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PubMed1987

Trazodone: a 5-year review of antidepressant efficacy.

Results from double-blind studies reported since 1981 were reviewed to evaluate trazodone's relative antidepressant efficacy and its safety profile. Trazodone's therapeutic efficacy compared favorably with that of the tricyclic antidepressant (TCA) agents in both endogenous and nonendogenous patients. Data also suggested that trazodone had a more pronounced, earlier anxiolytic action than the TCA agents. Trazodone may be more effective at lower than maximal doses; some studies that used high dosages--starting at 200 mg/day and rapidly titrated doses to as high as 600 mg/day--reported poorer therapeutic responses than did those that employed more conservative dosages. Trazodone therapy generally produced less pronounced anticholinergic effects than did the comparison TCA agent and it is often as sedating as amitriptyline but more sedating than imipramine. Untoward side effects may be reduced by taking trazodone after meals, and by using bedtime dosing. Issues of possible cardiotoxicity and priapism are reviewed briefly. Overall, studies in the past 5 years point to trazodone as being an effective antidepressant agent with a relatively favorable safety profile.

Depressive Disorder↗
PubMed1989

Microsurgical arterialization for vascular impotence.

Of 400 patients with erectile lesions Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavernosometry showed a concomitant increase of venous drainage in 38 of them. Phallo-arteriography in 22 males demonstrated occlusion of the internal pudendal artery in 21 of them. In 15 patients penile arterialization was done by interposition of a saphenous vein graft between the iliac artery and deep dorsal penile vein. In 4 of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively two thirds of the patients are doing well. Failures in 5 of them included 4 diabetic neurovascular lesions and 1 postoperative priapism.

Arteriosclerosis↗
PubMed1988

Long-term results of deep dorsal penile vein transsection in venous impotence.

29 individuals with venous impotence underwent transsection of the deep dorsal penile vein, of the superficial and ectopic veins, if any. 19 patients responded initially with either spontaneous erections or increased sensitivity of the cavernous bodies to intracorporeal papaverine. 1 patient developed postoperative priapism. The majority of patients who failed to respond had major leakage into the cavernous veins or abnormal connections between the spongious and cavernous bodies. An intraoperative decrease of flow rates to induce and maintain erection was found to be indicative for response. 10 individuals developed secondary erectile dysfunction 4-24 months after the initial response. A more extensive surgical approach should be considered to improve long-term success rates.

Adult↗
PubMed1991

Comparison of the effects of papaverine versus prostaglandin E1 on penile blood flow by color duplex sonography.

To compare the effects of papaverine (60 mg) and prostaglandin E1 (20 microgram: PGE1) on penile blood flow, the vascular response detected with color duplex ultrasound scanning and the clinical response in 34 impotent men were observed and recorded after they had received an intracorporeal injection of the respective drugs on separate days. The results demonstrate that PGE1 has the advantage of a slower onset, longer maintenance, less chance of priapism and is at least as effective as papaverine in inducing an increment of penile blood flow. In conclusion, PGE1 may be a better alternative to papaverine in the diagnosis and treatment of impotence.

Alprostadil↗
PubMed1993

Is the volume injected a parameter likely to influence the erectile response observed after intracavernous administration of an alpha-blocking agent?

In 12 impotent patients with spinal cord injury, we assessed the erectile response induced by intracavernous administration of 20 mg moxisylyte dissolved in 4 different volumes of solvent. We tested successively in each patient 0.4, 0.8, 1.2 ml and the volume usually injected of 2 ml, with a 7-day interval between 2 injections. The reduction in the volume from 2 to 0.4 ml did not thwart the quality of erection obtained by the intracorporeal administration of 20 mg moxisylyte. Indeed, for each erectile parameter (rigidity, abdominopenile angle, length and circumference of the penis), no statistically significant difference arose between the 4 tests. All patients achieved full rigidity. Neither priapism nor prolonged erection occurred. These results suggest that discreet and easily handled small-sized injection pens, containing little solution, could be conceived for autoinjection therapy.

Adult↗
PubMed1990

Sexual side effects of antipsychotic medication: evaluation and interventions.

