Meinhardt W, Kropman R F, Vermeij P
Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam.
Drug Saf. 1999 Feb;20(2):133-46. doi: 10.2165/00002018-199920020-00004.
Modern pharmacological treatment of impotence is determined by the presenting symptoms. Since this involves symptomatology with a heterogenous aetiology, many different drugs are involved in the treatment of impotence. Drugs used for libido and arousal problems include testosterone, yohimbine, trazodone and apomorphine. Since patient self-assessment is the only parameter that can be used to measure the result of treatment and positive results are seldom affirmed, no positive benefit of these agents can be assumed at present. Oral medications for erectile dysfunction include yohimbine, trazodone, apomorphine, phentolamine, arginine and sildenafil. Of these drugs, sildenafil has been the most systematically studied for effectiveness, but long term safety data await the results of post-marketing surveillance. Of the ejaculation disorder therapies, treatments for premature ejaculation are the best studied. Favourable results have been obtained with clomipramine, paroxetine and fluoxetine. The safety of these medications has been assessed through their long term use in psychiatry. Intracavernous self-injections for erectile disorders are performed using a variety of drugs and drug mixtures. Only alprostadil and the combination of papaverine with phentolamine are widely used. Alprostadil is very well tolerated; however, penile pain is a serious problem in a significant proportion of patients. Papaverine in combination with phentolamine is effective, but penile fibrosis and priapism occur more often than with the use of alprostadil. Several new developments in this area are currently under way. Alternative routes for medication for erectile dysfunction include ointments and patches to the penile skin and the glans. Only transurethral alprostadil, 'MUSE' (medicated urethral system for erection) has been shown to be effective in large trials. Long term safety still has to be demonstrated, but the 1-year safety profile is encouraging. In general, the end points of impotence treatment studies are very diverse so efficacy data can only be assessed in comparative studies. However, long term comparison studies have not been performed. Safety demands must be set very high for this type of treatment since the disorders being treated present no threat to the patient's health.
阳痿的现代药物治疗取决于所呈现的症状。由于这涉及到病因各异的症状学，许多不同的药物都被用于阳痿的治疗。用于性欲和唤起问题的药物包括睾酮、育亨宾、曲唑酮和阿扑吗啡。由于患者自我评估是唯一可用于衡量治疗结果的参数，且很少能确认有积极效果，目前无法假定这些药物有积极益处。用于勃起功能障碍的口服药物包括育亨宾、曲唑酮、阿扑吗啡、酚妥拉明、精氨酸和西地那非。在这些药物中，西地那非在有效性方面得到了最系统的研究，但长期安全性数据有待上市后监测的结果。在射精障碍治疗方面，早泄的治疗研究得最为充分。氯米帕明、帕罗西汀和氟西汀已取得了良好效果。这些药物的安全性已通过它们在精神病学中的长期使用得到评估。用于勃起功能障碍的海绵体内自我注射使用多种药物和药物混合物。只有前列地尔以及罂粟碱与酚妥拉明的组合被广泛使用。前列地尔耐受性很好；然而，相当一部分患者会出现阴茎疼痛这一严重问题。罂粟碱与酚妥拉明联合使用是有效的，但与使用前列地尔相比更常出现阴茎纤维化和阴茎异常勃起。该领域目前正在进行一些新的研究。用于勃起功能障碍的药物的替代给药途径包括阴茎皮肤和龟头的软膏和贴片。只有经尿道前列地尔，即“MUSE”（用于勃起的药物尿道系统）在大型试验中已被证明是有效的。长期安全性仍有待证实，但1年的安全性情况令人鼓舞。一般来说，阳痿治疗研究的终点非常多样，因此疗效数据只能在比较研究中进行评估。然而，尚未进行长期比较研究。由于所治疗的疾病对患者健康不构成威胁，所以对这类治疗的安全要求必须定得非常高。
