Individual Agents

The pharmacological agents useful in this disorder may be grouped under five broad categories of treatment (Table 64.2). Such a classification system takes into account the mode of drug action, the route of administration, and the means by which target organ selectivity is achieved.

Oral medication for treatment of ED is relatively new. Earlier measures often employed the intracaver-

TABLE 64.2 Classification by Mode of Action for Treatments of Erectile Dysfunction

Class Name Definition

I Central initiator Compounds that have the main site of action in the CNS to activate neural events that result in coordinated signaling that results in the initiation of a penile erection (e.g. apomorphine)

II Peripheral initiator Compounds that have the main site of action in the periphery to activate events that result in a penile erection (e.g. PGEj)

III Central conditioner Compounds that act mainly to improve the internal milieu of the CNS so that pe nile erection is enabled or enhanced, they do not on their own initiate an erection (e.g. trazodone)

IV Peripheral conditioner (local or systemic) Compounds that act mainly to improve the local or systemic internal milieu so that penile erection is enabled or enhanced (e.g. sildenafil)

V Other Other ways of promoting penile rigidity including devices and surgery (e.g. pros-


Reprinted with permission from Heaton JP, Adams MA, and Morales A. A therapeutic taxonomy of treatment for erectile dysfunction: An evolutional imperative. Int J Impot Res 1997;9:115-121. Dept of Urology, Queen's University, Kingston, Ontario.

nosal injection of a vasoactive agent or a systemic mode of drug administration. Local injections or dermal applications were frequently required for satisfactory pharmacological actions upon the vascular smooth muscles of the penis. Compounds with relatively short duration of action were found to be less than satisfactory in maintaining penile erections.

Combinations of drugs have sometimes been used to take advantage of the differing onset and duration of action of the individual compounds. A rapid onset of action and a sufficient duration are important characteristics of drugs used in the treatment of ED. Vasoactive agents that are orally effective have been available for about 20 years, but sildenafil and apomorphine (buccal) have significantly improved upon the therapeutic efficacy of orally active agents.

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