Dopamine receptor agonists may be most effective in treating ED in patients with Parkinson’s disease. Ropinirole has been shown to cause involuntary erections and improve erectile function in Parkinson’s disease Periodic subcutaneous injections of apomorphine used to treat “shutdowns” have caused erections in patients with Parkinson’s Disease.
The site of action of apomorphine is considered to be PARAVENTRICULAR Nucleus the hypothalamus. In addition, dopamine projections from the brain to the spinal cord, as well as internal dopaminergic innervation within the spinal cord, increase the possibility of an additional action of apomorphine at the spinal level. Sublingual forms of apomorphine (2 or 4 mg) were also effective in treating ED.
It should be taken into account that dopaminomimetics in patients with Parkinson’s disease can cause hypersexuality and inappropriate sexual behavior. Dopamine receptor agonist use was associated with compulsive sexual behavior in 2.7% of patients.
ED, in contrast to motor symptoms, is resistant to levodopa therapy, and in 0.9% of patients, taking levodopa led to the development of hypersexuality.
Phosphodiesterase type 5 inhibitors. Sildenafil is the most commonly used medication for the treatment of ED. It was found that sildenafil at a dose of 50 mg is effective in the treatment of ED
in men with Parkinson’s Disease and has good tolerance. Side effects (headache and facial flushing) were minor, transient, and did not require correction. The efficacy of sildenafil was evaluated in patients with Parkinson’s disease and depression. During treatment, an improvement in erections were observed in 85% of patients, and a decrease in the manifestations of depression-in 75%.
In a study involving 236 men with Parkinson’s disease who did not have cardiovascular disease, the effectiveness of sildenafil when taken at a dose of 100 mg was noted. There are warnings in the literature about the incompatibility of sildenafil with nitrates since their combined use can lead to severe hypotension. In addition, it is emphasized that in patients with Parkinson’s Disease, orthostatic hypotension should be excluded before prescribing sildenafil, which is a contraindication for its use.
Prostaglandin E1. As mentioned above, neurogenic ED has a very high sensitivity to PG E1. For patients with Parkinson’s Disease who have ED that is resistant to per os pharmacotherapy, an alternative is intracavernous administration of vasoactive PG E1. To avoid painful prolonged erections, the dosage of the drug should be increased slowly.
Neurostimulation of deep brain structures. Stimulation of the subthalamic nucleus is an effective therapeutic method for the treatment of advanced PD. Scientists have shown a significant reduction in the frequency of ED after electrical stimulation of the subthalamic nucleus, especially in men younger than 60 years.
Neuroimmunophilin ligands. Neuroimmunophilin ligands represent a new group of drugs that can presumably be applied to the brain.
with ED. Drugs of this group are derived from the immunosuppressant tacrolimus. There is evidence that they can affect the reverse development of neuronal degeneration.
However, further research is needed to evaluate their effectiveness in treating ED in patients with Parkinson’s disease.