Regular NSAID use linked to erectile dysfunction
Regular use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with erectile dysfunction (ED), researchers have suggested.
An analysis of data for over 80,000 men in the US aged between 45 and 62 years revealed that ED is more prevalent in those exposed to NSAIDs than in those who had not regularly taken the drugs (see Panel).
After adjusting for comorbidities such as diabetes, hypertension and a history of smoking, regular NSAID use was associated with a 22 per cent increase in ED risk. The risk increase was similar across the age range.
The researchers say their findings raise the question of the role inflammation and cyclo-oxygenase pathways have in causing ED.
Cyclo-oxygenase enzymes are involved in the production of prostaglandins, which might be vital for penile erection — meaning that the inhibition of cyclo-oxygenase by NSAIDs could contribute to ED, they explain.
They add that alternative explanations are possible, such as NSAID use being related to underlying problems that are the direct cause of the ED, and suggest further studies are needed to elucidate the relationship between NSAID use and ED.
“However, if this is a direct relationship, the current strategy of using NSAIDs for cardiovascular disease protection as well as other common uses of NSAIDs should be weighed against the potential side effects of ED,” they advise.
The study is due to be published in the April issue of The Journal of Urology (2011,185:1388).
Paul Wright, specialist cardiac pharmacist at Barts and The London NHS Trust, said he has not come across the link much in practice, but pointed out that cardiovascular disease (CVD) is known to increase the risk of ED due to endothelial dysfunction.
"The [study’s] definition of NSAID use is too broad — it included low-dose aspirin and paracetamol — and as such will select patients with CVD," he said, explaining that a high proportion of CVD patients will be taking aspirin 75mg daily.
"Although the final analysis had adjusted for most of these variables, it is very difficult to draw conclusions," he said. He suggested that further analysis of NSAID use excluding low-dose aspirin and paracetamol may yield different results and be better applied to practice.
Study method and results
Researchers analysed data collected in an earlier men’s health study for 80,966 US men.
Information on erectile function and NSAID use was self-reported via a questionnaire, with additional data on NSAID exposure obtained from pharmacy and electronic health records.
Men were defined as exposed to NSAIDs if they had: received more than a 100-day supply in total of at least one NSAID; been prescribed any NSAID for three or more doses per day; or self-reported using NSAIDs at least five days a week.
NSAID use was associated with a 22 per cent increase in the risk of ED compared with men in the unexposed group (adjusted odds ratio 1.22, 95 per cent confidence interval 1.18–1.27; P<0.001).
The increase in risk was similar across all age groups; 20 per cent for those aged 45–49 years, 22 per cent for those aged 50–59 years and 23 per cent for those aged 60–69 years (P<0.001 for all age groups).
Citation: The Pharmaceutical Journal URI: 11070444
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