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World J Diabetes. Mar 15, 2010; 1(1): 3-7
Published online Mar 15, 2010. doi: 10.4239/wjd.v1.i1.3
Systemic and metabolic effects of PDE5-inhibitor drugs
Antonio Aversa
Antonio Aversa, Department of Medical Pathophysiology, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
Author contributions: Aversa A solely contributed to this paper.
Correspondence to: Antonio Aversa, MD, PhD, Professor of Sexual Medicine, Department of Medical Pathophysiology, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy. antonio.aversa@uniroma1.it
Telephone: +39-06-49970721 Fax: +39-06-4461450
Received: July 8, 2009
Revised: November 30, 2009
Accepted: December 7, 2009
Published online: March 15, 2010

Phosphodiesterase type-5 inhibitor (PDE5-i) drugs were first marketed in 1998 (sildenafil) for 'ondemand' treatment of male erectile dysfunction (ED) of any origin. They selectively inhibit intrapenile PDE5 isoenzyme which in turn increases intracellular cyclic guanosine monophosphate levels, thus resulting in prolonged relaxation of cavernosum smooth muscle cells and facilitating the erectile process. Since 2003, two new molecules (tadalafil and vardenafil) have been introduced, resulting in greater interest in these compounds and leading patients to ask for more prescriptions from their doctors. The vast use of PDE5-i in diabetic and cardiovascular ED patients led researchers to investigate their possible extra sexual effects. Several studies investigating their effects on endothelium, coronary and pulmonary circulation, inferior oesophageal sphincter and kidney functions have appeared and, finally, sildenafil was approved for the treatment of pulmonary arterial hypertension. Recent animal studies highlighted a possible interaction between chronic PDE5 inhibition and glucose homeostasis which occurs through a marked improvement of high fat diet induced insulin resistance. If this data is extended to humans, a new scenario will be opened for the chronic use of PDE5-i for sexual rehabilitation along with cardiovascular and metabolic benefits.

Keywords: Endothelium, Insulin, Cardio protection, Diabetes, Atherosclerosis, Erectile dysfunction