Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Pharmacological Management of Erectile Dysfunction

Summary

Pharmacological treatment of erectile dysfunction includes all therapeutic modalities based on the use of erectogenic drugs, regardless of the route of administration. Intracavernous vasoactive injection therapy is the most commonly used treatment for erectile dysfunction. Most patients respond to intracavernous injection of either single or multiple vasoactive drugs. Major adverse effects related to this treatment include priapism, corporeal pain and the formation of nodules or plaques in the corpora cavernosa.

Oral administration of drugs aimed at improving erectile function has not produced results comparable with those obtained with intracavernous injection therapy. However, in patients with psychogenic or mild organic impotence, oral treatment with drugs that influence either central or peripheral pathways controlling erection may improve erectile function.

Topical administration of vasoactive drugs in the form of gels, liquid solutions or plasters is another attractive alternative for the treatment of psychogenic and mild organic erectile dysfunction. Although the ideal drug for the treatment of erectile dysfunction has not yet been identified, extensive laboratory and clinical research is ongoing and successful results are expected in the near future.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Consensus development conference statement. National Institute of Health: impotence. Int J Impot Res 1993; 5: 181–99

  2. 2.

    Goldstein I. How I work up impotence and non-surgical management of impotence and priapism. Proceedings Instructional Course 3. 89th Annual Meeting of the American Uro-logical Association; 1994 May 14–19; San Francisco

  3. 3.

    Goldstein I, Krane RJ. Diagnosis and therapy of erectile dysfunction. In: Walsh PC, Retik AB, Stamey TA, et al., editors. Campbell’s urology. Philadelphia: Saunders, 1992: 3033–72

  4. 4.

    Montorsi F, Guazzoni G, Bergamaschi F, et al. Four-drug in tracavernous therapy for impotence due to corporeal veno-occlusive dysfunction. J Urol 1993; 149: 1291–5

  5. 5.

    Montorsi F, Guazzoni G, Bergamaschi F, et al. Effectiveness and safety of multidrug intracavernous therapy for vasculogenic impotence. Urology 1993; 42: 554–8

  6. 6.

    Montorsi F, Guazzoni G, Bergamaschi F, et al. Clinical reliability of multi-drug intracavernous vasoactive pharmacotherapy for diabetic impotence. Acta Diabetol 1994; 31: 1–5

  7. 7.

    Montorsi F, Guazzoni G, Bergamaschi F, et al. Intracavernous vasoactive pharmacotherapy: the impact of a new self-injection device. J Urol 1993; 150: 1829–32

  8. 8.

    Zentgraf M, Accouche M, Junemann KP. Diagnosis and therapy of erectile dysfunction using papaverine and phentolamine. Urol Int 1988; 43: 65–8

  9. 9.

    Linet OI, Neff LL. Intracavernous prostaglandin El in erectile dysfunction. Clin Invest 1994; 72: 139–49

  10. 10.

    Marshall GA, Breza J, Lue TE Improved hemodynamic response after long-term intracavernous injection for impotence. Urology 1994; 43: 844–7

  11. 11.

    Wang Q, Large WA. Modulation of noradrenaline-induced membrane currents by papaverine in rabbit vascular smooth muscle cells. J Physiol (Lond) 1991; 439: 501–12

  12. 12.

    Andersson KE, Holmquist F, Wagner G. Pharmacology of drugs used for treatment of erectile dysfunction and priapism. Int J Impot Res 1991; 3: 155–72

  13. 13.

    Meinhardt W, Lycklama AAB, Kropman RF, et al. Comparison of a mixture of papaverine, phentolamine and prostaglandin E1 with other intracavernous injections. Eur Urol 1994; 26: 319–21

  14. 14.

    Wespes E, Rondeux Schulman CC. Effect of phentolamine on venous return in human erection. Br J Urol 1989; 63: 95–7

  15. 15.

    Moriel EZ, Rajfer J. Sodium bicarbonate alleviates penile pain induced by intracavernous injections for erectile dysfunction. J Urol 1993; 149: 1299–300

  16. 16.

    Schramek P, Plas EG, Hubner WA, et al. Intracavernous injection of prostaglandin E1 plus procaine in the treatment of erectile dysfunction. J Urol 1994; 152: 1108–10

  17. 17.

