digoxin and Erectile-Dysfunction

Chronic heart failure (HF) is an increasingly common cardiovascular disorder. The goal of health-care providers is to optimize quality of life in this population, including sexual health. Up to 75% of patients with HF report erectile dysfunction (ED). As HF is a condition with distinct physiologic sequelae, some unique organic and psychological factors contributing to ED in this patient population have been identified, along with risk factors common to the development of coronary artery disease, HF and ED. This review describes contributing factors to ED in the setting of HF and highlights treatment considerations for this distinct patient population.

Topics: Adrenergic beta-Antagonists; Angioplasty, Balloon; Depression; Digoxin; Diuretics; Endothelium, Vascular; Erectile Dysfunction; Exercise; Heart Failure; Humans; Male; Piperazines; Purines; Sexual Behavior; Sildenafil Citrate; Sulfones

Digoxin use has long been recognized to affect adversely male sexual function but the underlying mechanism is poorly understood. Digoxin is a known inhibitor of sodium/potassium adenosine triphosphatase (sodium pump), a plasma membrane enzyme that has a role in the regulation of smooth muscle tone. We investigated the effects of digoxin on human corpus cavernosum smooth muscle contractility and overall erectile function.. In human corporeal smooth muscle strips the in vitro effects of digoxin were assessed on sodium pump activity as measured by digoxin inhibitable uptake of 86rubidium, basal tone and endothelium dependent, neurogenic and nitric oxide donor induced relaxation. An in vivo prospective double-blind, placebo controlled, crossover, 4-period investigation was performed in 6 healthy male volunteers. The effects of digoxin on serum hormones, erectile function questionnaire, visual sexual stimulation and nocturnal penile tumescence were recorded.. In vitro digoxin caused concentration dependent inhibition of 86rubidium uptake (half maximum effect at 0.01 microM.) and contraction of corporeal smooth muscle (half maximum effect at 0.8 microM.). Therapeutic concentrations of digoxin (2 nM.) also inhibited relaxation induced by acetylcholine and electrical field stimulation, which release nitric oxide from corpus cavernosum endothelial cells and nonadrenergic noncholinergic nerves, respectively. In vivo digoxin diminished penile rigidity during visual sexual stimulation and nocturnal penile tumescence testing compared to placebo without influencing libido or serum testosterone, estrogen or luteinizing hormone levels.. Digoxin associated alteration of human erectile function may be explained, in part, by inhibition of corporeal smooth muscle sodium pump activity, which promotes contraction and impedes nitric oxide induced relaxation. Such findings suggest therapeutic use of digoxin for treatment of recurrent priapism states.

Topics: Adenosine Triphosphate; Adult; Cardiotonic Agents; Digoxin; Erectile Dysfunction; Humans; In Vitro Techniques; Male; Middle Aged; Muscle Contraction; Muscle, Smooth, Vascular; Penile Erection; Sodium-Potassium-Exchanging ATPase

Various data suggest that male patients who have received digoxin on a longterm basis have increased levels of serum estrogen and decreased levels of plasma testosterone and luteinizing hormone (LH). This study was undertaken to investigate the links between the long-term administration of digoxin therapy and sexual behavior, and the effect of digoxin on plasma levels of estradiol, testosterone, and LH. The patients of the study and control group (without digoxin) were of similar cardiac functional capacity and age (25-40 years) and were randomly selected from the rheumatic heart disease patients. A subjective assessment of sexual behavior in the study and control groups was carried out, using parameters such as sexual desire, sexual excitement, and frequency of sexual relations. Personal interviews and a questionnaire were also used for the evaluation of sexual behavior. The findings support the reports concerning digoxin effect on plasma estradiol, testosterone, and LH. The differences in the means were significant. Tests used to evaluate the changes in sexual behavior showed a significant decrease in sexual desire, sexual excitement phase (erection), and frequency of sexual relations in the study group.

Topics: Adult; Digoxin; Erectile Dysfunction; Estradiol; Humans; Libido; Luteinizing Hormone; Male; Testosterone

D.G. was a 59-year-old male patient who was retired and married, and had 3 children. He reported no psychopathology prior to a myocardial infarction he had in 1996. Following bypass surgery he had erectile dysfunction. Subsequently, gynecomastia developed as a side effect of spironolactone and digoxin treatment. After a long period of depression he claimed was caused by non-adaptation to the changes in his body, he realized differences about himself; he began to feel like a woman. Upon referral to our clinic, he said that he had decided to continue his life as a woman and wished to get pink colored (as opposed to blue for male) identity card issued by the Turkish Government for female Turkish citizens. He reported that his wish was to learn how to become a woman. This is the first case in the medical literature defined as sexual identity disorder secondary to a general medical condition. The case is discussed in terms of pathological grief reaction.

Topics: Bereavement; Depression; Digoxin; Erectile Dysfunction; Female; Gender Identity; Gynecomastia; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Myocardial Infarction; Spironolactone

The effect of long-term administration of digoxin on sexual dysfunction was investigated in correlation to plasma androgens level. The patients of the experimental (digoxin-treated) and control (without digoxin) groups were of similar cardiac functional capacity and age (25-40 years) and were randomly selected from the rheumatic heart disease patients. A subjective assessment of sexual behavior was carried out, using parameters such as sexual desire, sexual excitement, and frequency of sexual relations. Personal interviews and questionnaires were also used for the evaluation of sexual behavior. The findings support various reports concerning digoxin effect on plasma levels of testosterone (the difference in the mean was significant). The effect on plasma levels of androstenedione and dehydroepiandrosterone in the experimental group as compared to the control group were not significant. Tests used to evaluate the changes in sexual behavior, showed a significant decrease in sexual desire, sexual excitement phase (erection) and frequency of sexual relations in the digoxin-treated group.

Topics: Adult; Androgens; Androstenedione; Dehydroepiandrosterone; Digoxin; Erectile Dysfunction; Humans; Libido; Male; Middle Aged; Sexual Dysfunction, Physiological; Testosterone

Topics: Adult; Aged; Digoxin; Drug Therapy, Combination; Erectile Dysfunction; Heart Diseases; Humans; Male; Middle Aged; Verapamil