Oral phosphodiesterase type 5 inhibitors and male reproductive potential: an overview

Abstract

Background Phosphodiesterase type 5 inhibitors (PDE5Is), due to their efficacy and tolerable profile for more than 2 decades,are considered a good addition to the available treatments in patients with erectile dysfunction (ED). Aim We sought to assess the possible influence of oral PDE5Is on male human reproduction. Methods A literature review was performed in several databases, including the PubMed/Medline database, Scopus, Cochrane Library, EMBASE, Academic Search Complete, and Egyptian Knowledge Bank databases. The keywords/search terms were “PDE5Is,” “sildenafil,” “vardenafil,” “tadalafil,” or “avanafil,” combining and crossing them with “male infertility,” “semen,” “reproductive hormones,” or “sperm.” Results Overall, 101 articles were selected. After removal of duplicates and animal studies, 75 articles were finally subjected to review covering the different items related to male human reproduction, including effects of PDE5Is on different parameters of semen or reproductive hormones, as uses of PDE5Is in cases related to distinctive male factor infertility, such as ED, temporary ED, or ejaculatory failure alongside assisted reproduction (AR) procedures, and ejaculatory dysfunction in spinal cord lesions. We found 26 articles that addressed the direct effects of PDE5Is on semen and reproductive hormonal profiles, 16 in vivo studies and 10 in vitro studies. Oral PDE5Is have in general a stimulatory effect on sperm motility, while other semen parameters and reproductive hormonal profiles showed varied outcomes. Such effects are more pronounced with a long-term daily regimen than with an on-demand regimen. However, it seems that the best-controlled studies suggested no change in the sperm quality of male reproductive potential. Conclusion Oral PDE5Is have in general stimulatory effects on sperm motility, while other semen parameters and hormone profiles showed varied results. In addition, oral PDE5Is have played a useful role in conditions related to distinctive male factor infertility, such as ED, temporary ED, ejaculatory failure alongside AR, and ejaculatory dysfunction in spinal cord lesions.

A novel standard‐free detection of adulteration method for sildenafil derivatives in dietary supplements

“…Sildenafil (Viagra ® , Pfizer) was the first oral prescription drug for male erectile dysfunction approved by The US Food and Drug Administration in 1998 and has always been in short supply in the drug market (Goldstein et al, 1998;Gresser & Gleiter, 2002). Sildenafil is a synthetic phosphodiesterase type 5 enzyme (PDE-5) inhibitor, and the representative drugs also include tadalafil, vardenafil and avanafil (Madeira et al, 2021;Mostafa et al, 2023;Pyrgidis et al, 2021). To pursue drug effects unilaterally and obtain huge profits, some sexual enhancement dietary supplements, mainly available in online markets, have been adulterated with these PDE-5 inhibitors by aphrodisiac dealers (De ger & Madendere, 2021;Langarizadeh et al, 2023;Madeira et al, 2021;Mostafa & Alghobary, 2022).…”