Centrally acting mechanisms for the treatment of male sexual dysfunction.
The development of pharmacologic therapy for erectile dysfunction (ED) has been possible because of incremental growth in our understanding of the physiology of normal erections and the complex pathophysiology of ED. Although the oral phosphodiesterase type 5 (PDE5) inhibitors have provided safe, effective treatment of ED for some men, a large proportion of men who have ED do not respond to PDE5 inhibitors or become less responsive or less satisfied as the duration of therapy increases. Also, men who are receiving organic nitrates and nitrates, such as amyl nitrate, cannot take PDE5 inhibitors because of nitrate interactions. The current options for treatment beyond PDE5 inhibitors are invasive, unappealing to some patients, and sometimes ineffective. The search for other options by which ED can be treated has branched out and now encompasses centrally acting mechanisms that control erectile function. Drugs available in Europe include apomorphine. This article focuses on the mechanism of centrally acting agents and reviews clinical data on potential new centrally acting drugs for men who have ED.
Miner
Martin M
MM
Division of Biology and Medicine, Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. martin_miner@brown.edu
Seftel
Allen D
AD
D000818:Animals; D001058:Apomorphine / Q000494:pharmacology / Q000627:therapeutic use; D001341:Autonomic Nervous System / Q000187:drug effects*; D004298:Dopamine / Q000502:physiology; D018491:Dopamine Agonists / Q000494:pharmacology / Q000627:therapeutic use; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000453:epidemiology; D013007:Growth Hormone-Releasing Hormone / Q000502:physiology; D006801:Humans; D008297:Male; D053486:Melanocortins / Q000502:physiology; D009130:Muscle, Smooth / Q000187:drug effects; D009569:Nitric Oxide / Q000502:physiology; D009638:Norepinephrine / Q000502:physiology; D018847:Opioid Peptides / Q000502:physiology; D010410:Penile Erection / Q000187:drug effects* / Q000502:physiology; D010456:Peptides, Cyclic / Q000494:pharmacology / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D012701:Serotonin / Q000502:physiology; D016896:Treatment Outcome; D000521:alpha-MSH / Q000494:pharmacology / Q000627:therapeutic use
D018491:Dopamine Agonists; D053486:Melanocortins; D018847:Opioid Peptides; D010456:Peptides, Cyclic; D010726:Phosphodiesterase Inhibitors; D009569:Nitric Oxide; D012701:Serotonin; D000521:alpha-MSH; C476721:bremelanotide; D013007:Growth Hormone-Releasing Hormone; D001058:Apomorphine; D004298:Dopamine; D009638:Norepinephrine