Carter John E
Neurology, University of Texas Health Science Center at San Antonio, TX, USA.
J Neurol Sci. 2007 Nov 15;262(1-2):89-97. doi: 10.1016/j.jns.2007.06.018. Epub 2007 Aug 16.
The PDE-5 inhibitors sildenafil (Viagra) vardenafil (Levitra) and tadalafil (Cialis) have been taken by millions of men for erectile dysfunction. Transient visual symptoms are common but there also have been fourteen cases of nonarteritic anterior ischemic optic neuropathy (NAION) described in patients using these drugs as well as a few other vascular events. NAION is a common optic neuropathy in patients in the age group using these drugs and the question arises whether or not PDE-5 inhibitors are causing NAION. One case of NAION occurred after transient visual symptoms occurred with repeated use and one patient experienced a transient ischemic attack after taking a dose followed by a stroke on using the drug again later. Other than these two cases with strong dechallenge-rechallenge data, the evidence to support PDE-5 inhibitors as a cause of NAION or any vascular event is weak. PDE-5 inhibitors probably are a rare cause of a common ischemic disorder of the optic disc. They should be avoided in men who have already experienced NAION in one eye. Patients should be warned to seek medical attention if they have visual field or acuity loss after using PDE-5 inhibitors. Otherwise there is little basis for modifying the current guidelines for the use of these drugs.
数百万男性服用磷酸二酯酶-5（PDE-5）抑制剂西地那非（万艾可）、伐地那非（艾力达）和他达拉非（希爱力）来治疗勃起功能障碍。短暂性视觉症状很常见，但使用这些药物的患者中也有14例非动脉性前部缺血性视神经病变（NAION）的病例被描述，以及一些其他血管事件。NAION是使用这些药物的年龄组患者中常见的一种视神经病变，问题在于PDE-5抑制剂是否会导致NAION。1例NAION发生在反复使用后出现短暂性视觉症状之后，1例患者在服用一剂药物后经历了短暂性脑缺血发作，之后再次使用该药物时发生了中风。除了这两例有有力的撤药-再用药数据的病例外，支持PDE-5抑制剂是NAION或任何血管事件病因的证据很薄弱。PDE-5抑制剂可能是一种罕见的导致视盘常见缺血性疾病的病因。已经有一只眼睛发生过NAION的男性应避免使用。如果患者在使用PDE-5抑制剂后出现视野或视力丧失，应警告他们寻求医疗关注。否则，几乎没有理由修改这些药物的现行使用指南。
