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Addition of metformin to sildenafil treatment for erectile dysfunction in eugonadal nondiabetic men with insulin resistance. A prospective, randomized, double-blind pilot study.
J Androl 2012 Jul-Aug; 33(4):608-14JA

Abstract

Erection depends largely on the release of nitric oxide (NO) by vascular endothelial cells. Insulin resistance (IR) is a metabolic abnormality that produces endothelial dysfunction characterized by decreased synthesis and release of NO. The aim of this paper is to evaluate the effect of treatment with metformin on the response to sildenafil in patients with erectile dysfunction (ED) and IR enrolled in a prospective, randomized, controlled, double-blind placebo study. We included 30 male patients with ED, IR, and poor response to sildenafil. Exclusion criteria included pharmacologic, anatomic, or endocrine ED; diabetes; prostatic surgery; or chronic illnesses. Erectile function was rated according to the International Index of Erectile Function 5 (IIEF-5); IR was measured by homeostasis model assessment (HOMA; IR = HOMA ≥ 3). Patients were randomized to receive metformin (n = 17) or placebo (n = 13). After treatment with metformin, patients with ED showed a significant increase in IIEF-5 score and a significant decrease in HOMA, both occurring at month 2 (IIEF-5: 17.0 ± 6.0 vs 14.3 ± 3.9, P = .01; HOMA: 3.9 ± 1.6 vs 5.5 ± 2.4, P = .01) to 4 of treatment (IIEF-5: 19.8 ± 3.8 vs 14.3 ± 3.9, P = .005; HOMA: 4.5 ± 1.9 vs 5.5 ± 2.4, P = .04), with no changes in these parameters in patients with ED receiving placebo. Patients treated with metformin had more adverse events than those who received placebo: 61.5% compared with 7.7%, P = .03, respectively. Adverse events were mild, mainly gastrointestinal, and did not cause discontinuation of treatment. Treatment with metformin in patients with ED and poor response to sildenafil reduced the IR and improved erectile function.

Authors+Show Affiliations

Urology Division, Hospital Italiano de Buenos Aires, Gascón 450, Buenos Aires C1181ACH, Argentina. gaston.rey@hospitalitaliano.org.arNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22016348

Citation

Rey-Valzacchi, Gastón J., et al. "Addition of Metformin to Sildenafil Treatment for Erectile Dysfunction in Eugonadal Nondiabetic Men With Insulin Resistance. a Prospective, Randomized, Double-blind Pilot Study." Journal of Andrology, vol. 33, no. 4, 2012, pp. 608-14.
Rey-Valzacchi GJ, Costanzo PR, Finger LA, et al. Addition of metformin to sildenafil treatment for erectile dysfunction in eugonadal nondiabetic men with insulin resistance. A prospective, randomized, double-blind pilot study. J Androl. 2012;33(4):608-14.
Rey-Valzacchi, G. J., Costanzo, P. R., Finger, L. A., Layus, A. O., Gueglio, G. M., Litwak, L. E., & Knoblovits, P. (2012). Addition of metformin to sildenafil treatment for erectile dysfunction in eugonadal nondiabetic men with insulin resistance. A prospective, randomized, double-blind pilot study. Journal of Andrology, 33(4), pp. 608-14. doi:10.2164/jandrol.111.013714.
Rey-Valzacchi GJ, et al. Addition of Metformin to Sildenafil Treatment for Erectile Dysfunction in Eugonadal Nondiabetic Men With Insulin Resistance. a Prospective, Randomized, Double-blind Pilot Study. J Androl. 2012;33(4):608-14. PubMed PMID: 22016348.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Addition of metformin to sildenafil treatment for erectile dysfunction in eugonadal nondiabetic men with insulin resistance. A prospective, randomized, double-blind pilot study. AU - Rey-Valzacchi,Gastón J, AU - Costanzo,Pablo R, AU - Finger,Luis A, AU - Layus,Alberto O, AU - Gueglio,Guillermo M, AU - Litwak,León E, AU - Knoblovits,Pablo, Y1 - 2011/10/20/ PY - 2011/10/22/entrez PY - 2011/10/22/pubmed PY - 2012/12/10/medline SP - 608 EP - 14 JF - Journal of andrology JO - J. Androl. VL - 33 IS - 4 N2 - Erection depends largely on the release of nitric oxide (NO) by vascular endothelial cells. Insulin resistance (IR) is a metabolic abnormality that produces endothelial dysfunction characterized by decreased synthesis and release of NO. The aim of this paper is to evaluate the effect of treatment with metformin on the response to sildenafil in patients with erectile dysfunction (ED) and IR enrolled in a prospective, randomized, controlled, double-blind placebo study. We included 30 male patients with ED, IR, and poor response to sildenafil. Exclusion criteria included pharmacologic, anatomic, or endocrine ED; diabetes; prostatic surgery; or chronic illnesses. Erectile function was rated according to the International Index of Erectile Function 5 (IIEF-5); IR was measured by homeostasis model assessment (HOMA; IR = HOMA ≥ 3). Patients were randomized to receive metformin (n = 17) or placebo (n = 13). After treatment with metformin, patients with ED showed a significant increase in IIEF-5 score and a significant decrease in HOMA, both occurring at month 2 (IIEF-5: 17.0 ± 6.0 vs 14.3 ± 3.9, P = .01; HOMA: 3.9 ± 1.6 vs 5.5 ± 2.4, P = .01) to 4 of treatment (IIEF-5: 19.8 ± 3.8 vs 14.3 ± 3.9, P = .005; HOMA: 4.5 ± 1.9 vs 5.5 ± 2.4, P = .04), with no changes in these parameters in patients with ED receiving placebo. Patients treated with metformin had more adverse events than those who received placebo: 61.5% compared with 7.7%, P = .03, respectively. Adverse events were mild, mainly gastrointestinal, and did not cause discontinuation of treatment. Treatment with metformin in patients with ED and poor response to sildenafil reduced the IR and improved erectile function. SN - 1939-4640 UR - https://www.unboundmedicine.com/medline/citation/22016348/Addition_of_metformin_to_sildenafil_treatment_for_erectile_dysfunction_in_eugonadal_nondiabetic_men_with_insulin_resistance__A_prospective_randomized_double_blind_pilot_study_ L2 - http://www.diseaseinfosearch.org/result/9682 DB - PRIME DP - Unbound Medicine ER -