Abstract. The aim of this study was to evaluate the efficacy and safety of oral sildenafil to treat erectile dysfunction (ED) in chronic renal failure in patients on hemodialysis (HD). A double-blind, randomized, placebo-controlled study of oral sildenafil (50 mg) administered as required in HD patients with ED was designed. Patients on HD for at least 6 mo and who had a stable relationship with a female sexual partner were included. Patients older than 70 yr with penile anatomic abnormalities, cirrhosis, diabetes, angina, severe anemia, and those who were on nitrate treatment or with a recent history of stroke or myocardial infarction were not included. The International Index of Erectile Dysfunction (IIEF) was employed to evaluate ED and treatment response. Forty-one patients were evaluated (21 received placebo, and 20 sildenafil). Baseline clinical and demographic parameters were similar in both groups. Sildenafil was associated with improvement in the score of all questions and domains of the IIEF, except those related to sexual desire. Using the erectile function domain to evaluate primary efficacy, improvement was observed in 85% of the sildenafil patients compared with 9.5% of placebo patients. Sildenafil use resulted in normal EF scores in 35% of sildenafil patients. Sildenafil was well tolerated. Headaches and flushing occurred in both groups. Dyspepsia was reported by two patients in the sildenafil group. In conclusion, oral sildenafil seems to be an effective and safe treatment for ED in selected patients with chronic renal failure on hemodialysis.Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient to permit satisfactory sexual performance, and the resulting stress often impacts interaction with others (1). End-stage renal failure patients on hemodialysis (HD) are frequently affected by ED. The prevalence of ED in these patients has been estimated to be between 71 and 82% (2,3). This prevalence is positively associated with increasing age and diabetes and inversely associated with use of angiotensin-converting enzyme (ACE) inhibitors, even among patients with good functional status (3). In the state of Rio Grande do Sul (Brazil), we have estimated the prevalence of ED in HD patients to be 75% (unpublished observation).There are several management guidelines for ED. The UK guidelines (4) suggest that a detailed history is the most important aspect in the assessment of patients with ED. Treatment options for men with ED include psychosexual therapy, drug therapy, transurethral or intracavernosal therapy, treatment with vacuum-constriction devices, and surgical treatment (5).Recently, sildenafil, a selective inhibitor of phosphodiesterase type-5, which is the predominant isozyme inactivating cyclic guanosine monophosphate (cGMP) in the corpus cavernosum, has been shown to be an effective, well-tolerated treatment for non-uremic men with ED (6). Its use results in increased smooth muscle relaxation and improved erection when nitric oxide is released in the p...

Lofepramine, an imipramine derivative, shows lower acute toxicity in animals when compared with desipramine and imipramine. Its anticholinergic effect is less pronounced than that of desipramine. In an open clinical trial lofepramine showed a marked antidepressive action. A double-blind multicenter trial of lofepramine v. imipramine, evaluated by means of the AMP system, showed a remarkable degree of concurrence with regards to the effects of those two products.

Lofepramin is a new derivative of imipramine. Its effects and side effects were compared to those of imipramine in a double-blind trial. 49 hospitalized patients, suffering from endogenous depression, were treated for 20 days with 210 mg lofepramin daily and 52 other patients with 150 mg imipramine daily. The results of the repeated psychiatric examinations were documented using the AMP system. Both substances proved to have high antidepressant effects and showed no significant difference in the quality of their effects.