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Der Urologe, Ausgabe A

, Volume 43, Issue 7, pp 820–828 | Cite as

Erektile Dysfunktion

Neue Medikamente unter besonderer Berücksichtigung der PDE-5-Inhibitoren
  • H. Porst
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Zusammenfassung

Die Erektile Dysfunktion (ED) ist gerne mit Erkrankungen assoziiert, deren gemeinsame Basis eine endotheliale Dysfunktion ist. Häufig ist die ED auch mit LUTS kombiniert, wobei dann die gemeinsame Basis eine Rho-Kinase-Erhöhung und NO-Abnahme zu sein scheint.

Da alle drei PDE-5-Inhibitoren Sildenafil, Tadalafil und Vardenafil einen gemeinsamen Wirkmechanismus, die Hemmung der PDE 5, haben, unterscheiden sie sich bezüglich Wirksamkeit und Nebenwirkungsprofil kaum, mit Ausnahme von Farbsehstörungen, die häufiger bei Sildenafil und Rücken-/Muskelschmerzen, welche häufiger bei Tadalafil auftreten. Hauptunterschiedsmerkmal unter den 3 Substanzen ist ihre Pharmakokinetik, die letztendlich dafür verantwortlich ist, dass in den bislang veröffentlichten Vergleichsstudien in Abhängigkeit vom jeweiligen Studiendesign die überwiegende Mehrzahl der Patienten sich entweder für Tadalafil, den am längsten (36 h) wirksamen PDE-5-Hemmer oder für Vardenafil als relativ schnell wirksame Substanz entschieden haben.

Alle bislang publizierten Studien haben gezeigt, dass bezüglich des kardiovaskulären Risikos (Herzinfarktrate) alle drei PDE-5-Hemmer generell besser als Placebo, wenngleich auch nicht statistisch signifikant, abgeschnitten haben. Ohne Ausnahme gilt für alle drei PDE-5-Hemmer, dass sie bei gleichzeitiger Nitrat- und Molsidominmedikation kontraindiziert sind und Interaktionen insbesondere mit nicht uroselektiven α-Blockern zeigten, weshalb eine gleichzeitige Einnahme vermieden werden muss.

In naher Zukunft könnte die chronische (tägliche) Applikation eines PDE-5-Hemmers Vorteile bringen, zumindest bei den ca. 50–60% aller ED-Fälle, bei denen aufgrund der Diagnostik (Penis-Duplex/Doppler) eine endotheliale Dysfunktion sehr wahrscheinlich ist. Mögliche Neuentwicklungen in der ED-Therapie mit einem Zeitfenster von 5–8 Jahren bis zur Marktzulassung stellen Guanylatzyklaseaktivatoren, Rho-Kinase-Inhibitoren, Melanocortin-Rezeptoragonisten, die Gentherapie und das Tissue Engineering dar.

Schlüsselwörter

Erektile Dysfunktion Endotheliale Dysfunktion PDE-5-Inhibitoren Sildenafil Tadalafil Vardenafil 

Erectile dysfunction

New drugs with special consideration of the PDE 5 inhibitors

Abstract

Erectile dysfunction (ED) tends to be associated with other diseases, the common basis of which is endothelial dysfunction. ED is also frequently combined with LUTS and the common basis for both conditions seems to be elevation of Rho-kinase activity and decrease of NO concentration.

Because all three PDE 5 inhibitors sildenafil, tadalafil, and vardenafil have a common mode of action, i.e., inhibition of PDE 5, they are not different in terms of their efficacy and safety profile except for color vision disturbances which are more common after sildenafil and back pain/myalgia more often observed after tadalafil. The main differentiating characteristics among the three PDE 5 inhibitors are their pharmacokinetics. These are ultimately responsible for the observation that in head-to-head comparative trials depending on the respective study design the overwhelming majority of the patients opted either for tadalafil as the longest acting PDE 5 inhibitor (36 h) or for vardenafil as a relatively rapidly acting drug.

All published studies so far have shown that in terms of the cardiovascular risk profile (myocardial infarction rate) all three PDE 5 inhibitors performed better than placebo although the results were not statistically significant. Without any exception it applies to all three PDE 5 inhibitors that they are absolutely contraindicated in patients taking nitrate- or molsidomine-containing medications and that they may interact in particular with non-uroselective alpha-adrenoceptor blockers. This is why their simultaneous application with PDE 5 inhibitors has to be avoided.

In the near future chronic (daily) application of a PDE 5 inhibitor may show advantages, at least in those 50–60% of all patients in whom there is a high likelihood of endothelial dysfunction due to the diagnostic (penile duplex Doppler) outcome. Possible new developments in the management of ED with a time frame of 5–8 years until their market approval are guanylate cyclase activators, Rho-kinase inhibitors, melanocortin receptor agonists, gene therapy, and tissue engineering.

Keywords

Erectile dysfunction Endothelial dysfunction PDE 5 inhibitors Sildenafil Tadalafil Vardenafil 

Notes

Interessenkonflikt:

Keine Angaben

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Hamburg
  2. 2.Hamburg

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