Retinal and Optic Disc Vascular Changes in Patients Using Long-Term Tadalafil: A Prospective Non-Randomized Matched-Pair Study

Capece, Marco; Montorio, Daniela; Comune, Chiara; Aveta, Achille; Melchionna, Alberto; Celentano, Giuseppe; Imbimbo, Ciro; Crocetto, Felice; Califano, Gianluigi; Cennamo, Gilda

doi:10.3390/diagnostics11050802

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…Nevertheless, the effect of sildenafil on the retinal vascular structure is not limited to the mentioned hypotheses. Capece et al showed a decreased vessel density of retina and optic nerve in the group of participants consuming tadalafil for more than 6 months compared with the matched control group, and they theorize that this medication could damage retinal capillaries [ 25 ]. The vascular effect of 5-PDE inhibitors is not limited to the retina and optic disc; there are several reports of cerebral vascular accident, myocardial infarction, and deep vein thrombosis following consumption of these medications [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Central retinal vein and artery occlusion associated with sildenafil: a case report and review of the literature

Torkashvand,

Anvari,

Ketabi

et al. 2023

J Med Case Reports

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Background Sildenafil is a selective phosphodiesterase type 5 inhibitor used for the treatment of erectile dysfunction and pulmonary hypertension. It is available over the counter in many countries. While there have been a few reports of retinal vascular occlusion following sildenafil consumption, most cases have other comorbidities as risk factors for the disease, and the exact causal role of this drug in these conditions remains unclear. Case presentation We present the case of a healthy 32-year-old Iranian man who developed combined central retinal vein occlusion and retinal artery occlusion following sildenafil exposure. The patient underwent a hypercoagulative state workup for possible underlying risk factors. Additionally, we conducted a literature search on PubMed using the keywords: retinal vein occlusion AND Sildenafil OR Viagra, retinal artery occlusion AND Sildenafil OR Viagra, retinal vascular occlusion AND Sildenafil OR Viagra. To obtain more objective results in the reviews, we employed an adverse drug reaction possibility algorithm. The patient was found to be otherwise healthy, and ancillary tests were unremarkable. A literature review identified seven reports of retinal vascular occlusion following sildenafil use. In most of these cases, the role of sildenafil was not clearly established. To the best of our knowledge, our case achieved the highest score based on the algorithm compared with previous reports. Conclusion Sildenafil may be associated with severe retinal vascular accidents in otherwise healthy young individuals.

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Section: Discussionmentioning

confidence: 99%

Central retinal vein and artery occlusion associated with sildenafil: a case report and review of the literature

Torkashvand,

Anvari,

Ketabi

et al. 2023

J Med Case Reports

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“…However, the percentage of patients who discontinued the treatment is still high. In particular, PDE5-is are associated with several adverse effects, reducing the patients' compliance and drop-out [7]. On the other hand, several nutraceutical compounds, supplemented as single agents and/or in different combinations, have been reported to offer benefits in the treatment of ED, without adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Icarifil® in Association with Daily Use of Tadalafil (5 mg) versus Standard Tadalafil Daily Dose (5 mg) or Alone: Results from a Controlled, Randomized Clinical Trial

