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Treatment Modalities for Erectile Dysfunction in Neurologic Patients
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Oral PDE5 inhibitors (PDE5i), unless contraindicated, are often used first.17 Sildenafil, introduced in 1998, had a large impact due to its easy applicability, effectiveness, and safety. Its formats, delay of action, and half-life are given in Table 43.1.18 Its efficacy has been repeatedly demonstrated, mostly in men with SCI. The presence of an upper motor neuron lesion was significantly associated with therapeutic success, while patients with lower motor neuron lesions and cauda equina syndrome were poorer responders.19 Other PDE5i have become commercialized: vardenafil, tadalafil, and more recently avanafil, udenafil, and miradenafil, are available in some countries. The pharmacokinetics behind the drug's activity have been described before.20,21 The medications differ in time of onset, duration of action, and side effects (Table 43.1). How to use the drug must be clearly explained. It can be taken daily (e.g., tadalafil 5 mg) or on demand.22 It is not always the patient's first choice due to its restricted duration. Discontinuation of the intake is not rare and can be due to unawareness that sexual excitement is needed. There is a learning curve, and four to five trials with one drug are suggested before switching to another.21 The contraindication is the use of nitrate because of the risk of hypotension, including nitrogen paste used in rehabilitation centers for autonomic hyperreflexia. Caution is also needed in men with multiple system atrophy.10,20 Other limitations are uncontrolled hypertension, unstable angina, and the intake of alpha-blockers. Vardenafil should not be taken by men on type 1A or type 3 antiarrhythmics or in the presence of a prolonged QT syndrome.22
Considerations for prescribing pharmacotherapy for the treatment of erectile dysfunction
Published in Expert Opinion on Pharmacotherapy, 2021
Ahmed M. Bakr, Amro A. El-Sakka, Ahmed I. El-Sakka
Adding more drugs to this family such as Udenafil, sildenafil and TPN729MA may help reserve more invasive treatments for a limited unsatisfied group of patients with restricted naturalness and spontaneity. Udenafil is a selective PDE5i that is a safe and well-tolerated agent for the treatment of ED. In comparison to the placebo, Udenafil is associated with a significant improvement in the International Index of Erectile function (IIEF)-EF, Sexual Encounter Profile (SEP)2 and SEP3 [72]. The daily dose of Udenafil was subjected to randomized trials, and showed similar benefits on IIEF-EF, whatever the baseline level of erectile function is [73]. Mirodenafil is a new selective PDE5i. It showed efficiency and safety in a wide range of ED patients in randomized placebo-controlled trials [74]. TPN729MA is also a new selective PDE5i that is characterized by a long duration of action. In comparison to the vehicle in an experimental study, TPN729MA is associated with a significant increase in intracavernosal pressure in randomized groups of rat and dog models [75].
Treatment of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction
Published in The Aging Male, 2018
Aldo E. Calogero, Giovanni Burgio, Rosita A. Condorelli, Rossella Cannarella, Sandro La Vignera
Udenafil (Zydena) is a PDE5I developed by a Korean pharmaceutical company in 2005, with a pharmacokinetic profile in that its Tmax is about 1–1.5 h and its T1/2 is about 11–13 h. Its molecular structure is similar to that of sildenafil citrate, and the isoenzyme selectivity profile of udenafil is comparable to that of sildenafil. The clinical effect of udenafil is known to last for 24 h or more in clinical practice. Its product is available in tablet formulation of 100 mg and 200 mg. This drug is still not approved except in Korea, Russia, and Philippines, even if in United States phases IIa and III have been conducted since 2006. An open, prospective, non-comparative study by Chung et al. showed an improvement in IPSS, IIEF-5, and no significant changes in blood pressure and heart rate in 120 men, who were already receiving a stable α-blocker therapy, by adding udenafil 100 mg in combination therapy. The incidence of adverse events was similar to earlier reports on monotherapy using PDE-5i in patients with ED, or with monotherapy using α-blockers in patients with LUTS/BPH. Thus, the co-administration of udenafil and α-blockers did not elevate the incidence of such adverse events, so the therapy appeared safe [50].
An update on emerging drugs for the treatment of erectile dysfunction
Published in Expert Opinion on Emerging Drugs, 2018
U. Milenkovic, J. Campbell, E. Roussel, M. Albersen
This second-generation PDE5-I has been in circulation in South-Korea since 2005. It reaches peak plasma concentrations in 50-80 min with a 10-12 h half-life [75]. These properties partially unite the fast onset of action of sildenafil with the longer duration of tadalafil. It has an efficacy comparable to the currently available PDE5-I. Phase II studies revealed an efficacy rate for vaginal penetration of more than 90% (either with 100 or 200mg doses). Additionally, a phase III trial found that udenafil was also successful in the treatment of diabetic patients and patients taking several antihypertensive medications, with limited adverse events [76,77]. Furthermore, its combination with an alpha-blocker can ameliorate micturition complaints of patients with lower urinary tract symptoms and increase erection quality [78] (comparable to tadalafil). A once-daily low dosing of udenafil (25,50 or 75 mg) in patients with ED was tested in a phase II study. At 50 and 75 mg there were a significant improvement in the reported International index of erectile function (IIEF) scores compared to placebo treatment [79]. Undoubtedly, udenafil will find its place in the Western market, judging from its encouraging efficacy and safety profile.