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Zirak MR, Rahimian R, Mousavizadeh K, Dehpour AR. Mechanisms underlie the proconvulsant effects of sildenafil. Biomed Pharmacother 2020; 134:111142. [PMID: 33360157 DOI: 10.1016/j.biopha.2020.111142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mohammad Reza Zirak
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Rahimian
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
| | - Kazem Mousavizadeh
- Cellular and Molecular Research Center and Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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2
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Moussa M, Papatsoris AG, Abou Chakra M, Dabboucy B, Fares Y. Erectile dysfunction in common neurological conditions: A narrative review. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348971 DOI: 10.4081/aiua.2020.4.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022]
Abstract
Neurogenic erectile dysfunction (NED) can be defined as the inability to achieve or maintain an erection due to central or peripheral neurologic disease. Neurologic diseases can also affect the physical ability and psychological status of the patient. All these factors may lead to a primary or secondary NED. Medication history plays an important role since there are many drugs commonly used in neurologic patients that can lead to ED. The assessment of NED in these patients is generally evolving with the application of evoked potentials technology in the test of somatic and autonomic nerves, and functional magnetic resonance imaging. With the electrophysiological examinations, neurogenic causes can be determined. These tools allow to categorize neurologic lesion and assess the patient prognosis. The first-line treatment for NED is phosphodiesterase inhibitors. Second-line treatments include intracavernous and intraurethral vasoactive injections. Third-line treatments are penile prostheses. The efficacy and safety of each treatment modality depend on the specific neurologic condition. This review discusses the physiology, pathophysiology, diagnosis, and treatment of ED in multiple peripheral and central neurologic conditions, as well as for future research.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Beirut.
| | - Athanasios G Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens.
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut.
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de Carvalho MAJ, Chaves-Filho A, de Souza AG, de Carvalho Lima CN, de Lima KA, Rios Vasconcelos ER, Feitosa ML, Souza Oliveira JV, de Souza DAA, Macedo DS, de Souza FCF, de França Fonteles MM. Proconvulsant effects of sildenafil citrate on pilocarpine-induced seizures: Involvement of cholinergic, nitrergic and pro-oxidant mechanisms. Brain Res Bull 2019; 149:60-74. [PMID: 31004733 DOI: 10.1016/j.brainresbull.2019.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 03/26/2019] [Accepted: 04/09/2019] [Indexed: 12/12/2022]
Abstract
Sildenafil is a phosphodiesterase 5 inhibitor used for the treatment of erectile dysfunction and pulmonary hypertension. Proconvulsant effect is a serious adverse event associated with sildenafil use. Here, we investigated the possible proconvulsant effects of sildenafil in pilocarpine (PILO)-induced seizures model, which mimics some aspects of temporal lobe epilepsy. We also evaluated sildenafil's effects on hippocampal markers related to PILO-induced seizure, for instance, acetylcholinesterase (AChE) activity, oxidative stress and nitric oxide (NO) markers, namely nitrite, inducible NO synthase (iNOS) and neuronal NOS (nNOS). The influences of muscarinic receptors blockade on sildenafil proconvulsant effects and brain nitrite levels were also evaluated. Male mice were submitted to single or repeated (7 days) sildenafil administration (2.5, 5, 10 and 20 mg/kg). Thirty minutes later, PILO was injected and mice were further evaluated for 1 h for seizure activity. Sildenafil induced a dose- and time-progressive proconvulsant effect in PILO-induced seizures. Sildenafil also potentiated the inhibitory effect of PILO in AChE activity and induced a further increase in nitrite levels and pro-oxidative markers, mainly in the hippocampus. Repeated sildenafil treatment also increased the hippocampal expression of iNOS and nNOS isoforms, while the blockade of muscarinic receptors attenuated both sildenafil-induced proconvulsant effect and brain nitrite changes. Our data firstly demonstrated the proconvulsant effect of sildenafil in PILO-model of seizures. This effect seems to be related to an increased cholinergic-nitrergic tone and pro-oxidative brain changes. Also, our findings advert to caution in using sildenafil for patients suffering from neurological conditions that reduces seizure threshold, such as epilepsy.
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Affiliation(s)
- Michele Albuquerque Jales de Carvalho
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Adriano Chaves-Filho
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Alana Gomes de Souza
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Camila Nayane de Carvalho Lima
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Klistenes Alves de Lima
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Emiliano Ricardo Rios Vasconcelos
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Mariana Lima Feitosa
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - João Victor Souza Oliveira
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Denia Alves Albuquerque de Souza
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Danielle S Macedo
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil; National Institute for Translational Medicine (INCT-TM, CNPq), Ribeirão Preto, Brazil
| | - Francisca Cléa Florenço de Souza
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Marta Maria de França Fonteles
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Department of Physiology and Pharmacology, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Pharmacy Department, Faculty of Dentistry, Nursing and Pharmacy, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
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Effect of Tadalafil on Seizure Threshold and Activity of Antiepileptic Drugs in Three Acute Seizure Tests in Mice. Neurotox Res 2018; 34:333-346. [PMID: 29427285 PMCID: PMC6154210 DOI: 10.1007/s12640-018-9876-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 01/09/2023]
Abstract
Tadalafil, a selective phosphodiesterase type 5 inhibitor, is a long-acting oral agent for the treatment of erectile dysfunction of multiple etiologies. Although generalized tonic-clonic seizures were reported in a healthy man after taking tadalafil, the influence of tadalafil on seizure susceptibility has not been studied so far. Therefore, the aim of the present study was to investigate the effect of tadalafil on seizure threshold as well as on the activity of some first- and second-generation antiepileptic drugs in three acute seizure tests in mice. The obtained results showed that tadalafil, at the highest dose tested (20 mg/kg), significantly decreased the threshold for the first myoclonic twitch in the intravenous pentylenetetrazole (i.v. PTZ) seizure test. It did not affect the threshold for generalized clonic seizure and forelimb tonus in the i.v. PTZ, for tonic hindlimb extension in the maximal electroshock seizure threshold test, and for psychomotor seizure in the 6-Hz-induced seizure threshold test. Tadalafil did not alter the anticonvulsant activity of any of the studied antiepileptic drugs in electrically induced seizure tests. Interestingly, tadalafil potentiated the anticonvulsant activity of clonazepam and decreased the anticonvulsant activity of oxcarbazepine in the i.v. PTZ test. These interactions were pharmacodynamic in nature, as tadalafil did not alter clonazepam and oxcarbazepine concentrations both in serum and brain tissue. Furthermore, neither tadalafil alone nor its combinations with the studied antiepileptic drugs produced any significant impairment of motor coordination (assessed in the chimney test), muscular strength (investigated in the grip-strength test), and long-term memory (assessed in the passive avoidance task). In conclusion, tadalafil may increase the risk of myoclonic seizure and decrease the anticonvulsant efficacy of oxcarbazepine. Further studies are warranted to evaluate the safety of tadalafil usage in patients with epilepsy.
