madman
Super Moderator
ABSTRACT
Introduction: Erectile dysfunction (ED) is one of the most common complaints encountered by the practicing urologist, particularly when treating older men. The last 20 years have represented a pivotal time in the treatment of ED.
Areas covered: Several pharmacologic agents have been approved by regulatory agencies, including phosphodiesterase type 5 (PDE5) inhibitors, intraurethral suppositories, and vasoactive injectable agents. This review will focus on the pharmacodynamic properties of these agents and the clinical consequences of those properties.
Expert opinion: The decision on which agent to use should be individualized and based on the patient’s goals and the likelihood of success with the chosen treatment. The selection is also often driven by side-effect profiles that can be minimized by understanding the interplay between the individual patient and the medication. Thorough knowledge of the metabolism and pharmacologic properties of the available therapies will aid the urologist in selecting an individualized treatment plan for each patient.
Article highlights
● Pharmacologic treatments for men with ED can be offered orally, intraurethrally, or intracavernosally
● The PDE5 inhibitors are separated largely by their selectivity for PDE5 and duration of action with tadalafil representing the only approved long-acting option.
● Intraurethral and intracavernosal options bypass the nervous system and act locally to produce penile erection.
● Mechanical therapies are non-pharmacologic alternatives that can be offered to appropriately selected patients
● Complete knowledge of patients’ goals, comorbidities, and willingness to accept the associated side effects of each therapy is necessary to provide the optimal treatment regimen for a man with ED.
7. Conclusion
PDE5 inhibitors are typically the first-line treatment for ED due to their high levels of efficacy and tolerability. Before considering PDE5 inhibitors, the cardiovascular risk profile and the function of the liver and kidney must be thoroughly assessed. Choosing the optimal PDE5 inhibitor will depend on the frequency of intercourse and the patient’s sexual profile. Tadalafil has a longer duration of action and can be used for daily treatment, while avanafil is absorbed the most rapidly. In addition, sildenafil ODT and vardenafil ODT remain highly portable and do not need to be administered with water. Intraurethral alprostadil and ICI are second-line therapies in patients who do not respond to PDE5 inhibitors but represent options that do not require sexual stimulation or an intact nervous system. Both require patient counseling to ensure that the drug is administered properly.
Introduction: Erectile dysfunction (ED) is one of the most common complaints encountered by the practicing urologist, particularly when treating older men. The last 20 years have represented a pivotal time in the treatment of ED.
Areas covered: Several pharmacologic agents have been approved by regulatory agencies, including phosphodiesterase type 5 (PDE5) inhibitors, intraurethral suppositories, and vasoactive injectable agents. This review will focus on the pharmacodynamic properties of these agents and the clinical consequences of those properties.
Expert opinion: The decision on which agent to use should be individualized and based on the patient’s goals and the likelihood of success with the chosen treatment. The selection is also often driven by side-effect profiles that can be minimized by understanding the interplay between the individual patient and the medication. Thorough knowledge of the metabolism and pharmacologic properties of the available therapies will aid the urologist in selecting an individualized treatment plan for each patient.
Article highlights
● Pharmacologic treatments for men with ED can be offered orally, intraurethrally, or intracavernosally
● The PDE5 inhibitors are separated largely by their selectivity for PDE5 and duration of action with tadalafil representing the only approved long-acting option.
● Intraurethral and intracavernosal options bypass the nervous system and act locally to produce penile erection.
● Mechanical therapies are non-pharmacologic alternatives that can be offered to appropriately selected patients
● Complete knowledge of patients’ goals, comorbidities, and willingness to accept the associated side effects of each therapy is necessary to provide the optimal treatment regimen for a man with ED.
7. Conclusion
PDE5 inhibitors are typically the first-line treatment for ED due to their high levels of efficacy and tolerability. Before considering PDE5 inhibitors, the cardiovascular risk profile and the function of the liver and kidney must be thoroughly assessed. Choosing the optimal PDE5 inhibitor will depend on the frequency of intercourse and the patient’s sexual profile. Tadalafil has a longer duration of action and can be used for daily treatment, while avanafil is absorbed the most rapidly. In addition, sildenafil ODT and vardenafil ODT remain highly portable and do not need to be administered with water. Intraurethral alprostadil and ICI are second-line therapies in patients who do not respond to PDE5 inhibitors but represent options that do not require sexual stimulation or an intact nervous system. Both require patient counseling to ensure that the drug is administered properly.
