Avanafil (Stendra) for the treatment of erectile dysfunction
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madman
Super Moderator
Tadalafil: 15 years' journey in male erectile dysfunction and beyond
Abstract Tadalafil, Cialis, Eli Lilly & Co./ICOS, (6R,12aR)-6-(1,3-benzodioxol-5-yl)-2-methyl-2,3,6,7,12,12ahexahydropyrazino[10,20:1,6] pyrido[3,4-b]indole-1,4-dione, was first discovered in 2003. It was reported to have high diastereospecificity for phosphodiesterase 5 (PDE5) inhibitions...
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Pharmacodynamics of the agents used for the treatment of erectile dysfunction
ABSTRACT Introduction: Erectile dysfunction (ED) is one of the most common complaints encountered by the practicing urologist, particularly when treating older men. The last 20 years have represented a pivotal time in the treatment of ED. Areas covered: Several pharmacologic agents have been...
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Two Birds with One Stone: Regular Use of PDE5 Inhibitors for Treating Male Patients with ED and CVD
Abstract Patients with cardiovascular disease (CVD) frequently have erectile dysfunction (ED) because the two conditions have similar risk factors and potential mechanisms. The therapeutic effect of CVD is strongly dependent upon long-term management of the condition. Patients with CVD tend to...
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THE SCIENCE AND PRACTICE OF ERECTION PHYSIOLOGY: STORY OF A REVOLUTIONARY GASEOUS MOLECULE
THE SCIENCE AND PRACTICE OF ERECTION PHYSIOLOGY: STORY OF A REVOLUTIONARY GASEOUS MOLECULE Abstract The field of sexual medicine, in reference to the science of the sexual response and the clinical management of sexual dysfunctions, has evolved remarkably in the last 25 years. Erection...
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TESTOSTERONE POSITIVELY REGULATES FUNCTIONAL RESPONSES AND NITRIC OXIDE EXPRESSION IN THE ISOLATED HUMAN CORPUS CAVERNOSUM
ABSTRACT Background: Testosterone (T) deficiency is associated with erectile dysfunction (ED). The relaxant response of T on the corporal smooth muscle through a non-genomic pathway has been reported; however, the in vitro modulating effects of T on human corpus cavernosum (HCC) has not been...
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Hypertension and erectile dysfunction: breaking down the challenges
Abstract A diagnostic of hypertension increases the risk of erectile dysfunction (ED); likewise, ED can be an early sign of hypertension. In both cases, there is evidence that endothelial dysfunction is a common link between the two conditions. During hypertension, the sustained and widespread...
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Advantages of PDE5i in the Management of Glucose Metabolism Disorders
Advantages of Phosphodiesterase Type 5 Inhibitors in the Management of Glucose Metabolism Disorders: A Clinical and Translational Issue Among metabolic diseases, carbohydrate metabolism disorders are the most widespread. The most common glucose pathological conditions are acquired and may...
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The Use of Vasoactive Drugs in the Treatment of ED
Abstract: It is widely accepted that disorders of the male (uro) genital tract, such as erectile dysfunction (ED) and benign diseases of the prostate (lower urinary tract symptomatology or benign prostatic hyperplasia), can be approached therapeutically by influencing the function of both the...
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Practical Approaches to Treat ED in PDE5i Nonresponders
ABSTRACT: Erectile dysfunction (ED) is a common sexual disorder in adult males and one of the most important factors affecting their quality of life and that of their partners. Although PDE5 inhibitors (PDE5is) are the first choice for improving erectile function, there is a substantial...
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Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED
Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED A. Sebastianelli & P. Spatafora & S. Morselli & L. Vignozzi & S. Serni & K. T. McVary & S. Kaplan & S. Gravas & C. Chapple & Mauro Gacci Abstract Purpose of Review Aim of our systematic review is to...
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Sildenafil microemulsion-loaded hydrogels for TDS directly to the penis
Abstract: Sildenafil citrate is used to treat mild to moderate erectile dysfunction and premature ejaculation. However, it has low oral bioavailability, numerous adverse effects, and delayed onset of action. These problems may be resolved by transdermal delivery to the penis. Hence, sildenafil...
