sexual dysfunction

what drug is used to treat sexula dysfunction in premenopausal women

filbanserin

most common cause of sexua dysfunction

SSRI or SNRI. alternative is bupropion

drugs that can cause sexual/erectile dysfunction

alcohol

antidepressants (especially SSRIs and SNRIs)

antihypertensives (beta blockers, clonidine, thiazides)

antipsychotics (first generation (eg chlorpromazine), prolactin raisng second generation (eg risperidone)

BPH medications (finasteride, dutaseteride and silidosin)

natural products used in sexual dysfunction

yohimbe, l-arginine, panax ginseng. ginseng increases the risk of bleeding

what is first line for sexual dysfunction

PDE5i (sildenafil, tadalafil, vardenafil, avanafil). they are titrated as tolerated

common cause of treatment failute

timing of the dose

tadalafil (cialis)

used to treat BPH

PDE5i moa

release of nitric oxide,, which increase cGMP and cause smooth muscle relaxation. this permits blood flow in

what do PDE5i not do

they do not increase libido

starting dose of sildenafil

50 mg

starting dose of tadalafil and vardenafil

10mg

starting dose of avanafil

100mg

when to reduce starting dose

if >65, using an alpha blocker, using a cyp3a4 inhibitors, severe renal or liver disease. starting dose is reduced by 50%

which drugs are taken 1 hour before sexual activity

sildenafil, vardenafi,

which drug is taken 30 minutes before

tadalafil, avanafil (15-30 mins)

tadalafil can be taken

on-demand dosing

pde5i contraindications

nitrates

pde5i warnings and side effects

color discrimination, hearing loss, vision loss, hypotension, priapism (seek emergency if erection lasts longer than 4 hours), headache, flushing, dizziness, dyspepsia, back pain (mostly with tadalafil)

pde5i notes

sildenafil and vardenafil have decreased efficacy if taken with high fat meals or large meals

for ED, no more than one dose per day is recommended

if using pde5i and alpha blockers together

the patient should be stable on alpha 1 blocker before starting pde5i

what do cyp3a4 inducers do

decrease drug levels; monitor effectiveness

alprostadil moa

prostaglandin E1, a vasodilator that allows blood flow into the cavernosal arteries. it is either injected into the penis or a pellet is inserted

alprostadil side effects

penile pain, priapism

urethral pellets must be

refrigerated

drugs for hypoactive sexual desire

fibanserin and bremelanotide

fibanserin moa

agonist activity at 5-HT1A and antagonist activity at 5-HT2A.

filbanserin boxed warnings

contraindicated: with alcohol. REMS program required, cyp3a4i

filbanserin side effects

hypotension, syncope

filbanserin brand name

addyi

bremelanotide contraindications

hypertension or known cardiocascular disease