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阳痿治疗的耐受性和疗效的比较
Modern pharmacological treatment of impotence is determined by the
presenting symptoms. Since this involves symptomatology with a heterogenous
aetiology, many different drugs are involved in the treatment of impotence.
Drugs used for libido and arousal problems include testosterone, yohimbine,
trazodone and apomorphine. Since patient self-assessment is the only
parameter that can be used to measure the result of treatment and
positive results are seldom affirmed, no positive benefit of these
agents can be assumed at present. Oral medications for erectile dysfunction
include yohimbine, trazodone, apomorphine, phentolamine, arginine
and sildenafil. Of these drugs, sildenafil has been the most systematically
studied for effectiveness, but long term safety data await the results
of post-marketing surveillance. Of the ejaculation disorder therapies,
treatments for premature ejaculation are the best studied. Favourable
results have been obtained with clomipramine, paroxetine and fluoxetine.
The safety of these medications has been assessed through their long
term use in psychiatry. Intracavernous self-injections for erectile
disorders are performed using a variety of drugs and drug mixtures.
Only alprostadil and the combination of papaverine with phentolamine
are widely used. Alprostadil is very well tolerated; however, penile
pain is a serious problem in a significant proportion of patients.
Papaverine in combination with phentolamine is effective, but penile
fibrosis and priapism occur more often than with the use of alprostadil.
Several new developments in this area are currently under way. Alternative
routes for medication for erectile dysfunction include ointments and
patches to the penile skin and the glans. Only transurethral alprostadil,
'MUSE' (medicated urethral system for erection) has been shown to
be effective in large trials. Long term safety still has to be demonstrated,
but the 1-year safety profile is encouraging. In general, the end
points of impotence treatment studies are very diverse so efficacy
data can only be assessed in comparative studies. However, long term
comparison studies have not been performed. Safety demands must be
set very high for this type of treatment since the disorders being
treated present no threat to the patient's health.
【引自Drug Saf 1999 Feb;20(2):133-46】 |
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