Centrally acting drugs for erectile dysfunction: Do they have a future?

Initial placebo-controlled trials with sublingual apomorphine showed promising results for the drug as an option in the pharmacologic management of erectile dysfunction (ED). More recent studies propose poor erectile effects by apomorphine sublingual in patients with diabetes and fewer benefits than sildenafil in patients with ED. In June this year, the European Medicines Agency declared that due to commercial reasons, the marketing authorization for Uprima (Abbott Laboratories, Abbott Park, IL) was not renewed, and the drug is no longer available in the European Union. This does not mean that receptor functions in the central nervous system are uninteresting pharmacologic targets for ED. Experiences with apomorphine sublingual in humans should be acknowledged for a more careful preclinical and clinical characterization of agents with a central nervous system site of action. This article focuses on information obtained from human trials of central acting drugs for ED.