Pharmacotherapy for erectile dysfunction

J Sex Med. 2004 Sep;1(2):128-40. doi: 10.1111/j.1743-6109.2004.04021.x.

Abstract

Introduction: Advances in understanding of the biochemistry and physiology of penile erection have led to breakthroughs in pharmacotherapy of erectile dysfunction.

Aim: To provide recommendations/guidelines concerning state-of-the-art knowledge for the putative molecular and cellular mechanisms of action of centrally and peripherally acting drugs currently utilized in pharmacotherapy of erectile dysfunction.

Methods: An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a two-year period. Concerning the Pharmacotherapy for Erectile Dysfunction Committee there were 25 experts from 10 countries.

Main outcome measure: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

Results: Selective and potent oral PDE5 inhibitors have significantly more affinity than cGMP and form broader molecular interactions with multiple amino acids, thereby blocking access to cGMP in the catalytic sites of the PDE5 enzyme. PDE5 inhibitors, which vary as to biochemical potency, selectivity and pharmacokinetics, lead to cGMP elevation and relaxation facilitation of penile corpus cavernosum smooth muscle cells following sexual stimulation. Various centrally acting drugs influence sexual behaviour. In particular, the dopaminergic substance apomorphine is a central enhancer that acts in the paraventricular nucleus of the hypothalamus as a dopamine (D2) receptor agonist, induces and increases penile erection responses via disinhibition, following sexual stimulation.

Conclusions: There is a need for more research in the pharmacotherapeutic development of central and peripheral agents for safe and effective erectile dysfunction treatment.

MeSH terms

  • Apomorphine / therapeutic use
  • Dopamine Agonists / therapeutic use
  • Drug Therapy, Combination
  • Erectile Dysfunction / drug therapy*
  • Erectile Dysfunction / physiopathology
  • Erectile Dysfunction / psychology
  • Humans
  • Isoquinolines
  • Male
  • Naltrexone / analogs & derivatives
  • Naltrexone / therapeutic use
  • Naphthyridines / therapeutic use
  • Neuroprotective Agents / therapeutic use
  • Peptides, Cyclic / therapeutic use
  • Phosphodiesterase Inhibitors / therapeutic use
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Sexual Behavior / drug effects*
  • Sexual Behavior / physiology
  • Sexual Behavior / psychology
  • Trazodone / therapeutic use
  • alpha-MSH / analogs & derivatives
  • alpha-MSH / therapeutic use

Substances

  • Dopamine Agonists
  • Isoquinolines
  • Naphthyridines
  • Neuroprotective Agents
  • Peptides, Cyclic
  • Phosphodiesterase Inhibitors
  • Serotonin Uptake Inhibitors
  • melanotan-II
  • alpha-MSH
  • Naltrexone
  • Delequamine
  • Apomorphine
  • nalmefene
  • Trazodone