Sexual side effects of antipsychotic medications, which include disturbances of erection and ejaculation, changes in libido, and priapism in men and decreased libido, orgasmic dysfunction, and menstrual irregularities in women, are estimated to occur in 30 to 60 percent of persons taking the drugs. The authors review side effects associated with specific drugs and present guidelines for assessing whether sexual dysfunction is related to medication. Pharmacological interventions that may reduce antipsychotic-induced sexual dysfunction include gradually reducing the dose or changing the type of medication and administering other medications such as bethanechol, neostigmine, cyproheptadine, and bromocriptine that are known to improve sexual dysfunction.

Adult↗
PubMedDate not supplied

Intracavernosal papaverine and phentolamine for the medical management of erectile dysfunction in a genitourinary clinic.

A total of 160 men with erectile failure received treatment with 13,030 intracavernosal papaverine and phentolamine injections as outpatients. One-hundred-and-fifteen (72%) achieved an erection sufficient for sexual intercourse and after a mean follow-up period of 14.1 months, 55 (48%) are still attending and successfully using intracavernous therapy. Sixteen patients had a total of 22 episodes of priapism and one patient developed corporeal fibrosis. We conclude that intracavernous papaverine and phentolamine is an effective therapy for erectile failure in a genitourinary clinic.

Adult↗
PubMed1991

Urinary retention--an unusual dystonic reaction to continuous metoclopramide infusion.

Vomiting is one of the most distressing adverse effects of cancer chemotherapy. Metoclopramide by continuous infusion (400 micrograms/kg/h after a loading dose of 2.5 mg/kg) is a novel administration method for optimizing efficacy. A two-year-old boy developed urinary retention on three occasions, once accompanied by priapism and slurred speech, while receiving a continuous infusion. This was reversed by procyclidine, suggesting that it may have been a dystonic reaction.

Child, Preschool↗
PubMed1996

Nefazodone: its place among antidepressants.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, adverse effects, and drug interactions of nefazodone as well as to determine its place among currently available antidepressants. DATA SOURCES: A search of European and American literature using EMBASE and MEDLINE was completed. Nefazodone was the search term. DATA SYNTHESIS: Nefazodone is an antidepressant that blocks serotonin type 2 (5-HT2) receptors in addition to inhibiting the reuptake of serotonin and norepinephrine. In double-blind, placebo-controlled studies, nefazodone demonstrates antidepressant activity at dosages ranging from 400 to 600 mg/d. Sedation, dry mouth, nausea, and dizziness are the more common adverse effects of nefazodone. Nefazodone, an analog of trazodone, has not been associated with priapism at this time, and may have fewer sexual adverse effects than other antidepressants. More studies are needed to determine the potential role of nefazodone in treating anxiety, pain, and premenstrual syndrome. STUDY SELECTION: Only double-blind, placebo-controlled studies designed to establish the efficacy of nefazodone as an antidepressant were reviewed. CONCLUSIONS: Based on placebo-controlled, double-blind, comparative trials, nefazodone demonstrates greater efficacy than placebo, and equivalent efficacy to imipramine. Somnolence, dry mouth, nausea, dizziness, and constipation are the most common adverse effects. Nefazodone appears to have a milder adverse effect profile than the tricyclic antidepressants, causes fewer sexual dysfunctions than the serotonin selective reuptake inhibitors, and may cause less dizziness than trazodone. Nefazodone at dosages of at least 300 mg/d provides another option for the treatment of depression.

Antidepressive Agents, Second-Generation↗
PubMed1999

Clinical aspects of heparin-induced thrombocytopenia and thrombosis and other side effects of heparin therapy.

