In the treatment of ED, the concept of daily dosing or

02 Jun 2018 22:07

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Daily dosing of phosphodiesterase 5 inhibitors. One important issue is whether treatment with a different PDE5-I might salvage a patient that has failed to respond to one of the drugs in this class. Shifting patients to another phosphodiesterase 5 inhibitor.

‘High-dose' (overdosing) phosphodiesterase 5 inhibitors therapy. Furthermore, in the large trial 53 , although only hypogonadal patients were enrolled, testosterone supplementation was initiated after a Fildena-alone run-in period, at the end of which testosterone increased up to the normal range 54. Aripiprazole may improve the severity of sexual dysfunction, especially in ‘ease of sexual arousal' and ‘penile erection', by decreasing serum prolactin level because of D2 partial dopaminergic agonism 45,46 ED is common in men with hyperthyroidism and hypothyroidism 47,48 Treatment of the thyroid disorders may restore erectile function.

Prevention and treatment of ED concomitant diseases may not only improve the response to PDE5-Is but also serve to slow the progression of ED as underlying pathophysiological processes known to cause compromised erectile function are attenuated. In one unique randomized, open-label study of 60 patients with ED, one half of the participants were on PDE5-Is alone and the other half combined the drug with regular exercise for 3 months. Modification of lifestyle factors could help to improve erectile dysfunction (ED) as well as to reduce the risks of developing cardiovascular disease 16,17 It was hypothesized that lifestyle interventions improve endothelial function and nitric oxide (NO) bioavailability, and this may result in benefits on erectile function 18 These modifications may include increasing exercise, weight reduction, stopping smoking, and adherence to a Mediterranean diet.

Dosing instructions of PDE5-Is should include the time of onset, duration of efficacy, highest recommended dosage, the number of therapeutic trials, drug-drug interactions that may decrease or enhance the efficacy of the drug, and sufficient clarification of safety issues ( Table 1 ). Most patients who take PDE5-Is report that the drug takes at least 1 h to achieve the maximum effect, although the onset of effectiveness can range from 15 to 60 min 7 However, maximal efficacy of Fildena may show a broad individual range between 30 and 720 min 2 In the event that the first dose is unsuccessful, the patient must be advised to remain persistent and attempt intercourse on at least four occasions after taking the maximum dose of the PDE5-Is before aborting therapy. Re-education on the pharmacokinetic/dynamics of phosphodiesterase 5 inhibitors. It has been shown that 50% of nonresponders unaware of sexual stimulation can be converted to responders when told that the drug does not possess aphrodisiac properties and that appropriate sexual stimulation is needed 6 This should be applied to both PDE5-Is-naive patients and patients reporting oral treatment failure.

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