Sexual Dysfunction

Question 1

What are CI/warnings with PDE-5 inhibitors?

Answer 1

CI: Do not use with nitrates and riociguat (guanylate cyclase inhibitor
Warnings:
1. Vision loss (avoid with retinal disorders)/Impaired color discrimination(dose-related)
2. Hearing loss (+/- tinnitus or dizziness)
3. Hypotension
4. Priapism (emergency if >4h)
5. If Chest Pain occurs, seek immediate medical help

Question 2

What are SEs with PDE-5 inhibitors?

Answer 2

1. Headache
2. Flushing
3. Dizziness
4. Dyspepsia
5. Back pain (mostly tadalafil)

Question 3

How are PDE-5 inhibitors dosed for ED?

Answer 3

Sildenafil: 50mg x1 ~1h before activity
Vardenafil: 10mg x1 ~1h before activity
Tadalafil: 10mg x1 ~30 min before activity; daily and on-demend dosing
Avanafil: 100mg ~15-30min before activity

Question 4

When do PDE-5 inhibitors require dose adjustment?

Answer 4

1. ≥65y
2. Using an alpha blocker
3. CYP3A4 inhibitor
4. Severe renal/liver disease
   *** Reduce dose by 50%

Question 5

What are other dosing options for tadalafil?

Answer 5

Daily dosing: 2.5-5mg QD (DO NOT use daily dosing in renal/liver impairment)
On-demand dosing: 5-20mg QD prn
***Lasts the longest, known as “weekend pill”

Question 6

What PDE-5 inhibitors do not work as well when taken with a high-fat or large meal?

Answer 6

Sildenafil and Vardenafil

Question 7

Sildenafil

Answer 7

Viagra
Revatio (PAH)

Question 8

Tadalafil

Answer 8

Cialis
Adcirca (PAH)

Question 9

Vardenafil

Answer 9

Levitra

Question 10

Avanafil

Answer 10

Stendra

Question 11

What drugs can cause sexual dysfunction?

Answer 11

1. Alcohol
2. Antidepressants (SSRI/SNRI)
3. BP (Beta-blockers, clonidine, thiazides)
4. Antipsychotics (esp 1st gen and 2nd gen that cause high prolactin)
5. BPH medications (Finasteride, dutasteride, silodosin)

Question 12

What is the MOA of alprostadil?

Answer 12

Prostaglandin E1 is a vasodilator

Question 13

What are SEs with alprostadil?

Answer 13

1. Penile pain
2. Priapism
3. headache
4. dizziness

Question 14

What are storage requirements for alprostadil (Muse) urethrial pellets?

Answer 14

Refrigerate

Question 15

What drugs are approved for hypoactive sexual desire disorder?

Answer 15

1. Flibanserin (Addyi), 5HT1A agonist and 5HT2A antagonist
2. Bremelanotide (Vyleesi)

Question 16

What are BBWs/warnings with Flibanserin (Addyi)?

Answer 16

BBW: CI with alcohol due to increased risk of severe hypotension/syncope; CI in hepatic impairment with 3A4 inhibitors
Warnings: Hypotension/Syncope, CNS depression, Avoid in pregnancy/breastfeeding
*** D/C if no benefit after 8 weeks

Question 17

What are BBWs/warnings with Bremelanotide (Vyleesi)?

Answer 17

CI: Uncontrolled HTN or known CV disease
Warnings: HTN with bradycardia; Avoid in pregnancy use effective contraception
*** D/C if no benefit after 8 weeks