Efficacy and safety of PDE5 inhibitors in middle-aged and old patients with and without hypogonadism

[madman]

ABSTRACT

Purpose

Although several reviews have evaluated the use of PDE5 inhibitors (PDE5i) for treating erectile dysfunction (ED), their specific use in middle-aged and old patients has not been fully evaluated. Given that elderly patients with ED often have a complex combination of systemic and sexual health risk factors, the safety and efficacy of PDE5i in such a context are hereby reviewed.


Materials and methods

A thorough examination of existing literature has been conducted on PubMed.


Results

PDE5i has good safety and efficacy, but the situation is more complex for patients with hypogonadism than those with normal testosterone levels, with reduced responsiveness to PDE5i. In this case, combination therapy with testosterone is recommended, safe and effective.


Conclusions

Eliminating or reducing reversible risk factors and controlling or slowing the development of irreversible factors is an important foundation for using PDE5i to treat ED in all patients, especially middle-aged and elderly ones.




*The safety and efficacy of PDE5 inhibitors in middle-aged and elderly patients with ED and without hypogonadism


*Reversible risk factors


*Concomitant and underlying risks
-Metabolic disorders
-Endocrine diseases
-Cardiovascular disease
-Urological risk factors
-After radical prostatectomy
-Infertility
-Loss of control over erection and ejaculation (LCEE)
-Psychological and partner relationship factors


*The safety and efficacy of PDE5 inhibitors in middle-aged and elderly patients with ED and hypogonadism




Conclusion

As research continues to deepen, we are increasingly aware that sexual health is a barometer of overall human health, which enables us to apply a holistic (systemic) approach to thoroughly understand the risk factors of ED. The efficacy of PDE5i for ED in elderly patients also depends on the management of the complex interplay involving different general and sexual health risk factors that most elderly patients often exhibit. In the presence of various systemic and sexual health risk factors, PDE5i has shown good safety, with common adverse reactions including headache, flushing, and muscle pain. Compared with individuals with normal testosterone levels, patients with hypogonadism have a more multifaceted situation and reduced responsiveness to PDE5i. Combination therapy with testosterone can effectively improve responsiveness, and adverse events are not significantly increased. In summary, eliminating reversible risk factors and slowing or controlling the development of irreversible factors are important foundations for PDE5i therapy.

 

[madman]

Figure 1. The common systemic and sexual health risk factors related to ED and the differences in responsiveness to PDE5i between ED patients with and without hypogonadism. ED: erectile dysfunction; PDE5-is: phosphodiesterase type 5 inhibitors; RP: radical prostatectomy; PPRF: psychological and partner relationship factors; LUTS: lower urinary tract symptoms; DM: diabetes mellitus. “ …” represents the classification of risk factors of ED. “.-.-.” represents treatment. “——” represents a causal relationship

 

[madman]

Table 1. An overview of common drugs which may affect erectile function.

 

[madman]

*The efficacy of PDE5i for ED in elderly patients also depends on the management of the complex interplay involving different general and sexual health risk factors that most elderly patients often exhibit.

*Compared with individuals with normal testosterone levels, patients with hypogonadism have a more multifaceted situation and reduced responsiveness to PDE5i. Combination therapy with testosterone can effectively improve responsiveness, and adverse events are not significantly increased.

 

[madman]

*In summary, eliminating reversible risk factors and slowing or controlling the development of irreversible factors are important foundations for PDE5i therapy.