An update on the drug safety of treating erectile dysfunction

ABSTRACT

Introduction: Treatment options for erectile dysfunction (ED) have evolved over the last two decades, particularly after the introduction of phosphodiesterase type-5 inhibitors (PDE5Is). The path, however, has not been straightforward with issues raised regarding safety and toxicity following ED treatments.

Areas covered: A literature review was conducted on current evidence related to the safety of PDE5Is, intracavernosal injections and various older forms of oral therapies. Relevant trials were identified through a literature search of PubMed from 1980 to 2019.

Expert opinion: PDE5Is are now recommended as the first line therapy for the treatment of ED due to their efficacy and tolerable side effects. Comparison of the various PDE5Is on safety has not been supported by prime evidence, and consequently, the negative aspects of each inhibitor appear the same as defined in the literature. Other means of therapies for ED are still in the running, and these also present a different range of side effects. While intracavernosal injections have potential to cause priapism and penile fibrosis, intraurethral alprostadil may result in more systematic side effects. Alternative topical ED therapies are generally limited with their local side effects

KEYWORDS:

• Adverse effects
• alprostadil
• erectile dysfunction
• phosphodiesterase type 5 inhibitors
• prostaglandin E1
• safety

Article highlights

• PDE5Is have mild side effects in nature and are well-tolerated treatments for patients with ED.

• There is a gap in the literature showing direct comparative trials of various PDE5Is and their safety aspects.

• Intracavernosal therapy is linked to prolonged erection and penile fibrosis.

• Greater systematic adverse reactions are observed using intraurethral alprostadil treatment compared to intracavernosal alprostadil treatment.

• There are limited data regarding the adverse reactions of topical alprostadil therapy.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.