Do we need to adjust the dose of PDE5 inhibitors in erectile dysfunction patients of different ages?
Li Shu 53 years old this year, with erectile dysfunction (ED), often scolded his wife for his bad behaviour, so summon up courage to look for professional consulting doctor, know with the reason of the ED, at the same time, the doctor recommended the felling that non, sildenafil, tadalafil treatment (the drugs for five binary phosphate enzyme inhibitors, also known as PDE5 inhibitors).He worried that he was older and taking these drugs would affect his body. After all, old people could not be compared with young people, but the doctor gave him a detailed answer to his doubts.So how does Li Shu use medicine correctly under the doctor’s advice?First of all, what are the causes of ED in different ages?In general, ED with the young people in addition to the injury caused by structural ED, there are many reasons and psychological factors, such as the first tension fear, or the first failure cause negative emotions such as anxiety, or put the setbacks in his career, interpersonal tensions, economic burden to the husband and wife life.For the elderly, with the increase of age, the body’s various physiological functions are gradually declining, the metabolic ability is gradually reduced;Even peripheral vascular lesions, lipid metabolism disorders, elevated blood lipids and blood viscosity, atherosclerosis, endocrine disorders, reduced testosterone levels, hyperthyroidism or hypothyroidism, long-term drug use and other factors are risk factors for ED.What are the treatments for ED?For severe ED, auxiliary devices, vacuum negative compression devices, vascular reconstruction and other surgical treatment are required.Due to the convenience and poor treatment experience of these treatments, PDE5 inhibitors are the main treatment for ED according to the treatment guidelines.Drugs include avanafil, sildenafil, tadalafil and vardenafil mentioned by Li Shu.Although the characteristics of several drugs are different, they are all targeted at pentaphosphodiesterase (PDE5). By inhibiting the activity of PDE5, the blood vessels of the cavernose are finally relaxed to complete normal physiological functions.Should dosage be adjusted for PDE5 inhibitors in different age groups?This is done on a case-by-case basis, there is no need to adjust the dose. There are 2 drugs: avanafil, tadalafil.L The efficacy and safety of avanafil, a new generation of drugs, in foreign clinical trials are generally no different from that of young patients aged ≥65 years, so there is no need to adjust the dosage of avanafil due to age.No overall differences in efficacy or safety were observed in tadalafil clinical studies, so dose adjustment for age is not required.However, it should be considered that some older individuals are more sensitive to the drug, in which case the dose should be adjusted.Need to adjust the dose of sildenafil, vardenafil.L sildenafil clearance has been reduced in healthy elderly volunteers aged ≥65 years, so it is possible to increase both efficacy and adverse events if the dose is not adjusted. The initial dose of sildenafil in older adults should start at 25mg.L reduced clearance of vardenafil was found in older patients ≥65 years and the initial dose should be adjusted to consider 5mg.Can eat PDE5 inhibitor affect the body?Talking about this problem is actually people are very concerned about the adverse reactions after taking PDE5 inhibitors.In fact, medicine is a double-edged sword, both therapeutic effect, and adverse reactions.As mentioned above, PDE5 mainly exists in smooth muscle cells of the spongy body, but it is also distributed in vascular, visceral and airway smooth muscle, skeletal muscle, platelets and other tissues. Meanwhile, PDE5 inhibitors can also inhibit its isoenzymes (such as PDE1, PDE6 and PDE2) and cause adverse reactions in multiple systems throughout the body.For example, the main adverse reactions of sildenafil were visual abnormalities, such as blue and green vision, followed by facial flushing and headache, which were significantly related to the dose. The adverse reactions of 50mg were more obvious than that of 25mg.The main adverse reactions of tadalafil were myalgia.According to hospital statistics, 20 patients (30.77%) developed muscle pain on the 24th day after the first use of tadalafil 5mg, and the pain lasted 3 to 5 days after the drug withdrawal.The new generation of avanafil has a lower incidence of adverse reactions than the previous three generations of avanafil, as shown in the following comparison chart.Sildenafil related adverse visual effects, such as headache, nasal congestion and dizziness, have not been observed with avanafil, which is also less likely to occur due to chemical changes, so it may be more tolerated by people who are concerned about adverse drug reactions.Especially some patients with coronary heart disease, diabetes, hypertension and neurasthenia of chronic diseases, such as the elderly, need long-term use of expansion blood vessel, hypoglycemic, step-down and antianxiety drugs, such as burden of itself has a variety of drugs on the liver metabolism, if you use the drug adverse reaction is bigger, so it can aggravate the burden of liver, to this,The use of avanafil with a relatively low incidence of adverse reactions is more suitable.How do I take PDE5 inhibitors?O here to cut the non for example, said before the felling that actually don’t need to adjust the dose of different ages, generally starting doses of 100 mg, according to the actual effect of medication adjust the suitable dose, need to take with a cup of water, the felling that abnormal working time for 15 minutes, after use remember the two sides should cooperate with intimacy drug will work.Conclusion: For ED patients of different ages taking PDE5 inhibitors, the dose adjustment should be based on the characteristics of the drugs. Avanafil and tadalafil do not need to be adjusted, while sildenafil and vardenafil need to be adjusted according to age.In addition to the probability of different types of adverse reactions of various drugs are not quite the same, we only master the possible adverse reactions of their drugs, so when they happen, they will not panic and have no adequate measures, and they can consult professional doctors or pharmacists when necessary.What questions do you have about PDE5 inhibitors?Feel free to leave a comment in the comments section.Reference materials: adverse reactions and preventive measures of type 5 phosphodiesterase inhibitors in the treatment of erectile dysfunction