Erectile Dysfunction & NSAIDS

As I’m sure you all know the class of drugs listed as NSAIDS is one of very commonly used pain killers and includes: Aspirin, Tylenol , Ibuprofen (Asvil and Motrin), Alleve , Indomethacin and some others I have not named here.

Point is that these drugs are now being connected with an increase in Erectile Dysfunction. They all act as Antiprostaglandins.

Prostaglandins are found throughout the body and when a person suffers an injury the pain is thought to be from the release of Prostaglandin.

Consider the following: Caverject by Wyeth is an intracavernosal injection of Prostadyl which causes erections. All the Trimix intracavernosal drugs contain Prostadyl along with other chemicals such as apomorhine and Phentolamine.

In the premature newborn, if the circulation after birth continues to shunt blood around the lungs through an artery called the Ductus Areriosus, the trreatment is to inject Indomethacin which closes the ductus. In other words an antiprostaglandin is used to constrict an artery

Could the same thing be happening to the penile artery?

Good question . And food for thought.

Thanks for the information Doc.

Boxcar, check out the “smooth muscle theory” thread, and search for my posts and read the ones above and below. I don’t recall the details offhand, but the discussion relates to prostaglandins and effect on smooth muscle and thus on gains.

I think that any type of medical assertion or conclusion of this type should be referenced with a link.

What do you mean “connected”? Someone’s theory? Was a study done? What dosages? etc. Even some of the most established medical “facts” have some controversy associated with them. There can’t be much of discussion on this without providing more information about the souce.

http://www.meds … warticle/532225

Thanks Hobby. Here is the actual abstract for the study:
Effect of nonsteroidal anti-inflammatory drug use on the incidence of erectile dysfunction.

J Urol. 2006; 175(5):1812-5; discussion 1815-6 (ISSN: 0022-5347)

Shiri R; Koskimäki J; Häkkinen J; Tammela TL; Auvinen A; Hakama M
Tampere School of Public Health, University of Tampere, Tampere, Finland. r_shiri@yahoo.com

PURPOSE: We estimated the effect of nonsteroidal anti-inflammatory drug use on the incidence of erectile dysfunction. MATERIALS AND METHODS: The target population consisted of men 50, 60 or 70 years old residing in the study area in Finland in 1994. Questionnaires were mailed to 3,143 men in 1994 and to 2,864 men 5 years later. The followup sample consisted of 1,683 men who responded to baseline and followup questionnaires. We estimated the effect of NSAIDs on the incidence of ED in men free from moderate or complete ED at baseline (in 1,126). ED was assessed by 2 questions on subject ability to achieve or maintain an erection sufficient for intercourse. Confounding was assessed by stratification and by adjustment in multivariate Poisson regression model. RESULTS: The incidence of ED was 93 cases per 1,000 person-years in men who used and 35 in those who did not use NSAIDs. Among men with arthritis, the most common indication for NSAID use, ED incidence was 97 cases per 1,000 in those using and 52 in men who did not use NSAIDs. Compared with men who did not use NSAIDs and were free from arthritis, the relative risk of ED after controlling for the effects of age, smoking, and other medical conditions and medications was higher in men who used NSAIDs but were free of arthritis (IDR 2.0, 95% CI 1.2-3.5) and in those who used NSAIDs and had arthritis (IDR 1.9, 95% CI 1.2-3.1). The relative risk was only somewhat higher in men who had arthritis but did not use NSAIDs (IDR 1.3, 95% CI 0.9-1.8). CONCLUSIONS: The use of nonsteroidal anti-inflammatory drugs increases the risk of ED and the effect is independent of indication.

http://www.medscape.com/medline/abstract/16600768?queryText=nsaid%20erectile%20dysfunction

So, that sucks.

But it leaves a lot of questions unanswered:

-It doesn’t differentiate between types of NSAIDS or dosage, or frequency of use or length of use.

-When comparing arthitics who use NSAID’s vs. those that don’t, the ones who don’t probably have a milder case of the disease, which may be the reason they have less ED.

- People who have arthritis take a lot of NSAIDS, many to the point of always being drugged up. So it may only be an effect at high doses.

- All NSAIDS can not be lumped together. For example, Aspirin has been shown to reduce cardiovascular risk, while VIOXX has been shown to increase cardiovascular risk. The ED effect may be cardiovascular in nature, and therefore limited to those drugs like Vioxx (and Celebrex?)

I think it would be something to be concerned about if you take high dosages regularly of an NSAID, but I don’t think they provide enough evidence to say that taking aspirin for heart health could be bad.

In fact I wonder how they handled that in the study? So many people take aspirin, in very small doses, not for pain control but for its anti-platelet properties. Would they count that?

I refer you to Google. Put in: Antiprostaglandins and E.D. . There are several articles listed there that should make you pause before you take that aspirin or Ibuprofen.

Thank you Hobby for referring to an article in The Journal of Urology citing an erectile dysfunction rate of 95/1000 men ages 50-70 when using ANSAIDS as opposed to a rate of 35/1000 when not using ANSAIDS

Additionally, let me restate: Injecting protaglandin into the penis causes an immediate erection — that would make any man proud. Doesn’t it make sense to you that anything that was an antiprostaglandin would have an opposite effect?

Further————-aren’t you impressed that an ANSAID , given I/V closes an Artery successfully in Premies with persistent ductus flow?

Interesting thought, but no, this kind of drug does not obstruct arteries. By contrast, it is administered to patients with atherosclerosis because it REDUCES the risk of the arteries to narrow or shut down completely.

Later

Ticker

Be careful about using “logic” rather than data. The study that was done does raise an interesting question, but doesn’t mention ibuprofen or aspirin specifically, so it is definitely premature to say they that one should “take pause” before using those drugs occasionally.

There is clearly a difference in the reponse to Antiprostaglandin in different arteries. There is absolutley no doubt that the Ductus Arteriosus- the artery that shorts out the pulmonary flow prenatally goes into spasm ( resulting in its closing when Antiprostaglandin is administred I/V) On the other hand at the time of delivery prostaglandin rubbed on the crervix softens the cervix and helps it to efface i.e. loosen and thin out.

Since Intracavernosal prostaglandin ( prostadyl) causes an immediate erection, it seems to me that any chemical that acted in an opposite manner e.g. antiprostaglandin, would most assuredly have a negative effect on the erection.

How else to explain the increased E.D. in users of ANSAIDS?

Hey Boxcar, good to see you around again!

Tylenol is not an NSAID and should not be included in this list.

Ref: Acetaminophen for Back Pain

Quote: "Unlike aspirin and non-steroidal anti-inflammatory drugs, acetaminophen does not have an anti-inflammatory effect. "