Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

The effects of chronic phosphodiesterase-5 inhibitor use on different organ systems

International Journal of Impotence Research volume 19, pages 139–148 (2007)Cite this article

Abstract

Phosphodiesterase-5 (PDE-5) inhibitors selectively inhibit PDE-5 enzymes that are present in various tissues like penile tissue, platelets, vascular, and smooth muscle tissue. The drug's actions on these tissues have lead to the successful therapeutic use in patients suffering from conditions such as erectile dysfunction (ED) and pulmonary hypertension. PDE-5 inhibitors (PDE-5i) act on the erectile tissue causing penile smooth muscle relaxation and vasodilatation leading to penile erection. In addition, in particular when used in conjunction with prostaglandin inhibitors, PDE-5i cause vasodilatation in pulmonary vasculature hence decreasing both the pulmonary arterial pressure and resistance. PDE-5i have also shown to mildly decrease blood pressure, increase cardiac index, and increase coronary blood flow in experimental animals as well as in human studies. The Food and Drug Administration (FDA) has approved three PDE-5i for the treatment of ED: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) and one for pulmonary hypertension: sildenafil (Revatio). These agents are highly selective for PDE-5 enzymes as compared to other subclasses of PDE enzymes and have the almost identical pharmacological action but slightly different pharmacokinetics. Only little data exist about long-term use of PDE-5i and their effects on different organ system. This paper reviews the current information available on chronic PDE-5 inhibitor use.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Beavo JA . Cyclic nucleotide phosphodiesterases: functional implications of multiple isoforms. Physiol Rev 1995; 75: 725–748.

    Article  CAS  PubMed  Google Scholar 

  2. Reffelmann T, Kloner RA . Therapeutic potential of phosphodiesterase 5 inhibition for cardiovascular disease. Circulation 2003; 108: 239–244.

    Article  PubMed  Google Scholar 

  3. Wallis RM, Corbin JD, Francis SH, Ellis P . Tissue distribution of phosphodiesterase families and the effect of sildenafil on tissue cyclic nucleotides, platelet function, and the contractile responses of trabeculae carneae and aortic rings in vitro. Am J Cardiol 1999; 83: 3C–12C.

    Article  CAS  PubMed  Google Scholar 

  4. Senzaki H, Smith CJ, Juang GJ, Isoda T, Mayer SP, Ohler A et al. Cardiac phosphodiesterase 5 (cGMP-specific) modulates adrenergic signaling in vivo, and is down-regulated in heart failure. FASEB J 2001; 15: 1718–1726.

    Article  CAS  PubMed  Google Scholar 

  5. Gresser U, Gleiter CH . Erectile dysfunction: comparison of efficacy and side effects of the PDE-5i sildenafil, vardenafil and tadalafil: review of the literature. Eur J Med Res 2002; 7: 435–446.

    CAS  PubMed  Google Scholar 

  6. Corbin JD, Francis SH, Webb DJ . Phosphodiesterase Type 5 as a pharmacological target in erectile dysfunction. Urology 2002; 60: 4–11.

    Article  PubMed  Google Scholar 

  7. Mikhail GW, Prasad SK, Li W, Rogers P, Chester AH, Bayne S et al. Clinical and haemodynamic effects of sildenafil in pulmonary hypertension: acute and mid-term effects. Eur Heart J 2004; 25: 431–436.

    Article  CAS  PubMed  Google Scholar 

  8. Jackson G, Benjamin N, Jackson N, Allen MJ . Effects of sildenafil citrate on human hemodynamics. Am J Cardiol 1999; 83: 13C–20C.

    Article  CAS  PubMed  Google Scholar 

  9. Traverse JH, Chen YJ, Du R, Bache RJ . Cyclic nucleotide phosphodiesterase type 5 activity limits blood flow to hypoperfused myocardium during exercise. Circulation 2000; 102: 2997–3002.

    Article  CAS  PubMed  Google Scholar 

  10. Ludmer P, Selwyn A, Shook TL, Wayne RR, Mudge GH, Alexander RW et al. Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Eng J Med 1986; 315: 1046–1051.

    Article  CAS  Google Scholar 

  11. Bossaller C, Habib GB, Yamamoto H, Williams C, Wells S, Henry PD . Impaired muscarinic endothelium-dependent relaxation and cyclic guanosine-5′-monophosphate formation in atherosclerotic human coronary artery and rabbit aorta. J Clin Invest 1987; 79: 170–182.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Chester AH, O'Neil GS, Moncada S, Tadjkarimi S, Yacoub MH . Low basal and stimulated release of nitric oxide in atherosclerotic epicardial coronary arteries. Lancet 1990; 336: 897–900.

    Article  CAS  PubMed  Google Scholar 

  13. Nabel EG, Selwyn AP, Ganz P . Large coronary arteries in humans are responsive to changing blood flow: an endothelium-dependent mechanism that fails in patients with atherosclerosis. J Am Coll Cardiol 1990; 16: 349–356.

    Article  CAS  PubMed  Google Scholar 

  14. Kaiser FE, Viosca SP, Morley JE, Moordian AD, Davis SS, Korenman SG . Impotence and aging: clinical and hormonal factors. J Amer Geriatr Soc 1988; 36: 511–519.