Cai,

Palumbo,

Miacola

et al. 2024

JCM

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Background: The management of erectile dysfunction (ED) shows several grey zones and new treatments are required to reduce the percentage of patients discontinuing treatment. Here, we aim to evaluate the role of a natural mixture named Icarifil® (L-Citrulline, L-Carnitine, Eruca vesicaria, Panax ginseng, Tribulus terrestris, Turnera diffusa, Taurine, Vitamin E, Zinc) in the management of patients with ED. Methods: From September 2022 to March 2023, all patients attending 3 urological institutions due to ED were randomized to receive the following for 3 months: Icarifil® 1 sachet every 24 h (Group 1) or Icarifil® 1 sachet + tadalafil 5 mg 1 tablet every 24 h (Group 2) or tadalafil 5 mg 1 tablet daily (Group 3). All patients underwent urologic visits and dedicated questionnaires (IIEF-5, SEP-2, SEP-3) at enrollment and at the follow-up evaluation (3 months). Patient-Reported Outcomes (PROs) at the follow-up evaluation were used. The primary endpoint was the difference in the questionnaires at the follow-up visit compared to the one at enrollment among the study groups. Results: In the per-protocol analysis, 52 patients in Group 1, 55 in Group 2 and 57 in Group 3 were analyzed. At the follow-up evaluation, IIEF-5 scores improved in all the 3 groups between enrollment and the follow-up evaluation, but a statistically significant difference was reported between Group 2 (+7.4) and Group 1 (+4.1) or Group 3 (+5.1), (p < 0.001; p < 0.001). Moreover, 47 patients (94.0%) in Group 2 showed an improvement in the SEP questionnaires, when compared with the baseline, while 29 in Group 1 (56.9%) and 42 in Group 3 (82.3%) showed a statistically significant difference (p = 0.004; p = 0.003) among the groups. The PRO analysis reported better efficacy and patient satisfaction in Group 2 when compared with Group 1 or Group 3. Conclusions: In conclusion, Icarifil® is able to improve penile erectile function in mild–moderate ED and significantly improve the clinical efficacy of daily used tadalafil 5 mg. Icarifil® could represent an interesting alternative treatment in patients experiencing adverse effects or with contraindications for chronic treatment with PDE5-is.

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“…While phosphodiesterase type 5 inhibitors (PDE5is) can effectively treat ED, they do not provide long-term improvement in vascular dysfunction. 11 The concept of the visceral adiposity index (VAI) was introduced as an indicator of adipose tissue dysfunction, combining HDL cholesterol, triglyceride levels, body mass index (BMI), and waist circumference (WC) into a gender-speci c formula. 12 Our recent studies have shown that each unit increase in VAI is associated with a 1.3-fold increased risk of ED in men.…”

Section: Introductionmentioning

confidence: 99%

Can control of visceral adiposity index improve sexual function in men with metabolic syndrome?

Bolat,

Yılmaz,

Dündar

et al. 2024

Preprint

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The metabolic syndrome (MeTS) negatively affects male sexual function. Lifestyle changes improve erectile function. However, the effects of lifestyle changes on sexual function in men with and without MeTS on the visceral adiposity index (VAI) have not been adequately investigated. Patients with MeTS (n = 48) and those with no MeTS (n = 31) were recruited. Sexual functions and psychogenic status were assessed using the International Index of Erectile Dysfunction (IIEF) questionnaire and Beck’s depression inventory (BDI), respectively. The VAI was calculated using the gender-specific formula. Demographic, clinical, biochemical and hormonal data were recorded. Participants were advised to 8500 steps per day and dietary control. At least three months later, demographic and biochemical tests were repeated, and the VAI was calculated. Association between sexual functions, presence of MeTS and lifestyle changes via the VAI were analyzed. Each integer increase of the VAI was related to a 1.74-fold increased risk of ED in the MeTS group. The MeTS was related to moderate to severe ED than those with no MeTS (p = 0.033). A 24% decrease of the VAI was recorded in the MeTS group at the end of the study (p = 0.014). The MeTS criteria were disappeared in eight patients at the end of the study, with a slight decrease of VAI (p = 0.07). In the beginning, patients with MeTS and no-MeTS showed similar sexual satisfaction, orgasm, desire, and general satisfaction scores. Sexual satisfaction, orgasm and general satisfaction were improved in the non-MeTS group (p < 0.05). At the end of the study, the MeTS group showed similar sexual satisfaction, desire, orgasm and general satisfaction rates (p > 0.05). Higher VAI levels were related to the lower erectile function scores, particularly in patients with MeTS. Lifestyle changes improved male sexual function scores only in the non-MeTS group. Therefore, fighting against MeTS should be adopted as a global healthcare policy.

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Retinal and Optic Disc Vascular Changes in Patients Using Long-Term Tadalafil: A Prospective Non-Randomized Matched-Pair Study

Cited by 7 publications

References 31 publications

Central retinal vein and artery occlusion associated with sildenafil: a case report and review of the literature

Central retinal vein and artery occlusion associated with sildenafil: a case report and review of the literature

Icarifil® in Association with Daily Use of Tadalafil (5 mg) versus Standard Tadalafil Daily Dose (5 mg) or Alone: Results from a Controlled, Randomized Clinical Trial

Can control of visceral adiposity index improve sexual function in men with metabolic syndrome?

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