Source: Lee M, Sharifi R. Erectile dysfunction. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146067529. Accessed March 7, 2017.
Interconnected sinuses in two corpora cavernosa in penis fill with blood to produce erection.
Acetylcholine works with other neurotransmitters (ie, cyclic guanylate monophosphate, cyclic adenosine monophosphate, and vasoactive intestinal polypeptide) to produce penile arterial vasodilation and ultimately erection.
Organic ED associated with diseases that.
Compromise vascular flow to corpora cavernosum (eg, peripheral vascular disease, arteriosclerosis, and essential hypertension)
Impair nerve conduction to brain (eg, spinal cord injury and stroke)
Impair peripheral nerve conduction (eg, diabetes mellitus)
Secondary ED associated with hypogonadism.
Psychogenic ED associated with.
Social habits (eg, cigarette smoking and excessive ethanol intake) and medications (Table 1) can also cause ED
TABLE 1.Medication Classes That Can Cause Erectile Dysfunction |Favorite Table|Download (.pdf) TABLE 1. Medication Classes That Can Cause Erectile Dysfunction
|Drug Class ||Proposed Mechanism by Which Drug Causes Erectile Dysfunction ||Special Notes |
|Anticholinergic agents (antihistamines, antiparkinsonian agents, tricyclic antidepressants, phenothiazines) ||Anticholinergic activity || |
Second-generation nonsedating antihistamines (eg, loratadine, fexofenadine, or cetirizine) associated with less erectile dysfunction than first-generation agents.
Selective serotonin reuptake inhibitor (SSRI) antidepressants cause less erectile dysfunction than tricyclic antidepressants. Of SSRIs, paroxetine, sertraline, and fluoxetine cause erectile dysfunction more commonly than venlafaxine, nefazodone, trazodone, or mirtazapine.
Phenothiazines with less anticholinergic effect (eg, chlorpromazine) can be substituted in some patients if erectile dysfunction is a problem.
|Dopamine antagonists (eg, metoclopramide, phenothiazines) ||Inhibit prolactin inhibitory factor, increasing prolactin levels. || |
|Estrogens, antiandrogens (eg, luteinizing hormone–releasing hormone superagonists, digoxin, spironolactone, ketoconazole, cimetidine) ||Suppress testosterone-mediated stimulation of libido. || |
|Central nervous system depressants (eg, barbiturates, narcotics, benzodiazepines, short-term use of large doses of alcohol, anticonvulsants) ||Suppress perception of psychogenic stimuli. || |
|Agents that decrease penile blood flow (eg, diuretics, peripheral β-adrenergic antagonists, or central sympatholytics [methyldopa, clonidine, guanethidine]) ||Reduce arteriolar flow to corpora. || |
Any diuretic that produces significant decrease in intravascular volume can decrease penile arteriolar flow.
Safer antihypertensives include angiotensin-converting enzyme inhibitors, postsynaptic α1-adrenergic antagonists (terazosin, doxazosin), calcium channel blockers, and angiotensin II receptor antagonists.
|Miscellaneous ||Unknown mechanism || |
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