Comparison of efficacy and safety of daily oral L‐arginine and PDE5Is alone or combination in treating erectile dysfunction: A systematic review and meta‐analysis of randomised controlled trials

Abstract

The meta‐analysis was performed to assess the efficacy and safety of daily oral L‐arginine and phosphodiesterase type 5 inhibitors (PDE5Is) alone or combination in treating patients with erectile dysfunction (ED). We performed a search of randomised controlled trials in the following databases: PubMed, EMBASE and Cochrane Library databases. Four articles including 373 patients were studied. Erectile functions were significantly improved in three therapy groups compared with baseline. Patients who received the combination of L‐arginine and PDE5Is showed significant improvement compared to those treated with L‐arginine and PDE5Is alone, as assessed by sexual function index (p <0.00001 and p =0.005, respectively) and total testosterone (p <0.00001 and p =0.0007, respectively). Furthermore, patients who treated with PDE5Is alone exhibited the better efficacy than those treated with L‐arginine alone in respects of sexual function index (p <0.00001) and total testosterone (p =0.0001). However, the combination of L‐arginine and PDE5Is had no obvious difference relative to PDE5Is alone in terms of various adverse events (AEs). Conclusively, compared with monotherapy, the combination of L‐arginine and PDE5Is showed a greater improvement of sexual function and total testosterone, and did not significantly increase the AEs. Besides, PDE5Is alone revealed a better effect than those treated with L‐arginine alone for patients with ED.

Regulation of Neuropeptide Y Receptor Gene Expression and ‎Hormone Level in Obese Male Rats Receiving 6-Gingerol and L-Arginine ‎Supplementation

“…Ghlissi et al suggested that dietary ginger for 30 days decreased blood glucose and oxidative stress factor, improved reproductive organ weights and testosterone levels, enhanced semen quantity and motility, and ameliorated antioxidant activities of male diabetic rats (31). Serum testosterone levels in the L-arginine and the 6-gingerol-treated group were significantly increased compared to the HC control group, similar to other studies (32)(33)(34). Increasing testosterone levels is a fundamental goal of researchers, not only because of its effect on enhancing lipolysis and its anti-obesity effects but also because of stimulating the fertility process (32,33).…”

Post-Selective Serotonin Reuptake Inhibitor Sexual Dysfunctions(PSSD): Clinical Experience with a Multimodal Approach

“…It is therefore possible that boosting the nitrergic pathways may have rebalanced the iatrogenic dysfunctional serotonergic tonic inhibition. In this regard, a consistent body of literature stresses how L-arginine have shown a certain efficacity in the treatment of ED, especially in combination with PDE5i [42].…”

Is vitamin D and L-arginine deficiency associated with male erectile dysfunction?

“…Erectile function improved in men after oral administration of high dose L-arginine [14,15]. Moreover, the combination of L-arginine with a phosphodiesterase type 5 inhibitor (e.g., tadalafil) is more effective in improving erectile function in men [14,15]. Daily intake of L-arginine with tadalafil significantly increased the IIEF 5-item questionnaire scores, and total testosterone levels compared to single dose of each medication in diabetic patients with ED [16].…”

“…The use of L-arginine supplements significantly improved the International Index of Erectile Function (IIEF) subdomain scores of sexual intercourse satisfaction, orgasmic function, and erectile function [13]. Erectile function improved in men after oral administration of high dose L-arginine [14,15]. Moreover, the combination of L-arginine with a phosphodiesterase type 5 inhibitor (e.g., tadalafil) is more effective in improving erectile function in men [14,15].…”