Table 1.
Pharmacotherapeutics for Erectile Dysfunction
| Route of | ||||
|---|---|---|---|---|
| Therapeutic | Trade Name | Target | Mode of Action | Administration |
| Alprostadil | Caverject (Pharmacia, Kalamazoo, MI) | EP receptors, HCCSM | Increase cAMP, | IC, IU, |
| Edex (Schwarz Pharma, Milwaukee, WI) | SM relaxation | oral, topical | ||
| MUSE (Vivus Inc, Mountain View, CA) | ||||
| VIP + phentolamine | Invicorp* (Senetek PLC, Napa, CA) | VIP receptor agonist | Increase cAMP, | IC |
| Alpha-adrenergic | Prevents nor- | |||
| blocker | epinephrine | |||
| SM contraction | ||||
| Forskolin | - | Direct activator | Increase cAMP | IC† |
| adenylate cyclase | ||||
| Nitroglycerine | - | NO donor | Increase cGMP | Topical |
| Minoxidil | - | NO donor | Increase cGMP | Topical |
| Papaverine | - | PDE inhibitor, | Increase cAMP? | IC, topical |
| Antispasmodic | cGMP? | |||
| Milrinone | - | PDE-3 inhibitor | Increase cAMP | IC‡ |
| Sildenafil | Viagra (Pfizer Inc, New York, NY) | PDE-5 inhibitor | Increase cGMP | Oral |
| Vardenafil | Levitra (Bayer Pharmaceuticals Corp, | PDE-5 inhibitor | Increase cGMP | Oral |
| West Haven, CT) | ||||
| Tadalafil | Cialis (Lilly ICOS LLC, Indianapolis, IN) | PDE-5 inhibitor | Increase cGMP | Oral |
| Phentolamine | Regitine* (Novartis Pharmaceuticals, | Alpha-adrenergic | Prevents nor- | Oral, IC |
| Corp, East Hanover, NJ) | blocker | epinephrine | ||
| Vasomax† (Schering-Plough, | SM contraction | |||
| Kenilworth, NJ) | ||||
| Prazosin | Minipress* (Pfizer Inc, New York, NY) | Alpha-adrenergic | Prevents nor- | IC |
| blocker | epinephrine | |||
| SM contraction | ||||
| Chloropromazine | - | Alpha-adrenergic | Prevents nor- | IC |
| blocker | epinephrine | |||
| SM contraction | ||||
| Yohimbine | Yocon* (Glenwood LLC, Englewood, NJ) | Alpha2-adrenergic | CNS | Oral |
| blocker | ||||
| Trazadone | Desyrel* (Bristol-Myers Squibb Co, | Alpha2-adrenergic | CNS | Oral |
| New York, NY) | blocker | Prevents nor- | ||
| 5-HT1C agonist | epinephrine | |||
| SM contraction | ||||
| Apomorphine | Spontane* (TAP Pharmaceuticals, | Dopaminergic | CNS effects | Oral (SL) |
| Lake Forest, IL) | agonist |
*
Not yet approved for erectile dysfunction by the Food and Drug Administration.
†
Experimental use only.
‡
Experimental use only in Germany.
cAMP, 3′5′-cyclic adenosine monophosphate; cGMP, 3′5′-cyclic guanosine monophosphate; CNS, central nervous system; HCCSM, human corpus cavernosum smooth muscle; 5-HT1c, 5-hydroxytryptamine (serotonin); IC, intracavernosal; IU, intraurethral; PDE, phosphodiesterase; SL, sublingual; SM, smooth muscle; VIP, vasoactive intestinal peptide. Modified and reprinted from Nehra A et al23 with permission from Mayo Clinic Proceedings.