Prise en charge des troubles de l’éjaculation par chlorhydrate de midodrine (Gutron®) per os. Étude rétrospective chez 16 sujets

Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

“…Consistent with these findings, the present study suggests that midodrine has side-effects that are limited to spasms and mild signs of autonomic arousal (which also appeared during PVS), and relatively few headaches or negative signs of AD. Therefore, as others suggested [7,16], midodrine might be a functional treatment for anejaculation in men with SCI because it has a rapid onset of action (within 10-30 min), because it reaches its maximum effect within 1 h, can last 3-4 h, and because it is easy to use and well tolerated by patients. Furthermore, while midodrine targets specific α -adrenergic receptors rather than the overall autonomic system, its limited side-effects might be grounded on neurophysiological substrates that contrast with the massive effects reported with anticholinesterase drugs [12][13][14][15].…”

“…ephedrine, are too powerful for fertility tests, so that current pharmacotherapy is left with a gap that might be filled with midodrine. Reports from European clinics suggest successful results in various populations [19][20][21][22][23], including men with SCI [16][17][18], in treating anejaculation, increasing the sperm count in oligospermia, and converting retrograde ejaculation into antegrade ejaculation (although with some contradictory findings). While no severe sideeffects have been reported, those reported appear limited to tingling, hot flushes and spasms [16] (at least at dosages of 5-20 mg) with small increments in BP.…”

“…Reports from European clinics suggest successful results in various populations [19][20][21][22][23], including men with SCI [16][17][18], in treating anejaculation, increasing the sperm count in oligospermia, and converting retrograde ejaculation into antegrade ejaculation (although with some contradictory findings). While no severe sideeffects have been reported, those reported appear limited to tingling, hot flushes and spasms [16] (at least at dosages of 5-20 mg) with small increments in BP. Consistent with these findings, the present study suggests that midodrine has side-effects that are limited to spasms and mild signs of autonomic arousal (which also appeared during PVS), and relatively few headaches or negative signs of AD.…”

“…As midodrine targets the sympathetic (as opposed to the entire autonomic) system [16,17], it was thought to have fewer side-effects than the previously used cholinesterase inhibitors. Furthermore, as the injected form of midodrine was previously found to be effective in treating retrograde ejaculation, oral midodrine was expected to be effective in treating both retrograde ejaculation and anejaculation in patients with SCI.…”

Le recueil de sperme chez le blessé médullaire

“…II a une AMM dans le traitement de I'hypotension neurog~ne, aux doses de 2,5-10 mg per os trois lois par jour (les formes injectables ont ~td retirees du march~, elles avaient I'AMM pour le traitement de I'an~jaculation). Son utilisation chez le bless~ m6dullaire est rest~e confidentielle, bien que son efficacit~ potentielle ait ~t~ montr~e par des etudes fran(;aises sur des s~ries limitees de patients [2,22].…”