Nonarteritic anterior ischemic optic neuropathy with PDE-5 inhibitors for erectile dysfunction

Thurtell, Matthew J.; Tomsak, Robert L.

doi:10.1038/ijir.2008.25

Cited by 22 publications

(18 citation statements)

References 52 publications

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“…The most frequent, serious disorder associated with PDE5i use is nonarteritic ischemic optic neuritis (NAION), which may result in irreversible blindness (42). Whether PDE5i are actually responsible for NAION remains questionable, with only individual cases or small studies linking the two (43) and a number of larger studies finding no association (44,45). The effect of PDE5i on the auditory system has recently garnered attention as well.…”

Section: Pde5 Inhibition and Side Effect Profilementioning

confidence: 99%

PDE5 inhibitors: considerations for preference and long-term adherence

Smith

McCaslin

Gökçe

et al. 2013

International Journal of Clinical Practice

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Summary Introduction: Erectile dysfunction (ED) is a highly prevalent condition affecting nearly one in five men worldwide. The advent of phosphodiesterase type 5 inhibitors (PDE5i) has revolutionised the ED treatment landscape and provided effective, minimally invasive therapies to restore male sexual function. Materials and methods: A pubmed search was performed of all English language articles from 1996 to present reviewing PDE5i, including pharmacokinetics, efficacy profiles and comparisons, where available. Results: Currently available PDE5i in the United States include sildenafil, vardenafil, tadalafil and avanafil, each of which has unique side effect, pharmacokinetic and outcome profiles. Sildenafil is associated with increased rate of visual changes, vardenafil with QT prolongation and tadalafil with lower back pain. Avanafil and vardenafil orodispersible tablet rapidly achieve peak plasma concentration, which results in faster onset of action, whereas tadalafil exhibits the longest half‐life. First time response to PDE5i is approximately 60–70%, with no significant differences in efficacy noted among therapies. The literature does not clearly demonstrate a preference for one drug. High‐treatment success rates (89%) were reported when patients were prescribed all available PDE5i. Daily dosing with tadalafil is associated with improved erectile function (EF) over time. Finally, novel modes of patient–provider interaction, including internet‐based education, communication and prescribing, may also improve long‐term adherence. Conclusions: PDE5i represent first line therapy for ED with excellent overall efficacy and satisfactory side effect profiles. Enhanced communciation, coupled with increased knowledge of drug characteristics, comparative treatment regimens and optimal prescribing patterns, offer compelling tools to improve long‐term treatment success.

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Section: Pde5 Inhibition and Side Effect Profilementioning

confidence: 99%

PDE5 inhibitors: considerations for preference and long-term adherence

Smith

McCaslin

Gökçe

et al. 2013

International Journal of Clinical Practice

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“…The most widely discussed of these is nonarteritic ischemic optic neuritis (NAION), a cause of irreversible blindness [43]. While the role of PDE5I in causing NAION remains a controversial issue, the majority of reports linking PDE5I with this disorder have been single cases and small series [44]. This suggests that while NAION is an adverse event that may or may not be associated with PDE5I use (particularly in patients with other risk factors for optic disease), it is a fairly rare occurrence.…”

Section: Updates On Sexual/relationship Medicine Indications For Pde5mentioning

confidence: 99%

Continuing Medical Education: 2009 Update on Phosphodiesterase Type 5 Inhibitor Therapy Part 2: Updates on Optimal Utilization for Sexual Concerns and Rare Toxicities in This Class (CME)

