是怎样的呢?为了探索这一问题,Konstantinos     

一项随机、开放标签的交叉对比研究:他达拉非每日一次与他达拉非或西地那非临时服用对ED患者性自信及其他疗效的对比

<正>PDE5抑制剂的疗效维持时间对ED患者改善性交时间顾虑、增强性自信和性主动、改善与性伴侣亲密度具有重要意义。他达拉非OAD治疗比短效PDE5抑制剂如西地那非临时服用更有效改善ED患者的性心理。评价对于PDE5抑制剂疗效满意的ED患者,他达拉非OAD治疗是否比西地那非PRN治疗更好地改善     

Sildenafil: A 4-year update in the treatment of 20 million erectile dysfunction patients

Sildenafil citrate, the first internationally approved and widely used oral agent for the treatment of erectile dysfunction (ED), has revolutionized the treatment of ED throughout the past 5 years. This phosphodiesterase type-5 (PDE-5) inhibitor is selective for corpus cavernosum smooth muscle tissue and produces excellent erectile function. Its efficacy and safety over a wide variety of etiologies of ED and severities of ED demonstrates its usefulness in the clinical treatment of these patients. More than 20 million men have been treated worldwide with sildenafil with excellent results. ED caused by difficult-to-treat etiologies such as radical prostatectomy, severe diabetes, and spinal cord injury have demonstrated efficacy. Although sildenafil citrate, like all PDE-5 inhibitors, is contraindicated in patients taking nitrate medications for cardiac disease, it is effective and safe for those cardiovascular patients who are not taking nitrate medications. The incidence of adverse cardiovascular events in patients taking sildenafil does not differ from those of the general population. Investigations into the pharmacologic effect of sildenafil on coronary myocardial tissue further supports the safety of this medication. Sildenafil has been safe and effective in patients taking various medications including multiple antihypertensive drugs, selective serotonin reuptake inhibitors, cardiac, and diabetic medications.     

Effects of sildenafil and vardenafil treatments on sleep quality and depression in hemodialysis patients with erectile dysfunction

ED is prevalent in hemodialysis (HD) patients, and closely related to poor sleep and depression. Efficacy of treating ED either with sildenafil or vardenafil has been shown to be beneficial in ameliorating concomitant depression in non-HD patients. It is yet to be shown whether treatment of ED with a PDE-5 inhibitor would improve poor sleep in HD patients. We aimed to compare the effects of sildenafil and vardenafil on sleep quality and depression in HD patients with ED. A total of 32 maintenance HD patients with ED randomized into two groups to receive either sildenafil or vardenafil for 4 weeks. After a 2-week washout and a crossover, each group received the other drug for another 4-week period. Sleep quality and depression were evaluated via post-sleep inventory (PSI) and Beck's depression inventory (BDI), respectively, at baseline and at the end of the treatment. Sildenafil and vardenafil both improved PSI and BDI scores significantly compared with pretreatment values. However, there was no difference between sildenafil and vardenafil with respect to these parameters. PDE-5 inhibitors, sildenafil and vardenafil, caused a significant improvement in sleep quality and depression in this cohort of HD patients with ED.     

The effects of chronic phosphodiesterase-5 inhibitor use on different organ systems

Phosphodiesterase-5 (PDE-5) inhibitors selectively inhibit PDE-5 enzymes that are present in various tissues like penile tissue, platelets, vascular, and smooth muscle tissue. The drug's actions on these tissues have lead to the successful therapeutic use in patients suffering from conditions such as erectile dysfunction (ED) and pulmonary hypertension. PDE-5 inhibitors (PDE-5i) act on the erectile tissue causing penile smooth muscle relaxation and vasodilatation leading to penile erection. In addition, in particular when used in conjunction with prostaglandin inhibitors, PDE-5i cause vasodilatation in pulmonary vasculature hence decreasing both the pulmonary arterial pressure and resistance. PDE-5i have also shown to mildly decrease blood pressure, increase cardiac index, and increase coronary blood flow in experimental animals as well as in human studies. The Food and Drug Administration (FDA) has approved three PDE-5i for the treatment of ED: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) and one for pulmonary hypertension: sildenafil (Revatio). These agents are highly selective for PDE-5 enzymes as compared to other subclasses of PDE enzymes and have the almost identical pharmacological action but slightly different pharmacokinetics. Only little data exist about long-term use of PDE-5i and their effects on different organ system. This paper reviews the current information available on chronic PDE-5 inhibitor use.     