Heparin, first used to prevent the clotting of blood in vitro, has been clinically used to treat thrombosis for more than 50 years. Although several new anticoagulant drugs are in development, heparin remains the anticoagulant of choice to treat acute thrombotic episodes. The clinical effects of heparin are meritorious, but side effects do exist. Bleeding is the primary untoward effect of heparin. Major bleeding is of primary concern in patients receiving heparin therapy. However, additional important untoward effects of heparin therapy include heparin-induced thrombocytopenia, heparin-associated osteoporosis, eosinophilia, skin reactions, allergic reactions other than thrombocytopenia, alopecia, transaminasemia, hyperkalemia, hypoaldosteronism, and priapism. These side effects are relatively rare in a given individual, but given the extremely widespread use of heparin, some are quite common, particularly HITT and osteoporosis. Although reasonable incidences of many of these side effects can be "softly" deduced from current reports dealing with unfractionated heparin, at present the incidences of these side effects with newer low molecular weight heparins appear to be much less common. However, only longer experience will more clearly define the incidence of each side effect with low molecular weight preparations.

Anaphylaxis↗
PubMedDate not supplied

Clinical safety profile of sildenafil in Singaporean men with erectile dysfunction: pre-marketing experience (ASSESS-I evaluation).

Safety and tolerability of sildenafil citrate was assessed in a population subset of 60 Singaporean men with erectile dysfunction taken from the Asian Sildenafil Efficacy and Safety Study (ASSESS-I), a double-blind, placebo-controlled, flexible-dose study. The men, from two centres, with > or = 6 months' history of erectile dysfunction, were randomized to two treatment arms for 12 weeks. One group (30 patients) received sildenafil (initial dose 50 mg taken 1 h before sexual activity for the first 2 weeks, increased to 100 mg or decreased to 25 mg, according to efficacy and/or tolerability). The remaining 30 patients received a matching placebo. Incidence and type of adverse effects were evaluated at 2, 4, 8 and 12 weeks. Nine patients (30.0%) on sildenafil (33.1% in the full ASSESS-I study) and one patient (3.3%) on placebo (22.8% in the full ASSESS-I study) experienced treatment-related adverse events, the most frequent being headache in the sildenafil group (reported by five patients [16.7%]; 11.0% in the full ASSESS-I study). Flushing, visual disturbance, dizziness, insomnia, myalgia and back pain each occurred in one patient in the sildenafil group (3.3%); in the placebo group, one patient (3.3%) had headache. Importantly, the incidence of cardiovascular and respiratory system adverse events were relatively less than in the full ASSESS-I population (cardiovascular 3.3% in the present study versus 10.2% in the full ASSESS-I population; respiratory 3.3% versus 5.5%). All adverse events were transient and mild, and did not lead to treatment withdrawal. There was no effect on sitting blood pressure, heart rate or standard laboratory parameters; more importantly, there was no incidence of myocardial infarction, stroke or priapism. These results should reassure Singaporean patients and their physicians of the safety of sildenafil for erectile dysfunction.

Adult↗
PubMed2005

An evidence-based approach to the treatment of adults with sickle cell disease.

The application of evidence-based medicine to the management of adults with sickle cell disease (SCD) is currently primarily driven by clinical expertise and patient preference, as there is a paucity of randomized controlled trial (RCT) data to guide decision-making. A summary of SCD management principles in the areas of health care maintenance, transfusion therapy, treatment and prevention of painful episodes, acute chest syndrome, stroke, renal disease, contraception and pregnancy, and priapism is predominantly based on the authors' interpretation of available observational studies as well as the opinions of experts in SCD. RCTs impacting current practices address use of hydroxyurea to prevent painful episodes and acute chest syndrome, intensity of pre-operative transfusion, transfusion during pregnancy, and angiotensin-converting enzyme inhibitor therapy for proteinuria, but most issues in adult SCD care have not been rigorously studied and management may not be appropriately extrapolated from pediatric data. While challenging clinical problems need to be addressed by RCTs, there is also the need for development of practice guidelines using formal methodological strategies. This brief review is not a substitute for the process but provides a literature-based approach to making treatment decisions when caring for adults with SCD.

Adult↗
PubMed1999

Prospective pilot study of sildenafil for treatment of postradiotherapy erectile dysfunction in patients with prostate cancer.

