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In a prospective, double-blind and placebocontrolled study in 32 patients, the ef cacy of gingko biloba was evaluated over a period of 24 weeks [140] Gingko biloba did not result in a subjective, or a statistically signi cant objective (NPT testing) improvement of erection
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In a three arm, placebo-controlled study with trazodone, placebo or ginseng in 90 patients (30 in each arm), global ef cacy rates of 60% (p < 005) were reported for ginseng and 30% for both placebo and trazodone [140] The erection-promoting effect of ginseng is attributed to its saponin content, although its exact mechanism of action is unclear
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References
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1 Fleischer K, Hirsch-Tabor O Zur Potenzierung der Yohimbine-Wirkung M nchner Med Wochenschrift 1923;51:1506 1508 2 Ernst E, Pittler MH Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials J Urol 1998;159:433 436 3 Saenz de Tejada I Commentary on mechanisms for the regulation of penile smooth muscle contractility J Urol 1995;153:1762
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18 Heaton JPW, Morales A, Adams MA, et al Recovery of erectile function by the oral administration of apomorphine Urology 1995;45:200 206 19 Andersson KE, Steers WD The pharmacologic basis of sexual therapeutics In Morales, A, ed Erectile Dysfunction Issues in Current Pharmacotherapy London: Martin Dunitz Ltd, 1998, pp 97 124 20 Chen KK, Chan JYH, Chan SHH, et al Elicitation of penile erection after administration of apomorphine to paraventricular nucleus of hypothalamus in the rat Int J Impotence Res 1996;8:No3,105 21 Chen KK, Chan JYH, Chan SHH, et al Testesdependent elicitation of penile erection after administration of apomorphine into paraventricular nucleus of hypothalamus in the rat J Urol 1997;157:No4,35 22 Melis MR, Argiolas A Nitric oxide synthase inhibitors prevent apomorphine- and oxytocin-induced penile erection and yawning in male rats Brain Research Bulletin 1993;32:71 74 23 Paick JS, Lee SW The neural mechanism of apomorphine-induced erection: an experimental study by comparison with electrostimulation-induced erection in the rat model J Urol 1994;152:2125 2128 24 Tarcan T, Goldstein I, Park K, et al Systemic administration of apomorphine increases clitoral and vaginal arterial in ow in the rabbit Int J Impotence Res 1998;10:(Suppl3),S58 25 Giuliano F, Allard J, Rampin U, et al Proerectile effect of apomorphine delivered at the spinal level in anaesthetized rat Int J Impotence Res 2000;12: (Suppl3),S66:A22 26 Argiolas A, Hedlund H The pharmacology and clinical pharmacokinetics of apomorphine SL BJU International 2001;88:(Suppl3),18 21 27 Stief C, Padley RJ, Perdok RJ, Sleep DJ Cross-study review of the clinical ef cacy of apomorphine SL 2 and 3 mg: Pooled data from three placebo-controlled, xed-dose cross-over studies Eur Urol 2002; (Suppl1):12 36 28 Heaton J, Sleep D, Perdok R, et al Ef cacy and safety of Uprima (apomorphine SL) in patients with documented comorbidities of hypertension, coronary artery disease (CAD) or diabetes Int J Impotence Res 2001;13:(Suppl4),S32,Abstr87 29 Gontero P, Antonio RD, Pretti G, et al Clinical ef cacy of apomorphine SL in erectile dysfunction of diabetic men Int J Impotence Res 2005;17:80 85 30 Pavone C, Curto F, Anello G, et al Prospective, randomized, cross-over comparison of sublingual apomorphine (3 mg) with oral sildena l (50 mg) for male erectile dysfunction J Urol 2004;172:2347 2349
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31 Eardley I, Wright P, MacDonagh R, et al An open-label, randomised, exible-dose, crossoverstudy to assess the comparative ef cacy and safety of sildena l citrate and apomorphine hydrochloride in men with erectile dysfunction BJU Int 2004;93:1271 1275 32 Porst H, Jacob G, Albrecht S Sildena l (Viagra ) versus apomorphin in der behandlung der erektilen dysfunktion (ED): Multizentrische, offene, randomisierte,cross-over studie Urologe 2004;(Suppl1), S65 33 Ralph DJ, Sleep DJ, Perdok RJ, Padley RJ Adverse events and patient tolerability of apomorphine SL 2 and 3 mg: a cross-study analysis of phase II and II studies Eur Urol 2002;(Suppl1):21 27 34 Beavo JA Cyclic nucleotide phosphodiesterases: functional implications of multiple isoforms Physiol Reviews 1995;75:No4:725 748 35 Corbin JD, Francis SH, Webb D Phosphodiesterase type 5 as a pharmacologic target in erectile dysfunction Urology 2002;60:Suppl:SB,4 11 36 Corbin JD, Francis SH Pharmacology of phosphodiesterase 5 inhibitors IJCP 2002;56(6):453 459 37 Maurice DH Phsophodiesteraes and sexual function and dysfunction Presented at the ISSIR Symposium, Molecular Mechanisms of Erectile Function at the 4th Biennal Congress of ESSIR, Rome, 29 September 2001 38 Rybalkin SD, Beavo JA Multiplicity within cyclic nucleotide phosphodiesterases Biochemical Society Transactions 1997;24:1005 1009 39 K the A, Wiedenroth A, M gert HJ, et al Expression of different phosphodiesterase genes in human cavernosum smooth muscle J Urol 2001;165:280 283 40 Corbin JD Mechanism of action of PDE-5 inhibition in erectile dysfunction Int J Impotence Res 2004; 16:(Suppl1),S4 S7 41 Gantert LT, Drisko JE, Nargund RP, et al Melanocortin 4-receptor and 5 HT2C receptor modulation of erectogenesis in conscious rats as reported by telemetric measurement of intracavernous pressure Int J Impotence Res 2001;13:(Suppl5),S53,Abstr6 42 Lindia JA, Nargund R, Sebhat J, et al Erectogenic effects of a selective melanocortin-4 receptor (MC 4-R) agonist in a rat model of erectile activity Int J Impotence Res 2001;13:(Suppl5),S55,2001 43 McGowan E, Cashen DE, Drisco JE, et al Activation of melanocortin-4 receptor (MC 4-R) increases erectile activity in rats Int J Impotence Res 2001;13:(Suppl5), S55,Abstr13 44 Francis SH, Turko IV, Corbin JD Cyclic nucleotide phosphodiesterases: relating structure and function Prog Nucleic Acid Res Mol Biol 2001;65:1 52
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