title: Effects of pioglitazone on erectile dysfunction in sildenafil poor-responders: a randomized, controlled study.
abstract: OBJECTIVE
  The effects of pioglitazone on sildenafil responsiveness in men with erectile dysfunction(ED) and a history of poor response to sildenafil were assessed.
  
  
  METHODS
  In a double-blinded study,38 men aged 47 +/- 1.5 years with moderate-to severe ED and poor response to sildenafil were randomly assigned to take a premedication of pioglitazone 30 mg (n=19) or placebo (n=19) once daily for 9 weeks along with on-demand use of sildenafil during the last month of pioglitazone treatment.Erectile function (EF) scores, assessed by EF domain of International Index of Erectile Function (IIEF), along with responses to Global Assessment Questions (GAQs) were major outcome measures. Serum levels of total testosterone (T),dehydroepiandrosterone sulfate (DHEAS), glucose,lipid profile and liver function test were minor outcome measures.
  
  
  RESULTS
  Pioglitazone significantly improved major outcome measures compared with placebo. The decrease from baseline of total cholesterol level was more in pioglitazone than in placebo-treated groups. In 84% (32 out of 38) of the sildenafil poor-responders, at least one of the associated risk factors of ED was found. There was undiagnosed hypercholesterolemia in 34% of the subjects. Serum levels of T, DHEAS, glucose and other parameters remained unchanged in both groups. The intervention was well tolerated.
  
  
  CONCLUSIONS
  Pioglitazone increased sildenafil response to improve ED of men with prior sildenafil failure and seems to be safe based on the present preliminary study. This improvement is likely regardless of fasting glucose and sex hormones levels.
authors.affiliation: Department of Pharmacology & Razi Institute for Drug Research, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Gholamine
authors.forename: Massoumeh
authors.initials: M
authors.lastname: Shafiei
authors.forename: Manijeh
authors.initials: M
authors.lastname: Motevallian
authors.forename: Massoud
authors.initials: M
authors.lastname: Mahmoudian
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D004357:Drug Synergism; D007172:Erectile Dysfunction / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077205:Pioglitazone; D010879:Piperazines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011446:Prospective Studies; D011687:Purines / Q000493:pharmacokinetics / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000493:pharmacokinetics / Q000627:therapeutic use*; D045162:Thiazolidinediones / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D045162:Thiazolidinediones; D000068677:Sildenafil Citrate; D000077205:Pioglitazone