title: [Treatment of erectile dysfunction by phosphodiesterase-5 inhibitors and nonarteritic anterior ischemic optic neuropathy (NOIAN)].
abstract: BACKGROUND
  Following the notification of forty cases of varying degrees of vision loss in patients using phosphodiesterase-5 (PDE-5) inhibitors, the FDA (Food and Drug Administration) examined the possible link between these treatments of erectile dysfunction and NOIAN (nonarteritic anterior ischemic optic neuropathy). Following this investigation, the FDA requested modification of the summary of product characteristics (SPC) for this therapeutic category. The authors review this problem, especially in France.
  
  
  METHODS
  The authors performed a search of the Pubmed database and the French Pharmacovigilance database.
  
  
  RESULTS
  Since September 2006, 11 publications concerning 19 cases (14 with sildenafil and 2 with tadalafil) have been published. The mean age of these patients was 59.5 years (range: 42 to 69). Doses varied from 50 to 100 mg for sildenafil and 20 mg for tadalafil. Adverse effects (loss of visual acuity and decreased visual field) occurred between 30 min and 36 h after oral dosing. In 5 cases, treatment had been taken for more than one year. Ocular fundus examination showed papilloedema associated with several haemorrhages. Three patients presented a positive challenge. Several patients had a known risk factor for the development of NOIAN. One case was also reported to French Pharmacovigilance.
  
  
  CONCLUSIONS
  The population with erectile dysfunction also often presents generalized endothelial disease, which also constitutes a risk factor for NOIAN. Although no cases of NOIAN were reported during the initial clinical trials, the rapid onset of NOIAN after the dose of PDE-5 inhibitor and several cases of positive challenge suggest a possible causal relationship with these drugs. The ocular action of PDE-5 inhibitors could be explained by a modification of retinal blood flow related to their pharmacological effects.
  
  
  CONCLUSIONS
  The link between PDE-5 inhibitors and NOIAN has not been formally established. Before new studies are conducted to clarify this situation, practitioners must be aware of the potential ocular adverse effects related to the dose of PDE-5 inhibitors so that they can inform patients and notify any new cases. The SPCs of PDE-5 inhibitors were modified at the request of the FDA on 8 July 2005.
authors.affiliation: Service d'urologie, CHU de Bordeaux Pellegrin, 33076 Bordeaux, France. calvet_cyril@yahoo.fr
authors.forename: Cyril
authors.initials: C
authors.lastname: Calvet
authors.forename: Karin
authors.initials: K
authors.lastname: Martin
authors.forename: Grégoire
authors.initials: G
authors.lastname: Robert
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
authors.forename: Pirayeh
authors.initials: P
authors.lastname: Eftekhari
authors.forename: Houssam
authors.initials: H
authors.lastname: Farghal
authors.forename: Mathieu
authors.initials: M
authors.lastname: Molimard
authors.forename: Philippe
authors.initials: P
authors.lastname: Ballanger
mesh_terms: D001706:Biopsy; D002243:Carbolines / Q000627:therapeutic use; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000503:physiopathology; D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use; D000068581:Tadalafil; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D002243:Carbolines; D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068581:Tadalafil; D000068677:Sildenafil Citrate