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Phosphodiesterase Inhibitor

Aka: Phosphodiesterase Inhibitor, Phosphodiesterase 5 Inhibitor, PDE5, Avanafil, Stendra
  1. Preparations
    1. All agents are very expensive (except generic Sildenafil which costs $1/pill)
    2. Sildenafil (Viagra)
    3. Vardenafil (Levitra, Staxyn)
    4. Tadalafil (Cialis)
    5. Avanafil (Stendra)
      1. Released in 2014 with similar activity as Viagra (onset in 30 minutes and duration for 5 hours)
      2. Similar Drug Interactions as for Vardenafil (Levitra, Staxyn)
  2. Indications
    1. Psychogenic Impotence
    2. Neurogenic Impotence
    3. Vasculogenic Impotence
  3. Contraindications
    1. Absolute Contraindications
      1. Men using nitrates (causes profound Hypotension)
      2. Men using alpha blockers (e.g. Hytrin for BPH)
    2. Relative Contraindications
      1. Active coronary ischemia in men not on nitrates
      2. Congestive Heart Failure
        1. Borderline low Blood Pressure
        2. Bordrline low volume status
      3. Multidrug antihypertensive regimen
      4. Taking Cytochrome P450-3A4 (CYP3A4) inhibitor
    3. Areas where PDE5 agents may be used safely
      1. Safe in stable coronary disease (no nitrates)
        1. Debusk (2004) Am J Cardiol 93:147-53 [PubMed]
  4. Mechanism
    1. Phosphodiesterase Type 5 Inhibitor
      1. Phosphodiesterase Type 5 causes Erection to subside
    2. Blocks Phosphodiesterase Type 5
      1. Results in enhanced Erection if man is aroused
      2. Unlike Alprostadil, will not cause Erection
    3. Enhances vasodilating effect of Nitrous Oxide
      1. Normally released during sexual stimulation
  5. Efficacy
    1. Benefits those with organic and psychological Impotence
    2. Initial studies showed improved Erections in 70%
    3. Over Placebo, 3.6 times more likely to improve Erection
      1. Burls (2001) Br J Gen Pract 51:1004-12 [PubMed]
  6. Drug Interactions
    1. Decreased effect (or delayed affect) after a fatty meal (esp. Sildenafil, Verdenafil)
    2. Inhibit breakdown of Viagra via Cytochrome P3A4
      1. Cimetidine (Tagamet)
      2. Ketoconazole (Nizoral)
      3. Itraconazole (Sporonox)
      4. Mibefradil (Posicor)
      5. Protease Inhibitors (Ritonavir, Indinavir, Saquinavir, Atazanavir)
      6. Macrolides (Clarithromycin, Erythromycin)
    3. Profound Vasodilitation and Hypotension (Avoid)
      1. Nitroglycerin and other Nitrates
      2. Alpha-blockers (Flomax or Tamsulosin may be used instead)
        1. Uroxatral
        2. Doxazosin
        3. Terazosin
        4. Prazosin
  7. Adverse Effects: Viagra (but most apply to the PDE5 Class as a whole)
    1. Hypotensive effect for men on Nitrates (Avoid)
    2. Vision effects
      1. Temporary color vision disturbance (6%)
        1. Blue colors may appear to be green
      2. Blurred vision or Vision Loss
        1. Higher risk if atherosclerosis
        2. Rare occurence, but can be permanent
        3. Appears to occur with Levitra and Cialis as well
    3. Mild Headache (21%)
    4. Facial Flushing (27%)
    5. Indigestion or Dyspepsia (11%)
    6. Myalgias
    7. Does not cause Priapism
    8. Sensorineural Hearing Loss
      1. Sudden onset and permanent Hearing Loss
      2. McGwin (2010) Arch Otolaryngol Head Neck Surg 136(5):488-49 [PubMed]
Medication Costs
stendra (on 9/30/2016 at Medicaid.Gov Pharmacy Drug pricing)
STENDRA 100 MG TABLET $60.23 each
STENDRA 200 MG TABLET $59.82 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Phosphodiesterase Inhibitors (C0031638)