PURPOSE: Erectile dysfunction is a common late complication patients may experience after external-beam radiotherapy for prostate cancer. The efficacy and safety of oral sildenafil to correct sexual dysfunction caused by external-beam radiotherapy was studied in patients participating in our prospective trial. PATIENTS AND METHODS: Thirty-five assessable patients participated in this prospective pilot study. Using a 25-point scale based on the International Index of Sexual Function, erectile dysfunction was assessed weekly, during which time patients received sildenafil 100 mg orally once a week for 6 consecutive weeks. Response was defined as a score of 18 or more, corresponding to at least one successful attempt at sexual intercourse per week. RESULTS: Thirty patients (86%) completed the 6-week study. Seventy-seven percent of these patients had significantly improved erectile function, allowing recovery of full capacity for sexual intercourse. Of 27 patients not receiving concomitant hormone treatment, failure to respond was observed in only four patients (15%) compared with four (50%) of eight patients receiving hormonal treatment during the study. The time course of response was gradual, with 40%, 57%, 66%, 69%, and 74% responding at weeks 1 through 5, respectively. Therapy was generally well tolerated. The most frequently reported side effects in patients were flushing (37%), transient headache (17%), and dyspepsia (9%). No patient reported priapism, and no cardiovascular event or death was observed. After response, 12 patients (34%) reported the ability to achieve and maintain an erection sufficient for intercourse in the absence of sildenafil (ie, 24 hours to 6 days after taking the medication). CONCLUSION: This study suggests that oral sildenafil is well tolerated and can reverse erectile dysfunction after radiotherapy in a substantial proportion of prostate cancer patients.

Adult↗
PubMed2004

Randomized, crossover comparison study of the short-term effect of oral testosterone undecanoate and intramuscular testosterone depot on linear growth and serum bone alkaline phosphatase.

AIM: To compare the effects of oral testosterone undecanoate (TU) 40 mg daily and intramuscular depot sustanon 50 (SUS), 4 weekly, on short-term growth and bone turnover. METHOD: Prospective, randomised, cross-over study over 26 weeks with 4 weeks of run-in, 8 weeks of treatment I (TU/SUS), 4 weeks of wash-out, 8 weeks of treatment II (SUS/TU) and 4 weeks of final wash-out. MAIN OUTCOME MEASURES: Weekly change in lower leg length (LLL) as measured by knemometry, i.e. LLL velocity (LLLV) and absolute bone alkaline phosphatase levels (bALP), as well as percentage change in bALP (%bALP). PATIENTS: Fourteen boys with delayed growth and puberty; two declined and one boy with sickle cell trait dropped out with priapism a week after SUS. The remainder had a median age of 14.3 years (range 12.5-17.4), testicular volume of 2 ml each (2-6), HtSDS of -2.1 (-3.3 to -1.0) and BA delay of 2.4 years (0.7-4.4). RESULTS: Median LLLV in the treatment blocks was 0.7 mm/wk (-0.27 to 2.2) and LLLV during the run-in and wash-out periods was 0.27 mm/wk (-0.3 to 0.6) (p <0.005). LLLV during treatment with TU and SUS was 0.51 mm/wk (-0.22 to 2.17) and 0.67 mm/wk (-0.27 to 2.2), respectively (NS). Median LLLV during the washout phases that followed the TU block and the SUS block was similar at 0.28 mm/wk (-0.1 to 0.6) and 0.3 mm/wk (-0.2 to 0.6), respectively. LLLV peaks and troughs that were related to the timing of the injection were more evident during SUS therapy. Median bALP during the run-in period was 94.2 U/l (16-282) and the median %bALP during this period was 1.2% (-57, 16). The main rise in bALP occurred during the treatment blocks with a %bALP of 19.3% (-28.8, 121.7) (p <0.005). Median bALP at the beginning and end of the SUS block was 99.7 U/l (51.7, 225) and 170 U/l (64.8, 273), respectively (p <0.05). Median bALP at the beginning and end of the TU block was 111 U/l (51, 287) and 127.6 U/l (66.4, 298) (NS). Median %bALP during SUS was higher than during TU at 28.1% (4.4, 121.7) and 11.8% (-28.8, 83.6) (p = 0.07). CONCLUSION: At the doses studied, testosterone undecanoate was as effective as sustanon at promoting short-term growth but changes in bone alkaline phosphatase were more marked during sustanon therapy.

Administration, Oral↗
PubMed2006

Nitric oxide/redox-based signalling as a therapeutic target for penile disorders.

