ED drugs and systemic health: Could these medications offer broader benefits?
Industry Buzz
I don't think the research is at the point right now where I would recommend that people prophylactically take these drugs with the intention of [getting] cardiovascular benefits.
—Alan Shindel, MD
At this time, more research is needed to support the use of daily Cialis for major adverse cardiovascular events (MACE) prevention.
—Tony Chen, MD
Medications sometimes outgrow their original purpose.
Researchers are now exploring whether some erectile dysfunction (ED) medications may help with other conditions like stroke, diabetes, and an enlarged prostate.
Research published in the World Journal of Men’s Health suggests medications like Viagra may not only help with erectile dysfunction, but also other issues commonly affecting men with prostate cancer.[]
“The available evidence base is encouraging bearing in mind the potentially pleiotropic effects of PDE5i [phosphodiesterase 5 inhibitors] and could be particularly relevant in the case of prostate cancer patients,” the study authors write.[]
“The evidence base suggests that PDE5i could potentially co-treat several comorbidities in men treated for [prostate cancer] in addition to ED, provided high-quality randomised controlled trials replicate and confirm the findings of observational studies and animal models. If validated, PDE5i may be prescribed in appropriately selected patients and exert its beneficial effects in these men post [prostate cancer] treatment, not only improving health outcomes but also quality of life,” the study authors note.[]
PDE5 inhibitors: Improved conditions?
The researchers examined evidence from a number of studies published on PDE5 inhibitors (PDE5i).
They found improvements in a variety of conditions in addition to ED, including stroke, heart conditions, enlarged prostate, diabetes, and difficulties with urination.
Tony Chen, MD, a clinical assistant professor of urology at Stanford University School of Medicine, says the findings aren’t surprising.
“Given that [the] PDE5i class of medications was initially developed to treat cardiovascular disease, and that their mechanisms of action involve improving endothelial function by increasing nitric oxide bioavailability and elevating cGMP levels, it's not surprising that their use would have benefits in domains other than erectile dysfunction.” —Tony Chen, MD
“Sildenafil with TID dosing is used to treat pulmonary hypertension. Cialis with daily dosing is frequently used in BPH medical treatment,” Dr. Chen tells MDLinx.
He argues that at this stage, there are only some indications for the use of PDE5i beyond use in erectile dysfunction.
“Not all PDE5i are the same. If clinicians are interested in health benefits of PDE5i outside of erectile dysfunction, I'd consider daily Cialis over Viagra due to the former's longer half-life. At this time, more research is needed to support the use of daily Cialis for major adverse cardiovascular events (MACE) prevention, but it can be used in the treatment of BPH, especially in men who cannot tolerate alpha-blockers like tamsulosin,” he said.
More research is needed
Experts say more research is needed before physicians should consider prescribing PDE5i for anything other than FDA-approved indications.
“I don't think the research is at the point right now where I would recommend that people prophylactically take these drugs with the intention of [getting] cardiovascular benefits or some of the other prostate-type benefits that are mentioned [in the research],” Alan Shindel, MD, a professor of urology at the University of California, San Francisco, tells MDLinx.
The researchers note that the evidence reviewed in their study is mostly from observational studies and therefore does not prove a causal relationship between drugs like Viagra and improved outcomes in some conditions other than ED.
“High-quality RCTs are needed to characterise the clinical benefit of PDE5i in the common comorbidities in prostate cancer patients, thereby leading to clinical recommendations for this cohort, and the subsequent inclusion in guidelines,” the study authors write.[]
What this means for the clinic
While PDE5 inhibitors may have broader effects than previously recognized, current evidence does not support using these drugs beyond their established indications. For now, the findings mainly point to areas for future research, rather than changes in clinical care.
However, here are some key takeaways that can help advise patient counseling in the clinic:
PDE5 inhibitors remain first-line therapy for erectile dysfunction. Drugs such as Viagra and tadalafil Cialis should continue to be prescribed primarily for ED and certain urologic conditions such as benign prostatic hyperplasia.
Emerging research suggests possible benefits beyond ED. The findings suggest PDE5 inhibitors may be associated with improved outcomes in cardiovascular disease, stroke, diabetes, lower urinary tract symptoms, and benign prostatic hyperplasia, but more research is needed.
Could be relevant for prostate cancer survivors. Men treated for prostate cancer frequently experience erectile dysfunction[], making this population a potential focus for future research on the broader health benefits of these medications.