November 21, 2022

Erectile dysfunction in patients with diabetes mellitus: treatment with Vardenafil

By admin

Vardenafil

Why is Vardenafil suitable for diabetes mellitus?

The incidence of Erectile Dysfunction (ED) in patients with diabetes mellitus is much higher than in the general population and varies between 20-85%. The risk of developing ED in diabetes mellitus correlates not only with the duration of the latter, but also with the severity of metabolic disorders: it is higher in patients with uncontrolled glycemia and hyperlipidemia. The pathogenesis of ED in patients with diabetes mellitus in most cases is mixed (vascular, neurogenic and psychogenic). Representatives of the group of PDE-5 inhibitors, which are currently the drugs of choice in the treatment of ED, differ in pharmacological characteristics. It has been established that Vardenafil hydrochloride is the most powerful and selective inhibitor of PDE-5, which is expressed in its higher effectiveness in the treatment of ED in patients with diabetes mellitus and a low frequency of side effects.

Levitra vs Viagra, Cialis

Levitra, to a lesser extent than Viagra (Sildenafil Citrate), affects PDE-6, an isoenzyme contained in the retina of the eye, when blocked, color perception disorders occur. In addition, this drug, weaker than Viagra and Cialis (Tadalafil), interacted with PDE-11, an isoenzyme contained in striated muscles, testicles and lungs. Thus, Levitra is highly selective against PDE-5 and therefore safer: the drug does not inhibit spermatogenesis and does not cause color perception disorders.

Thus, the prevalence of ED among diabetic patients significantly exceeds that in the general population, while the severity of diabetes correlates with the frequency of ED. It is characteristic that ED can be an early manifestation of diabetes mellitus, which explains the need to determine blood glucose levels and/or glycated hemoglobin concentrations in all patients with erectile dysfunction. PDE-5 inhibitors, currently considered as the drugs of choice in the treatment of ED, differ in pharmacological characteristics, and Levitra is the most powerful and selective PDE-5 inhibitor, which is manifested by higher efficacy in the treatment of erectile disorders in patients with diabetes mellitus and a low frequency of side effects.

Side effects

Levitra is the most potent inhibitor of PDE-5, which explains its higher efficacy in patients with severe forms of ED in patients with diabetes mellitus.

Headache and hot flashes, which are the most expected side effects when taking all PDE-5 inhibitors, were also noted when taking Levitra. However, they were usually weakly expressed and had a transient character. The frequency of side effects that caused patients to stop treatment was 2% in the placebo group, 3 and 4%, respectively, in the groups of patients receiving Levitra at doses of 10 and 20 mg. Unlike Viagra and Cialis, there were no color vision disorders and back pain when taking Levitra. There was no effect of this drug on the cardiac index, cardiac output and systemic blood pressure.

The key factor determining the profile of side effects when using PDE-5 inhibitors is their selectivity against this isoenzyme. In the case of PDE-5 inhibitors, selectivity is usually estimated as the ratio of the forces of action on this isoenzyme (IC30) and other forms of PDE.

First-line drugs for the treatment of ED

The following representatives of this group have been approved for clinical use:

sildenafil citrate (Viagra, Pfizer),
tadalafil (Cialis, Eli Lilly),
vardenafil hydrochloride (Levitra, Bayer).

The mechanism of action of all these drugs is associated with a competitive and reversible inhibition of the activity of the PDE-5 isoform of phosphodiesterase, which dominates in the cavernous tissue. The intracellular concentration of cGMP (the main molecule that determines the tone of smooth muscle cells of cavernous tissue and penile vessels) depends on the ratio of its synthesis mediated by guanylate cyclase and decay as a result of the action of PDE-5. Inhibition of the activity of the latter leads to a significant increase in the content of cGMP in smooth muscle cells, which facilitates their relaxation and promotes the appearance of an erection.