title: Pharmacotherapy of erectile dysfunction: focus on cardiovascular safety.
abstract: Therapy of erectile dysfunction has been revolutionised in recent years, as specific pharmacological inhibitors of phosphodiesterase 5 (PDE5), such as sildenafil, tadalafil, or vardenafil, were shown to be highly effective in the treatment of erectile dysfunction. They dilate arterial smooth muscle cells of the corpora cavernosa, which express PDE5 abundantly, by inhibiting the breakdown of 3'5'-cyclic guanosine monophosphate. Despite theoretical concerns of a reduced myocardial tolerance to ischaemia or promoting cardiac arrhythmias, randomised trials and retrospective analyses do not support an increased cardiac risk with oral treatment. Therapeutic doses of PDE 5 inhibitors exhibit slight blood pressure lowering effects, and do not appear to compromise coronary blood flow in coronary artery disease. However, the combination of PDE5 inhibitors with any nitric oxide donor is absolutely contraindicated because of potentially life-threatening hypotension. Before prescribing medication for erectile dysfunction, any patient with cardiovascular disease should be evaluated for a potential risk of a cardiovascular event during sexual activity according to the Princeton Consensus Panel. When a stable cardiac condition can be achieved (low risk group), oral treatment for erectile dysfunction may be appropriate.
authors.affiliation: The Heart Institute, Good Samaritan Hospital, Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395, USA.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Reffelmann
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kloner
mesh_terms: D000284:Administration, Oral; D001058:Apomorphine / Q000008:administration & dosage / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D000075202:Contraindications; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D004347:Drug Interactions; D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D020030:Nitric Oxide Donors / Q000009:adverse effects / Q000627:therapeutic use; D018579:Patient Selection; D010726:Phosphodiesterase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D010879:Piperazines / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D011687:Purines; D018570:Risk Assessment; D000068677:Sildenafil Citrate; D013450:Sulfones
chemical_list: D018491:Dopamine Agonists; D020030:Nitric Oxide Donors; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D001058:Apomorphine