sildenafil-citrate and Parkinson-Disease

Erectile dysfunction (ED) is reported in a high percentage of patients with central neurological disorders (CND)..   An up-to-date review on oral phosphodiesterase 5 inhibitors (PDE5): sildenafil, tadalafil, and vardenafil for individuals with CND and ED.. Various questionnaires on ED, such as the International Index of Erectile Function composed of 15 questions.. Internationally published clinical studies evaluating the efficacy and safety of PDE5 on subjects with CND and ED were selected.. Overall, 28 articles on PDE5 used to treat patients with CND and ED were included. With each of the three PDE5 compared to placebo or erectile baseline, literature reported significant statistical improvement (P < 0.01; P < 0.05) only in patients with spinal cord injury (SCI). PDE5 efficacy was documented for SCI patients up to 10 years. The most frequent predicable factor for PDE5 success was the presence of upper motoneuron lesion. Each of the three clinical sildenafil studies documented statistically significant improvement on erectile function in Parkinson's patients (P < 0.01; P < 0.05). Two studies reported discordant results about sildenafil's effectiveness on multiple sclerosis (MS) patients; one on tadalafil showed significant statistical efficacy on erection versus baseline (P < 0.01; P < 0.05). The only spina bifida article determined that sildenafil remarkably improved erectile function. Overall, drawbacks were mostly slight-moderate, except in subjects with multiple system atrophy where sildenafil caused severe hypotension.. PDE5 represent first line ED therapy only for SCI patients, though treatment results through meta-analysis were not possible. Encouraging results are reported for Parkinson's and MS patients. PDE5 use for other CND patients is limited for various reasons, such as ED and concomitant libido impairment caused by depression and/or sexual endocrinology dysfunctions, and because PDE5 may cause a worsening of neurological illness. Medical centers staffed by health professionals able to counsel patients on the possible use of PDE5 are needed.

Topics: Carbolines; Central Nervous System Diseases; Clinical Trials as Topic; Humans; Imidazoles; Impotence, Vasculogenic; Male; Multiple Sclerosis; Parkinson Disease; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sildenafil Citrate; Spinal Dysraphism; Sulfones; Tadalafil; Treatment Outcome; Triazines; Vardenafil Dihydrochloride

Neurologic erectile dysfunction presents a diagnostic and treatment challenge to the internist and urologist. Multiple chronic disease modalities and traumatic etiologies exist. Education regarding these conditions and a detailed and thorough history and office work-up are the best resources for the clinician. Treatment can follow the model of proceeding from the least to most invasive procedure (process of care), taking into account patient and partner satisfaction. Because the psychology of grief and loss may enter into treatment of some neurologic conditions (e.g., erectile dysfunction after radical retropubic prostatectomy, spinal cord injury, or chronic diseases), a whole-patient approach encompassing psychotherapy is warranted.

Topics: Chronic Disease; Diabetic Neuropathies; Erectile Dysfunction; Humans; Intervertebral Disc Displacement; Male; Multiple Sclerosis; Parkinson Disease; Penile Prosthesis; Phosphodiesterase Inhibitors; Piperazines; Prostatectomy; Purines; Sildenafil Citrate; Spinal Cord Injuries; Sulfones

Topics: Alprostadil; Erectile Dysfunction; Humans; Male; Parkinson Disease; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Vasodilator Agents

The efficacy and safety of oral Sildenafil, a potent inhibitor of phosphodiesterase type 5, were evaluated in depressed men with idiopathic Parkinson's disease and erectile dysfunction. Thirty-three men were enrolled in a 4-month prospective, open-label, fixed-dose study, and received 50mg of Sildenafil in the home setting approximately 1 hour before sexual activity, not more than once daily. Efficacy was determined by responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) of the 15-item International Index of Erectile Function (IIEF). Other measures of efficacy included the five sexual function domains of IIEF, a global efficacy question, the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale-21 (HDRS-21).. At the end of the study, improved erections were reported by 84.8% of patients. Sildenafil significantly increased patients' ability to achieve and maintain erections. Significant improvements were also observed in the IIEF domains for erectile function, orgasmic function, intercourse satisfaction and overall sexual satisfaction. BDI and HDRS scores improved from baseline to the end of the study. A clear improvement of depressive symptoms was observed in 75% of patients. Sildenafil was well tolerated in all the patients.. Treatment with oral Sildenafil improves erectile function and, indirectly, depressive symptoms in patients with idiopathic Parkinson's disease stages 1-3, and is well tolerated.