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Beyond ED: Emerging indications of sildenafil
Sildenafil Beyond Erectile Dysfunction and Pulmonary Arterial Hypertension: Thinking About New Indications Moein Ala, Razieh Mohammad Jafari, Ahmad Reza Dehpour ABSTRACT Sildenafil, approved two decades ago, is the inhibitor of Phosphodiesterase 5 (PDE5). First of all, it was designated...
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Age related ED: How to Prevent it and Manage it
Looking at some of the more recent studies it has been stated that: *No evidence has emerged concerning the development of any form of dependence or tolerance with the chronic use of PDE5 inhibitors. Aging-related erectile dysfunction—a potential mechanism to halt or delay its onset Monica...
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Efficacy of TRT plus alternate-day tadalafil for patients with LOH
Efficacy of testosterone replacement therapy plus alternate-day tadalafil for patients with late-onset hypogonadism: An open-label, a randomized, crossover study Objective: To examine the efficacy and safety of combination treatment with testosterone replacement therapy plus alternate-day...
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superior efficacy of tamsulosin + PDE5i in treating BPH-related LUTS and ED
Efficacy and Safety of Combination Comprising Tamsulosin and PDE5-Is, Relative to Monotherapies, in Treating Lower Urinary Tract Symptoms and Erectile Dysfunction Associated With Benign Prostatic Hyperplasia: A Meta-Analysis Abstract We report the safety and efficacy of combination therapy...
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PDE5i: Structure-function regulation and therapeutic applications of inhibitors
Phosphodiesterase 5 (PDE5): Structure-function regulation and therapeutic applications of inhibitors ABSTRACT Phosphodiesterase 5 (PDE5) is one of the most well-studied phosphodiesterases (PDEs) that specifically targets cGMP typically generated by nitric oxide (NO)-mediated activation of the...
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Combination Therapies for ED
We believe that combination therapy with dual short- and long-acting PDE5 inhibitors may have an additive effect and should be considered, even as a first-line initial strategy in cases of more advanced ED. Tadalafil with its longer half-life, ability to be absorbed with a high-fat meal, and...
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Medicinal plants as a potential source of PDE5i
Ethnopharmacological relevance: The prevalence and distress caused by erectile dysfunction (ED) to both male and female partners are increasing at a steady rate. ED has now become the most treated sexual disorder for men among young and old age groups due to varying physical and psychological...
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Hypertension and erectile dysfunction: breaking down the challenges
Abstract A diagnostic of hypertension increases the risk of erectile dysfunction (ED); likewise, ED can be an early sign of hypertension. In both cases, there is evidence that endothelial dysfunction is a common link between the two conditions. During hypertension, the sustained and widespread...
www.excelmale.com
Erectile Dysfunction ED Drugs Have a Protective Effect on Kidneys and the Heart
Abstract The kidneys are vital organs that play an important role in removing waste materials from the blood, electrolyte balance, blood pressure regulation, and red blood cell genesis. Kidney disease can be caused by various factors, including diabetes, ischemia/reperfusion injury, and...
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An Overview of NO Signaling Pathways in Aging
Abstract Nitric Oxide (NO) is a potent signaling molecule involved in the regulation of various cellular mechanisms and pathways under normal and pathological conditions. NO production, its effects, and its efficacy are extremely sensitive to aging-related changes in the cells. Herein, we...
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Advances in Nanoparticle Delivery System for ED
ABSTRACT Introduction: The use of currently available treatment for male erectile dysfunction (ED) has some limitations that are related to efficacy and adverse effects. Nanotechnology has been used as a new tool in medicine to improve these limitations and new medications potentially to...
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ED Drugs May Help Metabolism and Fat Loss
Abstract The cyclic guanosine monophosphate (cGMP) signaling system is one of the most prominent regulators of many physiopathological processes in humans and rodents. It has been strongly established as an accomplished cellular signal involved in the regulation of energy homeostasis and cell...
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PDE5 Inhibitors for Erectile Dysfunction Treatment
Mohit Khera, MD, MBA, MPH, joins the Erectile Dysfunction Radio Podcast to discuss the use of PDE5 inhibitors for treating erectile dysfunction this week. PDE5 inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are often prescribed to treat erectile dysfunction...
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Speaking of Erectile Dysfunction
Erectile dysfunction affects nearly 30 million men in the United States and is often caused by an underlying medical condition that must be diagnosed and treated. In fact, ED can be a warning sign of something more serious. Join us for a candid discussion on the causes, diagnosis, and...