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Shridharani AN, Brant WO. The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol 2016; 5:88-101. [PMID: 26904415 PMCID: PMC4739980 DOI: 10.3978/j.issn.2223-4683.2016.01.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Erectile dysfunction (ED) related to compromise of the nervous system is an increasingly common occurrence. This may be due to the multifactorial nature of ED, the myriad of disorders affecting the neurotransmission of erectogenic signals, and improved awareness and diagnosis of ED. Nevertheless, neurogenic ED remains poorly understood and characterized. Disease related factors such as depression, decreased physical and mental function, the burden of chronic illness, and loss of independence may preclude sexual intimacy and lead to ED as well. The amount of data regarding treatment options in subpopulations of differing neurologic disorders remains scarce except for men with spinal cord injury. The treatment options including phosphodiesterase inhibitors, intracavernosal or intraurethral vasoactive agents, vacuum erection devices (VED) and penile prosthetic implantation remain constant. This review discusses the options in specific neurologic conditions, and briefly provides insight into new and future developments that may reshape the management of neurogenic ED.
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Affiliation(s)
- Anand N Shridharani
- 1 Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA ; 2 Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - William O Brant
- 1 Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA ; 2 Division of Urology, University of Utah, Salt Lake City, Utah, USA
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Nieoczym D, Socała K, Jedziniak P, Olejnik M, Wlaź P. Effect of sildenafil, a selective phosphodiesterase 5 inhibitor, on the anticonvulsant action of some antiepileptic drugs in the mouse 6-Hz psychomotor seizure model. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:104-10. [PMID: 23994662 DOI: 10.1016/j.pnpbp.2013.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/07/2013] [Accepted: 08/20/2013] [Indexed: 01/06/2023]
Abstract
Sildenafil, a selective phosphodiesterase 5 inhibitor (PDE5), has been recently reported to have both pro- and anticonvulsant action in various experimental models of seizures and epilepsy. Furthermore, it affects anticonvulsant action of some antiepileptic drugs (AEDs) in mice seizure tests and both pharmacodynamic and pharmacokinetic interactions were noted. The present study was carried out to investigate influence of sildenafil on the threshold for 6 Hz-induced psychomotor seizures in mice. Effect of sildenafil on activity of some AEDs, i.e., phenobarbital (PB), clonazepam (CZP), ethosuximide (ETS), valproic acid (VPA), tiagabine (TGB), oxcarbazepine (OXC) and levetiracetam (LEV), in 6 Hz test was also examined. Moreover, combination of sildenafil with LEV was investigated in terms of influence on motor coordination (determined by the chimney test), muscular strength (evaluated in the grip-strength test) and long-term memory (assessed in the passive avoidance task) in mice. To determine the type of pharmacological interaction between sildenafil and LEV, free plasma and total brain concentrations of this AED were determined by LC-MS/MS method. Sildenafil at a dose ranging from 10 to 40 mg/kg statistically increased psychomotor seizure threshold in mice. Moreover, sildenafil enhanced the anticonvulsant action of all the studied AEDs in this test. Interactions between this PDE5 inhibitor and PB, CZP, ETS, TGB and OXC seem to be pharmacodynamic. Since sildenafil increased free plasma and total brain concentration of LEV, interactions between these drugs have pharmacokinetic nature. This kind of interaction was also noted between sildenafil and VPA. Neither LEV (2.32 mg/kg) nor its co-administration with sildenafil (40 mg/kg) produced any significant changes in motor coordination, muscular strength and long-term memory in mice.
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Affiliation(s)
- Dorota Nieoczym
- Department of Animal Physiology, Institute of Biology and Biochemistry, Maria Curie-Skłodowska University, Lublin, Poland
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Matos G, Hirotsu C, Alvarenga TA, Cintra F, Bittencourt L, Tufik S, Andersen ML. The association between TNF-α and erectile dysfunction complaints. Andrology 2013; 1:872-8. [DOI: 10.1111/j.2047-2927.2013.00136.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 01/10/2023]
Affiliation(s)
- G. Matos
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - C. Hirotsu
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - T. A. Alvarenga
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - F. Cintra
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - L. Bittencourt
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - S. Tufik
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - M. L. Andersen
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
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