Definition (NCI) Any substance that inhibits phosphodiesterase, an enzyme that catalyzes the breaking of a phosphodiester bond. Usually, this refers to cyclic nucleotide phosphodiesterase, an enzyme that breaks the phosphodiester bond in the second messenger molecules cAMP and cGMP. Inhibition of cyclic nucleotide phosphodiesterase can be used to affect vasodilation.
Definition (MSH) Compounds which inhibit or antagonize the biosynthesis or actions of phosphodiesterases.
Definition (CSP) any substance or agent which suppresses, prevents or opposes the actions or biosynthesis of phosphodiesterases.
Concepts Pharmacologic Substance (T121)
MSH D010726
SnomedCT 346625000, 373692009
English Antiphosphodiesterases, Phosphodiesterase Antagonists, Phosphoric Diester Hydrolase Inhibitors, PHOSPHODIESTERASE INHIB, PHOSPHORIC DIESTER HYDROLASE INHIB, PHOSPHODIESTERASE ANTAG, PDE Inhibitor, phosphodiesterase inhibitor, phosphodiesterase inhibitors, Phosphodiesterase inhibitor, Phosphodiesterase inhibitor (product), Phosphodiesterase inhibitor (substance), Phosphodiesterase Inhibitor, Phosphodiesterase Inhibitors
French Inhibiteurs de la phosphodiestérase, Antiphosphodiestérases, Anti-phosphodiestérases
Swedish Fosfodiesterashämmare
Czech sildenafil, fosfodiesteráza - inhibitory, inhibitory fosfodiesterázy, antagonisté fosfodiesterázy, fosfodiesterasa - inhibitory
Finnish Fosfodiesteraasinestäjät
Russian FOSFODIESTERAZY INGIBITORY, FOSFODIESTERAZY ANTAGONISTY, ФОСФОДИЭСТЕРАЗЫ АНТАГОНИСТЫ, ФОСФОДИЭСТЕРАЗЫ ИНГИБИТОРЫ
Japanese ホスホジエステラーゼ拮抗物質, ホスホジエステラーゼ阻害物質, ホスホジエステルヒドロラーゼ阻害剤, ホスホジエステラーゼ阻害剤
Polish Inhibitory fosfodiesterazy
Spanish inhibidor de la fosfodiesterasa (producto), inhibidor de la fosfodiesterasa (sustancia), inhibidor de la fosfodiesterasa, Antagonistas de Fosfodiesterasa, Inhibidores de Fosfodiesterasa, Inhibidores de Hidrolasa Diéster Fosforica
German Phosphodiesterase-Antagonisten, Phosphodiesteraseinhibitoren, Phosphorsäure-Diester Hydrolase Inhibitoren
Italian Inibitori della fosfodiesterasi
Portuguese Antagonistas da Fosfodiesterase, Inibidores de Fosfodiesterase, Inibidores de Fosfodiester Hidrolase
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Phosphodiesterase 5 inhibitor (C1318700)

Definition (MSH) Compounds that specifically inhibit PHOSPHODIESTERASE 5.
Concepts Pharmacologic Substance (T121)
MSH D058986
SnomedCT 407313002, 407316005
English Phosphodiesterase 5 inhibitor, PDE-V Inhibitor, Phosphodiesterase V Inhibitor, PDE5 Inhibitor, Inhibitors, PDE5, Phosphodiesterase Type 5 Inhibitors, Phosphodiesterase 5 Inhibitors, Inhibitors, PDE-5, PDE 5 Inhibitors, PDE-5 Inhibitors, Inhibitors, Phosphodiesterase 5, PDE5 Inhibitors, pde 5 inhibitor, 5 inhibitors phosphodiesterase, phosphodiesterase 5 inhibitor, PDE 5 inhibitor, Phosphodiesterase 5 inhibitor (product), Phosphodiesterase 5 inhibitor (substance)
French Inhibiteurs de la PDE-5, Inhibiteurs de la phosphodiestérase de type 5, Inhibiteurs de la phosphodiestérase-5, Inhibiteurs de la PDE5
German PDE5-Hemmer, Phosphodiesterase-5-Inhibitoren, PDE5-Inhibitoren, PDE-5-Inhibitoren, Phosphodiesterase-5-Hemmer, PDE-5-Hemmer
Czech PDE5 inhibitory, fosfodiesterasa 5 - inhibitory, fosfodiesteráza 5 - inhibitory, inhibitory fosfodiesterázy 5
Italian Inibitori della fosfodiesterasi 5
Spanish Inhibidores de Fosfodiesterasa 5, inhibidor de fosfodiesterasa 5 (producto), inhibidor de fosfodiesterasa 5 (sustancia), inhibidor de fosfodiesterasa 5
Russian ФОСФОДИЭСТЕРАЗЫ 5 ИНГИБИТОРЫ, FOSFODIESTERAZY 5 INGIBITORY
Portuguese Inibidores da Fosfodiesterase 5
Polish Inhibitory 5 fosfodiesterazy
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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