Topics: Administration, Oral; Depression; Erectile Dysfunction; Humans; Male; Middle Aged; Parkinson Disease; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Purines; Sildenafil Citrate; Sulfones

To assess the efficacy and safety of sildenafil citrate (Viagra) in men with erectile dysfunction and parkinsonism due either to Parkinson's disease or multiple system atrophy.. Twenty four patients with erectile disease were recruited, 12 with Parkinson's disease and 12 with multiple system atrophy, into a randomised, double blind, placebo controlled, crossover study of sildenafil citrate. The starting dose was 50 mg active or placebo medication with the opportunity for dose adjustment depending on efficacy and tolerability. The international index of erectile function questionnaire (IIEF) was used to assess treatment efficacy and a quality of life questionnaire to assess the effect of treatment on sex life and whole life. Criteria for entry included a definite neurological diagnosis and a standing systolic blood pressure of 90-180 mm Hg and diastolic blood pressure of 50-110 mm Hg, on treatment if necessary. Blood pressure was taken at randomisation (visit 2) and crossover (visit 5) lying, sitting, and standing, before and 1 hour after taking the study medication in hospital.. Sidenafil citrate was efficacious in men with parkinsonism with a significant improvement, as demonstrated in questionnaire responses, in ability to achieve and maintain an erection and improvement in quality of sex life. In Parkinson's disease there was minimal change in blood pressure between active and placebo medication. In multiple system atrophy, six patients were studied before recruitment was stopped because three men showed a severe drop in blood pressure 1 hour after taking the active medication. Two were already known to have orthostatic hypotension and were receiving treatment with ephedrine and midodrine but the third had asymptomatic hypotension. However, the blood pressures in all three had been within the inclusion criterion for the study protocol. Despite a significant postural fall in blood pressure after sildenafil, all patients with multiple system atrophy reported a good erectile response and were reluctant to discontinue the medication.. Sidenafil citrate (50 mg) is efficacious in the treatment of erectile dysfunction in parkinsonism due to Parkinson's disease or multiple system atrophy; however, it may unmask or exacerbate hypotension in multiple system atrophy. As Parkinson's disease may be diagnostically difficult to distinguish from multiple system atrophy, especially in the early stages, we recommend measurement of lying and standing blood pressure before prescribing sildenafil to men with parkinsonism. Furthermore, such patients should be made aware of seeking medical advice if they develop symptoms on treatment suggestive of orthostatic hypotension.

Topics: Aged; Blood Pressure; Cross-Over Studies; Diastole; Double-Blind Method; Ephedrine; Erectile Dysfunction; Humans; Hypotension, Orthostatic; Male; Middle Aged; Midodrine; Multiple System Atrophy; Parkinson Disease; Phosphodiesterase Inhibitors; Piperazines; Purines; Quality of Life; Severity of Illness Index; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Systole; Time Factors; Treatment Outcome; Vasoconstrictor Agents

The present report describes a case of choreoathetotic movements which were most probably induced by sildenafil in a patient with Parkinson's disease (PD) treated with levodopa/carbidopa (LD/CD).. A 56-year-old retired man was admitted to hospital because of bizarre, involuntary movements and anxiety. Before admission he had taken sildenafil 100 mg. He had a previous history of PD for 5 years and during the last 3 years he was stable with long-acting LD/CD and selegiline. He is in Stage 2 according to Hoehn and Yahr Staging of PD. The patient did not have any problems with erectile function and he took sildenafil 50 minutes after the last daily dose of LD/CD. The patient was discharged from the hospital 12 hours after the admittance without any symptoms of choreoathetosis.. Choreoathetotic dyskinesia is an adverse effect which was provoked by sildenafil administration (drug abuse) in a previously stabile responder to LD therapy, but probably had a lower threshold for dyskinesia. Predisposition for this pharmacokinetic interaction could be a short time interval between LD and sildenafil applied in high dosage.

Topics: Antiparkinson Agents; Athetosis; Carbidopa; Chorea; Drug Combinations; Drug Interactions; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones

Topics: Acquired Immunodeficiency Syndrome; Circumcision, Male; Humans; Male; Parkinson Disease; Piperazines; Purines; Sildenafil Citrate; Sulfones

Topics: Antiparkinson Agents; Apomorphine; Erectile Dysfunction; Humans; Injections, Subcutaneous; Male; Multiple System Atrophy; Parkinson Disease; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones

Sildenafil citrate (Viagra) is a phosphodiesterase type V inhibitor used to treat erectile dysfunction. Ten men with idiopathic Parkinson's disease (PD) and erectile dysfunction were prescribed 50-100 mg sildenafil citrate to use in eight sexual encounters over a 2-month period. Patients underwent Unified Parkinson's Disease Rating Scale (UPDRS) evaluations and completed a Beck's Depression Inventory (BDI) and a Sexual Health Inventory-M version (SHI-M) at baseline and after 8 weeks. There was statistically significant improvement in total SHI-M scores (23.8 +/- 2.0 vs 16.6 +/- 2.8; p = 0.01), overall sexual satisfaction (p = 0.03), satisfaction with sexual desire (p = 0.04), ability to achieve erection (p = 0.02), ability to maintain erection (p = 0.03), and ability to reach orgasm (p = 0.04) with use of sildenafil citrate. UPDRS and BDI scores were not significantly changed. Side effects included headache in one patient during three sexual encounters. In this open-label study, sildenafil citrate significantly improved sexual function in men with PD and erectile dysfunction.

Topics: Aged; Dose-Response Relationship, Drug; Erectile Dysfunction; Humans; Libido; Male; Neurologic Examination; Parkinson Disease; Penile Erection; Phosphodiesterase Inhibitors; Pilot Projects; Piperazines; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome