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An Update on Pharmacological Treatment of Erectile Dysfunction

European Endocrinology, 2006(2):92-95; DOI: http://doi.org/10.17925/EE.2006.00.02.92

Erectile dysfunction (ED) is a highly prevalent disease that is expected to affect 322 million men by 2025. Risk factors include ageing, cardiovascular disease (CVD), diabetes, hyperlipidaemia, smoking, absence of physical exercise and obesity. ED is associated with depression and has a negative impact on patients’ and partners’ quality of life. Potentially reversible causes include specific endocrinopathies, pelvic or perineal trauma, drugs, lifestyle and psychosocial factors. However, the majority of men with ED will not be treated with cause-specific treatment options.
The advent of new oral drugs has revolutionised the treatment of ED. Optimal therapy for patients with ED may be challenging. In order to properly counsel patients with ED, physicians must be fully informed on all treatment options as part of a patient-centred model of care for ED.
Oral Pharmacotherapy
Sildenafil
Sildenafil was the first phosphodiesterase type 5 (PDE5) inhibitor, and it has been available since 1998. It is administered orally on demand in 25mg, 50mg and 100mg doses in the presence of sexual stimulation (maximum dosing once-daily). The recommended starting dose is 50mg. The onset of action can be less than 30 minutes and efficacy may be maintained for up to 12 hours. A heavy fatty meal results in reduced and prolonged absorption. Alcohol does not have an impact on absorption in regular doses.
Successful sexual intercourse was demonstrated in 69% of all attempts for the men receiving sildenafil (compared with 22% for placebo; p<0.001) (see Table 1). Mean numbers of successful attempts per month were 5.9 for sildenafil compared with 1.5 for placebo. In a three-year study, 32% of patients discontinued treatment. Only 6.7% of discontinuations were treatment-related (5.7% for insufficient response and 1% for adverse events). Most patients received 100mg sildenafil doses (88% at three years). Improvement in the ability to achieve erections was reported by 71% of patients in a clinical practice setting.
The efficacy of sildenafil in almost every subgroup of patients (elderly men, patients with ischaemic heart disease, hypertension, chronic renal failure (CRF), spinal cord injury, depression and bilateral nerve-sparing radical prostatectomy) is well established. Lower efficacy rates are expected in diabetic patients (50–60%).
Both patients and partners report higher levels of satisfaction (up to 90%) after sildenafil treatment relative to placebo. Sildenafil also improved all aspects of health-related quality of life.