Clinical applications of centrally acting agents in male sexual dysfunction

Abstract

Currently available agents for erectile dysfunction (ED) share the same mechanism of action and pharmacologic properties. Therefore, they share the same limitations, including a principal focus on erection as an end-organ process. One of the relatively unexplored areas of research has been the potential for centrally acting agents to improve male sexual response. A variety of neurohormones and neurotransmitter systems are involved in the male sexual response, including testosterone, dopamine, serotonin and the melanocortin systems. Investigations to determine the utility of centrally acting agents as monotherapy or adjunctive therapy in men with ED or other forms of sexual dysfunction are underway. Bremelanotide, a melanocortin agonist, has been tested in men with ED and may prove to be one of the first centrally acting agents to have clinical utility in male sexual dysfunction.

Mechanisms of Penile Erection and Basis for Pharmacological Treatment of Erectile Dysfunction

“…A wide variety of drugs has been recommended for treatment of ED, and the various options have been ERECTILE MECHANISMS AND ED TREATMENT extensively reviewed (Carson and Lue, 2005;Hatzimouratidis and Hatzichristou, 2008;Hellstrom, 2008;Dorsey et al, 2010;Eardley et al, 2010;Giovannoni et al, 2010;Hatzimouratidis et al, 2010;Albersen et al, 2011). Major advances have been made in our understanding of the mechanisms of penile erection and of drug action during the last decade.…”

Yohimbine relaxes the human corpus cavernosum through a non-adrenergic mechanism involving the activation of K+ATP-dependent channels

“…7 Another medication, bremelanotide, a melanocortin agonist of central action, seems to improve the quality of erection in male patients with erectile dysfunction. 12 The medicine commonly used for erectile dysfunction, the sildenafil, has its central effect improved when associated to yohimbine. 13 Unlike most published studies, using compromised corpus cavernosum tissues donated by penile prosthesis patients, 4,14 in this study we used samples retrieved from cadaver donors during the removal of organs for transplantation.…”

The future is today: emerging drugs for the treatment of erectile dysfunction

“…[27] The specific dopamine receptor subtype responsible for erectogenic effects is unclear. Although it was formerly believed that the effects were mediated in large part by D2 receptors, recent evidence points toward the D4 receptor subtype as a mediator for the pro-erectogenic effects of dopamine.…”