Switching from Long-Term Treatment with Self-Injections to Oral Sildenafil in Diabetic Patients with Severe Erectile Dysfunction

Perimenis, Petros; Markou, S.; Gyftopoulos, Kostis; Athanasopoulos, Anastasios; Giannitsas, Konstantinos; Barbalias, George A.

doi:10.1016/s0302-2838(02)00032-5

Cited by 48 publications

(26 citation statements)

References 22 publications

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“…Diabetic men with ED have displayed impaired response rates across all of the therapeutic trials. 35,36 In our study, the animals that received daily sildenafil by gavage demonstrated an improved response to cavernous nerve stimulation compared with controls. This, in part, supports the finding by others that sildenafil enhanced electrical field stimulation-mediated relaxation and restored cGMP formation in a rabbit diabetes model.…”

Section: Vitamin E Vit E + Sildenafilmentioning

confidence: 48%

Effect of PDE5 inhibition combined with free oxygen radical scavenger therapy on erectile function in a diabetic animal model

Young

Freeman

et al. 2003

Int J Impot Res

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Phosphodiesterase (PDE) inhibitors represent an important advance in the treatment of erectile dysfunction (ED). In spite of widespread use and generally good efficacy, as a class they remain ineffective in 15-57% of men. Specific cohorts of patients with severe vascular or neurogenic basis to their ED, such as diabetic men or those who have undergone radical pelvic surgery, demonstrate lower response rates with PDE inhibition treatment. We believe that circulating levels of nitric oxide (NO) may be enhanced through delivery of adequate concentrations of free oxygen radical scavenger molecules such as vitamin E. Higher levels of NO, theoretically, should produce increased penile blood flow with the potential for a synergistic effect when combined with a PDE5 inhibitor. With this hypothesis in mind, 20 adult male Sprague-Dawley streptozotocin-induced (60 mg/kg i.p.) diabetic rats were divided into four therapeutic groups (n ¼ 5). Group IFcontrol animals received peanut oil, group IIFvitamin E 20 IU/day, group IIIFsildenafil 5 mg/kg/day and group IVFvitamin E 20 IU/day plus sildenafil 5 mg/kg/day, by oral gavage daily for 3 weeks. Erectile function was assessed as a rise in intracavernous pressure following cavernous nerve electrostimulation. Penile tissue was harvested to determine the changes in tissue morphology including neuronal nitric oxide synthase, smooth muscle a-actin and endothelial cell integrity. PDE5 protein content and activity were measured. Significant increases in intracavernous pressure were measured in the animals receiving combined vitamin E plus sildenafil treatment. Immunohistochemical staining showed increases of neuronal nitric oxide synthase, endothelial cell and smooth muscle cell staining. Western blot analysis did not show significant differences of PDE5 protein between the groups. However, higher PDE5 activity was measured in the sildenafil group and lower activity of PDE5 was recorded in the cohort receiving vitamin E with sildenafil. Vitamin E enhanced the therapeutic effect of the PDE5 inhibitor in a meaningful way in this animal model of diabetes. This study indicates a potential means of salvaging erectile function among patients who are refractory to sildenafil.

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Section: Vitamin E Vit E + Sildenafilmentioning

confidence: 48%

Effect of PDE5 inhibition combined with free oxygen radical scavenger therapy on erectile function in a diabetic animal model

Young

Freeman

et al. 2003

Int J Impot Res

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“…While self-injections still have their place for a limited number of patients, 28 the therapeutic management of ED was revolutionized after the introduction of oral sildenafil for both psychogenic and organic ED. 10 Basic research into ED has demonstrated the importance of the NO/cGMP/PDE5 interactions for the natural erection process.…”

Section: Discussionmentioning

confidence: 99%

Vardenafil (Levitra) for erectile dysfunction: a systematic review and meta-analysis of clinical trial reports

et al. 2004

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“…Thus, when 81 ED patients with diabetes (29 with type I, 52 with type II), who had been successfully treated with injections, were changed to sildenafil 100 mg, 23 discontinued because of insufficiency. 83 Men with insulin-dependent diabetes or requiring both PGE 1 and/or papaverine were more likely not to respond to sildenafil. 83 Sildenafil improved erectile function to a similar extent in ED patients taking antihypertensives as in patients not taking antihypertensives.…”

Section: Diabetes and Cardiovascularmentioning

confidence: 97%

“…83 Men with insulin-dependent diabetes or requiring both PGE 1 and/or papaverine were more likely not to respond to sildenafil. 83 Sildenafil improved erectile function to a similar extent in ED patients taking antihypertensives as in patients not taking antihypertensives. 32 Sildenafil also improved erectile function in patients with stable coronary artery disease.…”

Section: Diabetes and Cardiovascularmentioning

confidence: 97%

Do vardenafil and tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?

Doggrell

2006

Int J Impot Res

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Erectile dysfunction (ED) affects up to 50% of men between the ages of 40 and 70 years of age. Sildenafil, vardenafil and tadalafil have all been shown to be similarly effective in the treatment of men with ED of vary etiologies, to have similar adverse effects profiles, and to improve quality-oflife by similar amounts. As these phosphodiesterase 5 (PDE5) inhibitors all increase the hypotensive effects of nitrates, they are not suitable for use in patients taking nitrates for the treatment of ischaemic heart disease. All three inhibitors must be used with caution in patients taking a 1 -adrenoceptors antagonists for benign prostatic hyperplasia. Although nonarteritic anterior ischaemic neuropathy has been reported in some users of the PDE5 inhibitors, there is no conclusive evidence that PDE5 inhibitors cause this rare effect. Tadalafil has a longer half-life than sildenafil or vardenafil, and a longer duration of action than sildenafil and vardenafil. Most preference studies have shown tadalafil to be preferred, but there are serious limitations to some of these studies. One approach to treatment is to give each patient a short-and long-acting agent, and for individuals to decide their preference.

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Switching from Long-Term Treatment with Self-Injections to Oral Sildenafil in Diabetic Patients with Severe Erectile Dysfunction

Cited by 48 publications

References 22 publications

Effect of PDE5 inhibition combined with free oxygen radical scavenger therapy on erectile function in a diabetic animal model

Effect of PDE5 inhibition combined with free oxygen radical scavenger therapy on erectile function in a diabetic animal model

Vardenafil (Levitra) for erectile dysfunction: a systematic review and meta-analysis of clinical trial reports

Do vardenafil and tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?

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