Pharmacotherapy for erectile dysfunction

Objective: To review advances in the pharmacological treatment of erectile dysfunction (ED) highlighting potential neuro-endocrine and molecular targets. Methods: A comprehensive MEDLINE and PUBMED search was utilized to investigate current novel mechanistic approaches in treating erectile dysfunction. Search criteria included, but were not limited to, erectile dysfunction (ED), cGMP, nitric oxide, Rho-kinase, phosphodiesterase, gene therapy, apomorphine, melanocortin and corpora cavernosa. Articles relating to in vitro, animal and in vivo experimental therapy were evaluated and included in this review and future directions are described. Results: Current first-line ED treatment often involves the use of phosphodiesterase inhibitors. However, many novel pharmacotherapeutic approaches under development including the use of melanocortins and Rho-kinase inhibitors as well as the introduction of gene therapy have demonstrated efficacy in animal as well as early human trials. Conclusions: The success of oral pharmacotherapy for ED has been accompanied by renewed interest into the ED pathophysiology and signal transduction pathways. This has led to the identification of new therapeutic targets, which are poised to change the dynamic of ED management by broadening treatment alternatives to include other oral and genetic therapies.