Keene L C, Davies P H
Sandwell Healthcare NHS Trust, West Bromwich, West Midlands.
Adverse Drug React Toxicol Rev. 1999 Mar;18(1):5-24.
Erectile dysfunction is a highly prevalent medical problem affecting a significant proportion of men. It is important for a number of reasons, causing impairment of quality of life and, if related to drug therapy, leading to non-compliance. Drug therapy accounts for erectile dysfunction in approximately 25% of cases and is mostly readily reversible when the offending agent is stopped, or a suitable alternative is substituted. Many classes of drug may be responsible, interfering with the normal physiological processes leading to penile erection in a dose-related fashion, and in ways which can usually be predicted from their pharmacology. The most commonly implicated classes of drug include antihypertensives such as thiazide diuretics and beta-adrenoceptor antagonists and psychotherapeutic drugs, especially selective serotonin reuptake inhibitor (SSRI) antidepressants. We review the agents which can cause erectile dysfunction, the evidence for this adverse effect and the physiological mechanisms involved. We present an approach to the management of the patient with erectile dysfunction in whom concomitant drug therapy may be responsible. We recommend that drug therapy should always be considered as a possible cause of erectile dysfunction before specific investigation and therapy is considered.
勃起功能障碍是一个非常普遍的医学问题，影响着相当一部分男性。它因多种原因而重要，会导致生活质量受损，若与药物治疗相关，则会导致患者不依从治疗。药物治疗约占勃起功能障碍病例的25%，当停用致病药物或换用合适的替代药物时，大多很容易逆转。许多类药物都可能导致勃起功能障碍，它们以剂量相关的方式干扰导致阴茎勃起的正常生理过程，且通常可从其药理学特性预测其作用方式。最常涉及的药物类别包括噻嗪类利尿剂和β-肾上腺素受体拮抗剂等抗高血压药物以及心理治疗药物，尤其是选择性5-羟色胺再摄取抑制剂（SSRI）类抗抑郁药。我们综述了可导致勃起功能障碍的药物、这种不良反应的证据以及所涉及的生理机制。我们提出了一种对可能因合并药物治疗而导致勃起功能障碍的患者的管理方法。我们建议，在考虑进行具体检查和治疗之前，应始终将药物治疗视为勃起功能障碍的一个可能原因。
