Non-classical effects of sildenafil in clinical medicine: an interdisciplinary approach

Abstract

Based on the results of modern clinical and experimental studies, the review article discusses issues of pharmacotherapeutic feasibility, pathogenetic validity and safety of the first and most studied phosphodiesterase type 5 inhibitor – sildenafil – in general clinical practice according to «non-classical» (non-erectogenic) indications in the framework of an interdisciplinary approach modern medicine. As it is known, at present, phosphodiesterase type 5 inhibitors are both the «first line» therapy for treating erectile dysfunction (as monotherapy), as well as an effective option for monotherapy or combined pharmacotherapy of lower urinary tract symptoms on the background of benign prostatic hyperplasia in men with erectile dysfunction. However, given the universality and fundamentality of the mechanisms of their pharmacological action (first of all, the effect on the metabolism of one of the key vasomodulators of the vascular bed, nitric oxide NO), the list of potential and promising indications for prescribing these drugs is constantly expanding due to the presence of various «non-classical» (non-erectogenic) effects, which makes them very attractive for wider application not only in urological practice, but also in other medical specialties. The article describes in more detail and purposefully the accumulated to date scientific and practical data on the effectiveness of the use and potential mechanisms of action of sildenafil in cardiology, endocrinology, neurology, nephrology, obstetrics and gynecology, andrological reproductology and oncology, and also presents the results of studies confirming its safety in the treatment of relevant specialized diseases.