Sapienza University of Rome, Endocrinology and Food and Science Section, Rome, Italy.
Expert Opin Pharmacother. 2013 Jul;14(10):1333-44. doi: 10.1517/14656566.2013.799665. Epub 2013 May 16.
Phosphodiesterase type 5 inhibitors (PDE5-i) are used for the oral treatment of erectile dysfunction (ED). Since the launch of sildenafil more than 15 years ago, new molecules have become available. At present, in addition to tadalafil and vardenafil, there are three other drugs, udenafil, avanafil and mirodenafil, marketed in some countries which appear to be promising.
The clinical pharmacological differences in dosage and side effects of all PDE5-i are evaluated.
All PDE5-i are equally effective and safe for the treatment of ED. On-demand use of any PDE5-i is also safe for patients with comorbid conditions. Tadalafil seems to be the preferred drug by patients and physicians, probably due to its peculiar pharmacological profile that makes sexual intercourse more spontaneous for the patients. Preliminary data suggest that the use of vardenafil may also be beneficial in cases of ED associated with premature ejaculation. Daily treatment is another option in men with ED and documented vascular or prostate disease. In geriatric or in difficult-to-treat populations, the evaluation of testosterone plasma levels will help to predict the efficacy of any PDE5-i. Remarkably, when such drugs are withdrawn for any reason, ED most often continues to occur because of the presence of an underlying disease.
磷酸二酯酶 5 抑制剂（PDE5-i）被用于口服治疗勃起功能障碍（ED）。自 15 多年前西地那非上市以来，已有新的分子问世。目前，除了他达拉非和伐地那非外，还有另外三种药物，乌地那非、阿伐那非和米罗那非，在一些国家上市，似乎很有前途。
评估了所有 PDE5-i 的剂量和副作用的临床药理学差异。
所有 PDE5-i 对于治疗 ED 都是同样有效和安全的。按需使用任何 PDE5-i 对合并症患者也是安全的。他达拉非似乎是患者和医生更喜欢的药物，可能是因为它独特的药理学特性使患者的性生活更加自然。初步数据表明，在与早泄相关的 ED 病例中，使用伐地那非也可能有益。对于有血管或前列腺疾病的 ED 男性，每日治疗是另一种选择。在老年或难以治疗的人群中，评估血浆睾酮水平将有助于预测任何 PDE5-i 的疗效。值得注意的是，由于存在潜在疾病，当因任何原因停止使用这些药物时，ED 通常会继续发生。