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The 4 Pillars of Men's Health and expectations on male sexuality
The 4 Pillars of Men's Health and expectations on male sexuality with Dr. Mohit Khera 4 PILLARS OF HEALTH: LIFESTYLE MODIFICATION (diet, exercise, sleep, stress reduction) 4:28-4:50 4:50-6:20 (ED) “I'm a big proponent of daily Cialis.....because every day it puts blood and oxygen into the...
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Physiology of Erection and Erectile Dysfunction
Physiology of Erection and Pathophysiology of Erectile Dysfunction (2021) Susan M MacDonald, Arthur L Burnett INTRODUCTION The complex pathway from sexual arousal to penile erection has been elucidated in great detail. Advances in neuroimaging have delineated the cortical and limbic system...
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Comparison of genuine, generic, and counterfeit Cialis tablets
Comparison of genuine, generic, and counterfeit Cialis tablets using vibrational spectroscopy and statistical methods (2021) Dita Spálovská, Tomáš Pekárekb, Martin Kuchař ,Vladimír Setnička Abstract The dubious online market in phosphodiesterase type 5 inhibitors is growing on a global...
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Testosterone and male sexual function
Androgens and male sexual function (2022) Giovanni Corona, MD, Ph.D., Consultant Endocrinologist, Giulia Rastrelli, MD, Ph.D., Associate professor of Endocrinology, Linda Vignozzi, MD, Ph.D., Associate professor of Endocrinology, Mario Maggi, MD, Ph.D., Full professor of Endocrinology Sexual...
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Testosterone Therapy and ED
Testosterone replacement therapy and erectile dysfunction (2021) Ifeanyi C. Onyeji and Raul I. Clavijo Testosterone (T) deficiency and erectile dysfunction (ED) are independently functionally and socially impairing, and their concurrence in men can be challenging to treat. Successful...
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Targeting of PDE5 for Preservation of Penile Health
Molecular Pharmacotherapeutic Review Targeting of PDE5 for Preservation of Penile Health (2008) ARTHUR L. BURNETT ABSTRACT The molecular science of erection physiology has established that phosphodiesterase 5 (PDE5) serves an important biological role in the penis. Current research in the...
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Get Hard -Treating Erectile Dysfunction
On episode 20, the Man Up podcast welcomes Dr. Mohit Khera, professor at the Baylor School of Medicine. Dr. Khera is a sexual medicine expert and will answer all the questions you had about erectile dysfunction treatments. What are ED treatments? What lifestyle changes can you make to...
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Viagra's impact on the treatment/management of ED
https://www.urologytimes.com/view/dr-burnett-on-viagra-this-transformed-the-field-in-a-significant-way Urology Times® is celebrating its 50th anniversary in 2022. To mark the occasion, we are highlighting 50 of the top innovations and developments that have transformed the field of urology...
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It's time to talk about erectile dysfunction
It’s not a topic most men want to discuss, yet an open conversation is the first step to finding a solution for erectile dysfunction. No two men are alike and treatment depends on the cause of the problem. Don’t let erectile dysfunction affect your confidence and intimacy any longer. Hear from...
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madman
Super Moderator
Q&A - The Past,Present & Future of Erectile Dysfunction
1. so it was just interesting to know that uric acid or hyper gout is a risk factor for erectile dysfunction, so would you recommend screening for hyperuricemia for any patient visiting with erectile dysfunction?
2. what is the recommended startup dose for Avanafil? Would you start the patient with 200 mg right away or you will just startup with a 100 mg if failed and after how many trials will you go for 200 mg? Is the 50 mg daily something recommended or not?
1. we have a big population now of patients of the first-generation PDE5 that they are doing very well whether they are taking Tadalafil or Vardenafil, do you think that we should suggest for them to switch if they are doing well on their medication or to stick to what's working?
2. we all know from all data that erectile dysfunction is a window on a patient heart that you have to check him for diabetes, high uric acid, and triglycerides but also there is a lot of data that correcting high uric acid or correcting high triglyceride is better for the patient but does not affect his sexual dysfunction so correcting these comorbidities is good for the patient but does not reflect on the sexual part he still needs the medication for that, do you have any data opposite to this?
1. I want to ask about the physiological or cellular cause between HDL and testosterone, why do we get this testosterone with the HDL, what is the actual physiological event happening?
