Medical Treatment of Erectile Dysfunction: Too Many Medical Prescriptions?

Abstract

Erectile dysfunction (ED) is a worldwide commonly reported condition; epidemiological data showed a prevalence ranging from 2.3 to 53.4% within different population subsets. In this context, the advent of phosphodiesterase type 5 inhibitors (PDE5is) in the second mid of 1990s has deeply changed the treatment scenario of this bothersome condition. Being user-friendly compounds with an excellent overall safety profile, PDE5is emerged as the first-line treatment for ED, thus overcoming topical alprostadil and intracavernous injections (ICIs). However, available data on treatment-utilization patterns and medical prescriptions of PDE5is showed a range of as wide as 22-78% of patients reporting to purchase PDE5is even without a proper medical prescription. Moreover, an increase in the recreational use of PDE5is among young men has been observed in the last decades, with a worrisome diffusion of potential health-risky behaviours associated with this habit. Indeed, treatment of ED should carefully follow internationally based clinical guidelines to avoid inappropriate drug prescriptions, which may eventually expose treated patients to drug-related side effects. Thereof, a careful assessment of the so-called modifiable and reversible ED risk factors along with a patient-tailored screening for potential contraindications to the treatment itself should be performed in every case. Lastly, although conclusive data still lack, the potential association between life-risky PDE5is side effects (i.e. cardiovascular adverse events, melanoma skin cancer and worsening of prostate cancer outcomes) should be carefully taken into account when counselling patients for ED treatment.

Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions

“…First and foremost, the largest health threats come from the use of wrong dosages of the intended drug − either too low to be effective, or at excessively high and possibly toxic levels, with large variations in drug contents. 6,59,67,125,129 The risk of overdosage of the medication is also possible for products with low content of the API, as consumers might be taking more than one tablet to achieve the desired effect. 6,18 However, in order to generate revenue and refrain the buyer to search for more efficacious products, counterfeiters are generally likely to use include the main API or similar active ingredients, or, as reported below, to add other APIs aiming to increase the efficacy.…”

“…7 Counterfeit products are often produced in poor quality laboratories, resulting in the presence of residual solvents and contaminants in the finished product. 6,45,62,125,128,129 An analysis of counterfeited or illegal PDE5i collected between 2005 and 2011 in Italy reported that excipients were different than expected from a genuine product in 80% of analyzed samples, with presence of potentially toxic compounds in 17% of tablets. 19 These substances include ethanol, acetone, tetrachloromethane and dicloromethane 63 as well as paints and printer inks, 8 potentially harmful to the consumers as well as to the environment.…”

“…112,121 First and foremost, as previously reported, the high success of the genuine drugs made them quite recognized even to the general population and widely adopted worldwide. 116,121,129 ED is a frequent complaint in aging men, 158 and it is largely expected that many elderly people would look for treatment in order to improve their sexual health; however, there is compelling evidence that some individuals would take such drugs for recreational purposes in the absence of medical suggestion, even among younger men. 129,136,[159][160][161][162] Considering the social stigma for ED, it is unsurprising that many subjects would prefer buying online, in full anonymity, rather than buying in person 18,65,117,129 : indeed, PDE5i have the highest prevalence among drugs bought through the internet, 8,125,129 and younger subjects are indeed those who buy drugs online more frequently.…”