    Imagawa A, Kimura K, Kawanishi Y. Effect of moxisylyte hydrochloride on isolated human penile corpus cavernosum tissue. Life Sci 1989; 44: 619–23

  18. 18.

    Costa P, Sarrazin Bressolle F, et al. Efficiency and side effects of intracavernous injections of moxisylyte in impotent patients: a dose-finding study versus placebo. J Urol 1993; 149: 301–5

  19. 19.

    Truss MC, Becker AJ, Thon WF, et al. Intracavernous calcitonin gene-related peptide plus prostaglandin El: possible alternative to penile implants in selected patients. Eur Urol 1994; 26: 40–5

  20. 20.

    Stief CG, Wetterauer U, Schaebsdau F, et al. Calcitonin generelated peptide: a possible role in human penile erection and its therapeutical application in impotent patients. J Urol 1991; 146: 1010–4

  21. 21.

    Stief CG, Holmquist F, Djamilian M, et al. Preliminary results with the nitric oxide donor linsidomine chloridrate in the treatment of human erectile dysfunction. J Urol 1992; 148: 1437–40

  22. 22.

    Porst H. Prostaglandin El and the nitric oxide donor linsidomine for erectile failure: a diagnostic comparative study of 40 patients. J Urol 1993; 149: 1280–3

  23. 23.

    Wegner HEH, Knispel HH. Effect of nitric oxide-donor, linsidomine chloridrate, in treatment of human erectile dysfunction caused by venous leakage. Urology 1993; 42: 409–11

  24. 24.

    Virag R, Shoukry K, Floresco J, et al. Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8-year experience with 615 cases. J Urol 1991; 145: 287–91

  25. 25.

    Govier FE, McClure RD, Weissman RM, et al. Experience with triple-drug therapy in a pharmacological erection program. J Urol 1993; 150: 1822–4

  26. 26.

    Valdevenito R and Melman A. Intracavernous self-injection pharmacotherapy program: analysis of results and complications. Int J Impot Res 1994; 6: 81–91

  27. 27.

    McClure RD. Endocrine evaluation and therapy of erectile dysfunction. Urol Clin North Amer 1988; 15: 53–64

  28. 28.

    Morales A, Johnston B, Heaton JWP, et al. Oral androgens in the treatment of hypogonadal impotent men. J Urol 1994; 152: 1115–8

  29. 29.

    Morales A, Condra M, Owen JA, et al. Oral and transcutaneous pharmacologic agents for the treatment of impotence. In: Tanagho EA, Lue TF, McClure RD, editors. Contemporary management of impotence and infertility. Baltimore: Williams and Wilkins, 1988: 178–85

  30. 30.

    McClure RD, Oses R, Ernest ML. Hypogonadal impotence treated by transdermal testosterone. Urology 1991; 37: 224–8

  31. 31.

    March CM. Bromocriptine in the treatment of hypogonadism and male impotence. Drugs 1979; 17: 349–58

  32. 32.

    Cooper AJ. Bromocriptine in impotence. Lancet 1977; 2: 567

  33. 33.

    Riley AJ, Goodman RE, Kellett JM, et al. Double blind trial of yohimbine hydrochloride in the treatment of erection inadequacy. Sex Marit Ther 1989; 4: 17–26

  34. 34.

    Susset JG, Tessier CD, Wincze J, et al. Effect of yohimbine hydrochloride on erectile impotence: a double blind study. J Urol 1989; 141: 1360–3

  35. 35.

    Reid Surridge DH, Morales A, et al. Is yohimbine effective in the treatment of organic impotence? Results of a controlled trial. J Urol 1987; 137: 1168–72

  36. 36.

    Montorsi F, Ferini Strambi L, Guazzoni G, et al. Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology 1994; 44: 732–6

  37. 37.

    Korenman SG and Viosca SP. Treatment of vasculogenic sexual dysfunction with pentoxifylline. JAGS 1993; 41: 363–6

  38. 38.

    Saenz de Tejada I, Ware JC, Blanco R, et al. Pathophysiology of prolonged penile erection associated with trazodone use. J Urol 1991; 145: 60–4

  39. 39.