Shindel

2009

The Journal of Sexual Medicine

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Introduction Highly selective inhibitors of phosphodiesterase type 5 (PDE5I) have been commercially available for over a decade. Our knowledge of these drugs continues to expand. Aims To review recent (since 2007) developments on the utilization of PDE5I in clinical practice. The focus of this manuscript is on the use of PDE5I for sexual concerns. Also reviewed are recent reports of rare but potentially serious toxicity. Methods Pubmed search utilizing the search terms “phosphodiesterase type 5 inhibitor,”“PDE5 inhibitor,”“sildenafil,”“vardenafil,” and “tadalafil.” Articles were screened for their relevance to the clinical practice of sexual medicine and/or PDE5I toxicity. Publications on routine dose PDE5I for penile rehabilitation, lower urinary tract symptoms, and stuttering priapism are summarized in a separate manuscript in this series. Main Outcome Measures Peer-reviewed publications since the last major update on PDE5I published in the medical literature. Results Recent investigations have suggested a number of interventions to potentially improve patient compliance with PDE5I therapy. Additionally, the approval in the past year of tadalafil as a daily medication signifies a potential paradigm shift in our concept of this disorder. Daily dosing may be useful in some men; however, the other available PDE5I continue to show excellent efficacy in the management of erectile dysfunction (ED). In addition to direct effects on ED, several recent reports highlight the use of PDE5I for improvement of premature ejaculation, sexual relationship status, and sexual function in women. There have also been several recent reports of rare but serious toxicity, particularly ototoxicity, associated with PDE5I use. Conclusions Recent studies have suggested new ways to optimize utilization of PDE5I not only for the management of ED but also for other sexual concerns in both men and women. Rare but serious toxicities have been reported with PDE5I and, therefore, judicious counseling is indicated before prescribing these medications.

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“…The proposed risk factors include: (1) the anatomic predisposition of a “crowded” optic disk [4], [5]; (2) systematic conditions, such as hypertension [6], [7], diabetes mellitus (DM) [8]–[10], hyperlipidemia [6], [10], [11], sleep apnea syndrome[12], [13] and nocturnal hypotension [14], [15]; (3) side effects of some medical or surgical interventions, such as erectile dysfunction drugs [16], [17], amiodarone [18], [19], instance liposuction and hemodialysis [20]; and (4) genetic factors [20]–[23]. Among these factors, DM, an important risk factor, needs further investigation.…”

Section: Introductionmentioning

confidence: 99%

The Association between Diabetes Mellitus and Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

et al. 2013

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BackgroundThe association of diabetes mellitus (DM) with nonarteritic anterior ischemic optic neuropathy (NAION) has been inconclusive.PurposeTo determine whether DM is associated with an increased risk of NAION.MethodsA comprehensive literature search was performed for published studies reporting both DM and NAION based on PubMed and EMBASE. After reviewing characteristics of all the included studies systematically, meta-analytical method was employed to calculate the pooled odds ratio (OR) and associated 95% confidence interval (CI) from random-effects models. Heterogeneity was assessed by Q-statistic test. Funnel Plot, Begg's and Egger's linear regression test were applied to evaluate publication bias. A sensitivity analysis and meta-regression analysis were also performed to assess the robustness of results.Results2,096 participants from 12 case-control studies were pooled for a meta-analysis. The result of meta-analysis of these studies indicated that DM is associated with increased risk of NAION (pooled OR = 1.64, 95% CI = 1.17–2.30; P = 0.004). Sensitivity analysis indicated our findings are robust, and meta-regression analysis revealed no significant effect in terms of geographical area, gender, age of patients with NAION, the year of the publication, source of the controls, and sample size (all p>0.05). Evidence of publication bias was not observed in our study.ConclusionMeta-analysis suggests that DM might be associated with increased risk of NAION.

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Nonarteritic anterior ischemic optic neuropathy with PDE-5 inhibitors for erectile dysfunction

Cited by 22 publications

References 52 publications

PDE5 inhibitors: considerations for preference and long-term adherence

PDE5 inhibitors: considerations for preference and long-term adherence

Continuing Medical Education: 2009 Update on Phosphodiesterase Type 5 Inhibitor Therapy Part 2: Updates on Optimal Utilization for Sexual Concerns and Rare Toxicities in This Class (CME)

The Association between Diabetes Mellitus and Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

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