2. Can we combine PDE5 inhibitors with ICI prostaglandin just to give a more potent erection
1. How do the second-generation PDE5 inhibitors differ from the first generation?
2. Is there a role for Avanafil and treating LUTS symptoms like Tadalafil?
1. On a real-life daily basis how would we perfectly recommend the usage of Avanafil for the daily use or OND use and for combinations and even salvaging non-responders in your daily practice?
2. In your presentation in the comparison between step two and step three in the meta-analysis regarding the efficacy of 100 and 200 mg of Avanafil the step two odds ratio is lower than the step three which is unlogic?
1. How to counsel the patient about drugs and about food interaction, alcohol interaction things like that?
2. Avanafil has been here for 10-12 years, why it's so late to come on I mean internationally it was not very well represented in the major meetings, can you give us a backstage story about why Avanafil is a late boomer?
1. Sometimes we get the patients who have a blown picture of hypogonadism, he's weak he has poor libido his muscle is weak his mood is not right he's not responding well to PDE5 and you check his testosterone and it is low normal it is still within the normal limit but clinically he's manifesting with hypogonadism, do you treat these patients even though they have normal testosterone/low testosterone or do you wait?
1. What will you do for a patient with the refractory hypogonadism not responding even to injectable testosterone, from time to time we face something like this cases, and whatever you do testosterone is still low patient is symptomatic even with injectables what will you do?
2. Can Avanafil be used as a salvage therapy as a second generation for patients who failed the first generation?
1. Would you prefer to use a direct testosterone shot or use the aromatase inhibitor to raise the endogenous testosterone?
1. In the slides you mentioned you said that about 8-10 years tolerance may occur to the first generation of PDE5 inhibitors, what are the current criteria of the patient that can tolerate Avanafil?
2. Can we switch between the first and second generation if there are no response to things?
1. Is there any benefit from Avanafil in the cardiac patient who is on nitrate or is it safe?
1. Is it effective in venous leakage?
madman
Super Moderator
Giovanni Corona
*ESSENTIALLY TESTOSTERONE IS THE GASOLINE IS THE FUEL OF THE MACHINE WITHOUT TESTOSTERONE THERE IS NO PDE5 AND PDE5 OUTCOMES ARE WORSE
* PROBABLY THE BETTER PDE5 ENZYME SELECTIVITY IS THE MOST IMPORTANT ADVANTAGE OF THIS KIND OF DRUG OF AVANAFIL SO BY BEING MORE SELECTIVE FOR PDE5 IS ABLE TO GIVE A RAPID ONSET OF THE ACTION WITH THE LOWEST INCIDENCE OF SIDE EFFECTS
* 8-10 YEARS TOLERANCE MAY OCCUR TO THE FIRST-GENERATION PDE5 INHIBITORS
*IN MY MIND THE VENOUS LEAK IS MORE RELATED TO ENDOTHELIAL DYSFUNCTION OF THE CORPORA CAVERNOSA MAINLY BECAUSE YOU KNOW THE VAST MAJORITY OF THE SURGICAL OUTCOMES WERE NEGATIVE FOR VENOUS LEAKAGE
*ESSENTIALLY TESTOSTERONE IS THE GASOLINE IS THE FUEL OF THE MACHINE WITHOUT TESTOSTERONE THERE IS NO PDE5 AND PDE5 OUTCOMES ARE WORSE
* PROBABLY THE BETTER PDE5 ENZYME SELECTIVITY IS THE MOST IMPORTANT ADVANTAGE OF THIS KIND OF DRUG OF AVANAFIL SO BY BEING MORE SELECTIVE FOR PDE5 IS ABLE TO GIVE A RAPID ONSET OF THE ACTION WITH THE LOWEST INCIDENCE OF SIDE EFFECTS
* 8-10 YEARS TOLERANCE MAY OCCUR TO THE FIRST-GENERATION PDE5 INHIBITORS
*IN MY MIND THE VENOUS LEAK IS MORE RELATED TO ENDOTHELIAL DYSFUNCTION OF THE CORPORA CAVERNOSA MAINLY BECAUSE YOU KNOW THE VAST MAJORITY OF THE SURGICAL OUTCOMES WERE NEGATIVE FOR VENOUS LEAKAGE
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