Oxidative and/or nitrosative stress is implicated in the pathogeneses of assorted penile disorders of clinical significance, notably erectile dysfunction, priapism and penile fibrosis. It is becoming increasingly recognised that the generation and activity of reactive oxygen and nitrogen species in the penis influence vascular homeostasis of this organ, with adverse effects exerted at cellular and molecular levels. Furthermore, these elements may interact with molecular signalling pathways operating in the penis, modulating their functional roles. This interaction in particular suggests that by accessing molecular targets associated with oxidative/nitrosative stress in the penis, new pharmacotherapeutic approaches may be developed to promote normal erectile ability and preserve erectile tissue health. This notion pertains to, but also extends beyond, interventions which predictably target components of the nitric oxide-based signal transduction pathway for the on-demand treatment of erectile dysfunction. The next line of pharmaceuticals for disorders of the penis, in general, may well spawn from an integrative understanding of the complex regulatory interactions influenced by, as well as influencing nitric oxide signalling in this organ.

Animals↗
PubMed2006

Treatment of erectile dysfunction in multiple sclerosis.

Erectile dysfunction in men with multiple sclerosis (MS) is a very common symptom that often leads to a reduced quality of life. It is related to neurological dysfunction, psychological factors, side effects of medication or generalized MS symptoms, such as fatigue or micturition problems, usually in combination. The question of sexual dysfunction should always be broached during routine follow-up, regardless of age and social status. The possibility that erection problems can be a side-effect of drugs commonly used in MS must also be remembered. There are several effective pharmacological treatments, such as phosphodiesterase inhibitors and prostaglandin E(1) (alprostadil). The contraindications and side effects should be familiar to the MS doctor. Dose titration in the initial stages is recommended to avoid priapism. In the future, combinations of impotence drugs may be tested.

Alprostadil↗
PubMedDate not supplied

Renal involvement in human rabies: clinical manifestations and autopsy findings of nine cases from northeast of Brazil.

A retrospective study was conducted in nine patients with rabies admitted to a hospital of Fortaleza, Brazil. Autopsy was performed in all cases. The ages ranged from three to 81 years and six were males. They all were bitten by dogs. The time between the accident and the hospital admission ranged from 20 to 120 days (mean 45 +/- 34 days). The time until death ranged from one to nine days (mean 3.3 +/- 5.5 days). The signs and symptoms presented were fever, hydrophobia, aerophobia, agitation, disorientation, dyspnea, sialorrhea, vomiting, oliguria, sore throat, pain and hypoesthesia in the site of the bite, headache, syncope, cough, hematemesis, mydriasis, hematuria, constipation, cervical pain and priapism. In three out of six patients, there was evidence of acute renal failure, defined as serum creatinine > or = 1.4 mg/dL. The post-mortem findings in the kidneys were mild to moderate glomerular congestion and mild to intense peritubular capillary congestion. Acute tubular necrosis was seen in only two cases. This study shows some evidence of renal involvement in rabies. Histopathologic findings are nonspecific, so hemodynamic instability, caused by autonomic dysfunction, hydrophobia and dehydration must be responsible for acute renal failure in rabies.

Acute Kidney Injury↗
PubMed2005

[Ketogenic diet for intractable epilepsy in children and adolescents: report of six cases].

BACKGROUND: This study aims to report on use of the ketogenic diet in a group of six children and adolescents with intractable epilepsy. METHODS: Authors reviewed the medical records of every patient under 15 years of age who received the ketogenic diet between April 1999 and July 2003. A comparison is made between treatment results, adverse events and beneficial effects with the pertinent medical literature. RESULTS: The ketogenic diet was administered to six patients, whose median age was 7.0 years (range, 1.8-12.2). Average duration of diet application was of 9.7 months (range, 7 days-4 years). A reduction equal to or greater than 50% in seizure frequency was observed in half of the cases. Complications included neutropenia, constipation, dehydration, priapism, and seizure recurrence. CONCLUSIONS: The ketogenic diet was effective and safe in three out of six patients with intractable epilepsy. Neutropenia was the most common complication.

Age of Onset↗