    Kurt U, Ozkardes H, Altug U, et al. The efficacy of antiserotoninergic agents in the treatment of erectile dysfunction. J Urol 1994; 152: 407–9

  40. 40.

    Albo M, Steers WD. Oral trazodone as initial therapy for management of impotence [abstract no. 524]. J Urol 1993; 149: 344A

  41. 41.

    Heaton JPW, Morales A, Adams MA, et al. Recovery of erectile function by the oral administration of apomorphine. Urology 1995; 45: 200–6

  42. 42.

    Paick JS and Won Lee S. The neural mechanism of apomorphine-induced erection: an experimental study by comparison with electrostimulation-induced erection in the rat model. J Urol 1994; 152: 2125–8

  43. 43.

    Segraves RT, Bari M, Segraves et al. Effect of apomorphine on penile tumescence in men with psychogenic impotence. J Urol 1991; 145: 1174–5

  44. 44.

    Gwinup G. Oral phentolamine in non specific erectile insufficiency. Ann Intern Med 1988; 109: 162–3

  45. 45.

    Zorgniotti AW. Experience with buccal phentolamine mesylate for impotence. Int J Impot Res 1994; 6: 37–41

  46. 46.

    Wagner G, Lacy S, Lewis R, et al. Buccal phentolamine. A pilot trial for male erectile dysfunction at three separate clinics. Int J Impot Res 1994; 6 Suppl. 1: D78

  47. 47.

    Zorgniotti AW, Lizza ER Effect of large doses of the nitric oxide precursor, L-arginine, on erectile dysfunction. Int J Impot Res 1994; 6: 33–6

  48. 48.

    Goldstein JA. Erectile function and naltrexone. Ann Intern Med 1986; 105: 799–801

  49. 49.

    Brennemann W, Stitz B, Wan Ahlen H, et al. Treatment of idiopathic erectile dysfunction in men with the opiate antagonist naltrexone — a double-blind study. J Androl 1993; 14: 407–10

  50. 50.

    Smith DM, Levitte SS. Association of fluoxetine and return of sexual potency in three elderly men. J Clin Psychiatry 1993; 54: 317–9

  51. 51.

    Anderson DC, Seifert CF. Topical nitrate treatment of impotence. Ann Pharmacother 1993; 27: 1203–5

  52. 52.

    Owen JA, Saunders F, Harris et al. Topical nitroglycerin: a potential treatment for impotence. J Urol 1989; 141: 546–8

  53. 53.

    Cavallini G. Minoxidil versus nitroglycerin: a prospective double-blind controlled trial in transcutaneous erection facilitation for organic impotence. J Urol 1991; 146: 50–3

  54. 54.

    Radomski SB, Herscorn S, Rangaswamy S. Topical minoxidil in the treatment of male erectile dysfunction. J Urol 1994; 151: 1225–6

  55. 55.

    Chancellor MB, Rivas DA, Panzer DE, et al. Prospective comparison of topical minoxidil to vacuum constriction device and intracorporeal papaverine injection in treatment of erectile dysfunction due to spinal cord injury. Urology 1994; 43: 365–9

  56. 56.

    Kim ED, El-Rashidy R, McVary KT. Papaverine topical gel for treatment of erectile dysfunction. J Urol 1995; 153: 361–5

  57. 57.

    Padma-Nathan H, Keller T, Proppiti R, et al. Hemodynamic effects of intraurethral alprostadil: the medicated urethral system for erection (MUSE). Int J Impot Res 1994; 6 Suppl. 1: A42

  58. 58.

    Wolfson B, Pickett S, Scott NE, et al. Intraurethral prostaglandin E-2 cream: a possible alternative treatment for erectile dysfunction. Urology 1993; 42: 73–5

  59. 59.

    Foreman MM, Wernicke JE Approaches for the development of oral drug therapies for erectile dysfunction. Semin Urol 1990; 8: 107–12

Download references

Author information

Correspondence to Dr Francesco Montorsi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Montorsi, F., Guazzoni, G., Rigatti, P. et al. Pharmacological Management of Erectile Dysfunction. Drugs 50, 465–479 (1995). https://doi.org/10.2165/00003495-199550030-00005

Download citation

Keywords

  • Erectile Dysfunction
  • Naltrexone
  • Yohimbine
  • Trazodone
  • Erectile Function