Erectile dysfunction in the cardiac patient

Erectile dysfunction (ED) often is caused by endothelial dysfunction and may be a sign that a patient has vascular disease elsewhere in the body. Risk factors for coronary artery disease such as lipid abnormalities, smoking, diabetes, and hypertension also are risk factors for ED. Oral therapy for ED, such as sildenafil, inhibits phosphodiesterase-5 (PDE-5) and the breakdown of cyclic guanosine monophosphate. PDE-5 inhibitors have been shown to be safe and effective for the therapy for ED, but remain contraindicated in patients receiving organic nitrates. These agents are mild vasodilators and are being investigated for their treatment potential for patients with pulmonary hypertension, heart failure, and endothelial dysfunction.     

Prevalence and medical management of erectile dysfunction in Asia

Erectile dysfunction (ED) is an important worldwide health issue that has a significant negative impact on the quality of life and life satisfaction of both the affected individual and his partner. Here we review the prevalence of ED in Asia, associated factors that may influence sexual attitudes and sexual behaviours, and randomized clinical trials (RCTs) of phosphodiesterase-5 (PDE-5) inhibitors to evaluate the clinical efficacy and safety of PDE-5 inhibitors in Asian men. We searched for English-language articles in MEDLINE and PubMed from January 2000 to September 2010. Our results showed that the overall reported prevalence rate of ED in Asia ranged widely, from 2% to 88%. This finding indicates that ED is a common and major health problem in this region. However, sociocultural and economic factors in Asia prevent people from seeking and obtaining appropriate medical care. We found reports on five kinds of PDE-5 inhibitors for the management of ED: sildenafil, vardenafil, tadalafil, udenafil and mirodenafil. The results of RCTs showed that these five PDE-5 inhibitors are more effective than placebo in improving erectile function in Asian men with ED and that these drugs have similar efficacy and safety profiles.     

Drug Insight: oral phosphodiesterase type 5 inhibitors for erectile dysfunction

Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men. At present, first-line oral pharmacotherapy for most patients with ED is a phosphodiesterase type 5 (PDE-5) inhibitor, of which three are currently available worldwide. Sildenafil (Viagra, Pfizer) has a very satisfactory efficacy-safety profile in all patient categories. The first PDE-5 inhibitor to reach the market, it is now the most widely prescribed oral agent for ED. Tadalafil (Cialis, Lilly ICOS) and vardenafil (Levitra, Bayer/GlaxoSmithKline) were introduced to the European Union and the US in 2003 and 2004, respectively. These three PDE-5 inhibitors share many characteristics, but each has unique features. This review describes the chemical, pharmacologic and clinical features of sildenafil, vardenafil and tadalafil as oral first-line treatments for ED. First, we describe the physiology of penile erection and PDE-5 inhibitor pharmacology, including chemistry, PDE selectivity, pharmacokinetics, and possible drug interactions. We then summarize data on the efficacy and safety profiles of the three PDE-5 inhibitors for the treatment of ED in the general population, in patients with diabetes mellitus and in men that have undergone bilateral nerve-sparing retropubic radical prostatectomy.     

Synergetic effect of testosterone and phophodiesterase-5 inhibitors in hypogonadal men with erectile dysfunction: A systematic review

Testosterone deficiency seems to impair the clinical response to phophodiesterase-5 (PDE-5) inhibitors in patients with erectile dysfunction (ED). In hypogonadal men, testosterone repletion was associated with enhanced sexual function in patients who failed initial treatment with sildenafil or tadalafil. We conducted a systematic review of studies that evaluated combination therapy of testosterone and PDE-5 inhibitors in patients with ED and low, low-normal testosterone levels who failed monotherapy. The studies we examine are heterogeneous with several methodological drawbacks and that, overall, the addition of testosterone to PDE-5 inhibitors might benefit patients with ED associated with testosterone <300 ng/dL (10.4 nmol/L) who failed monotherapy. Further studies, with a randomized placebo-controlled and double blind design, are needed to describe the appropriate target patient group, testosterone cut-off and to define the optimal dose and duration of combination therapy.     

Clinical update on phosphodiesterase type-5 inhibitors for erectile dysfunction

Erectile dysfunction (ED) affects the sexual lives of millions of men. The first-line oral pharmacotherapy for most ED patients is phosphodiesterase type-5 (PDE-5) inhibitors, of which three are available. Sildenafil is the most widely prescribed oral agent for ED and has a very satisfactory efficacy–safety profile in all patient categories. Tadalafil and vardenafil were introduced in the European Union and in the United States in 2003 and 2004, respectively. The three PDE-5 inhibitors share many pharmacological and clinical characteristics, and each has unique features. This review, which is based on the contemporary literature on PDE-5 inhibitors, describes the chemical, pharmacological, and clinical features of sildenafil, vardenafil, and tadalafil. The first section reviews the pathophysiology of penile erection and PDE-5 inhibitor pharmacology. The second section summarizes data regarding efficacy and safety of the three drugs in treating ED in the general population as well as in selected patient categories.