    Article  CAS  Google Scholar 

  15. Seftel AD, Sun P, Swindle R . The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol 2004; 171: 2341–2345.

    Article  PubMed  Google Scholar 

  16. Shabsigh R, Fishman IJ, Schum C, Dunn JK . Cigarette smoking and other vascular risk factors in vasculogenic impotence. Urology 1991; 38: 227–232.

    Article  CAS  PubMed  Google Scholar 

  17. Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, Mckinlay JB . Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology 2000; 56: 302–306.

    Article  CAS  PubMed  Google Scholar 

  18. Billups KL, Bank AJ, Padma-Nathan H, Katz S, Williams R . Erectile dysfunction is a marker for cardiovascular disease: Results of the minority health institute expert advisory panel. J Sex Med 2005; 2: 40–52.

    Article  PubMed  Google Scholar 

  19. Burnett AL . Role of nitric oxide in the physiology of erection. Biol Reprod 1995; 52: 485.

    Article  CAS  PubMed  Google Scholar 

  20. Andersson KE, Wagner G . Physiology of penile erection. Physiol Rev 1995; 75: 191–236.

    Article  CAS  PubMed  Google Scholar 

  21. Medina P, Segarra G, Vila JM, Domenech C, Martinez-Leon JB, Lluch S . Effects of sildenafil on human penile blood vessels. Urology 2000; 56: 539–543.

    Article  CAS  PubMed  Google Scholar 

  22. Ballard SA, Gingell CJ, Tang K, Turner LA, Price ME, Naylor MA . Effects of sildenafil on the relaxation of human corpus cavernosum tissue in vitro and on the activities of cyclic nucleotide phosphodiesterase isozymes. J Urol 1998; 159: 2164–2171.

    Article  CAS  PubMed  Google Scholar 

  23. Wallis RM, Corbin JD, Francis SH, Ellis P . Tissue distribution of phosphodiesterase families and the effects of sildenafil on tissue cyclic nucleotides, platelet function, and the contractile responses of trabeculae carneae and aortic rings in vitro. Am J Cardiol 1999; 83: 3C–12C.

    Article  CAS  PubMed  Google Scholar 

  24. Hyland R, Roe EG, Jones BC, Smith DA . Identification of the cytochrome P450 enzymes involved in the N-demethylation of sildenafil. Br J Clin Pharmacol 2001; 51: 239–248.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Muirhead GJ, Faulkner S, Harness JA, Taubel J . The effects of steady-state erythromycin and azithromycin on the pharmacokinetics of sildenafil in healthy volunteers. Br J Clin Pharmacol 2002; 53: 37S–43S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Wilner K, Laboy L, LeBel M . The effects of cimetidine and antacid on the pharmacokinetic profile of sildenafil citrate in healthy male volunteers. Br J Clin Pharmacol 2002; 53: 31S–36S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hellstrom W, Gittelman M, Karlin G, Segerson T, Thibonnier M, Taylor T et al. Vardenafil for treatment of men with erectile dysfunction: efficacy and safety in a randomized double blind placebo controlled trial. J Androl 2002; 23: 763–771.

    CAS  PubMed  Google Scholar 

  28. Brock G, McMahon CG, Chen KK, Costigan T, Shen W, Watkins V et al. Efficacy and safety of tadalafil in the treatment of erectile dysfunction: results of an integrated analysis. J Urol 2002; 168: 1332–1336.

    Article  CAS  PubMed  Google Scholar 

  29. Padma-Nathan H, Stecher VJ, Sweeny YM, Orazem J, Tseng LJ, Deriesthal H . Minimal time to successful intercourse after sildenafil citrate. Urology 2003; 62: 400–403.

    Article  CAS  PubMed  Google Scholar 

  30. Sénz de Tejada I, Anglin G, Knight JR, Emmick JT . Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care 2002; 25: 2159–2164.

    Article  Google Scholar 

  31. Behrend L, Vibe-Petersen J, Perrild H . Sildenafil in the treatment of erectile dysfunction in men with diabetes: demand, efficacy and patient satisfaction. Int J Impot Res 2005; 17: 264–269.

    Article  CAS  PubMed  Google Scholar 

  32. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA, for the Sildenafil Study Group. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998; 338: 1397–1404.

    Article  CAS  PubMed  Google Scholar 

  33. Steidle C, Feldman R, Lettieri J, Agarwal V, Segerson T . Pharmacokinetics of vardenafil (a new selective PDE5 inhibitor) in the elderly and subgroup data on efficacy and safety in elderly patients with erectile dysfunction. Annual American Geriatrics Society Meeting, May 9–13, 2001.

  34. Conti CR, Pepine CJ, Sweeney M . Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol 1999; 83: 29C–34C.

    Article  CAS  PubMed  Google Scholar 

  35. Zapol WM, Rimar S, Grillis N, Marletta M, Bosken CH . Nitric oxide and the lung. Am J Respir Crit Care Med 1994; 149: 1375–1380.

    Article  CAS  PubMed  Google Scholar 

  36. Sanchez LS, de la Monte SM, Filippov G, Jones RC, Zapol WM, Bloch KD . Cyclic-GMP-binding, cyclic-GMP-specific phosphodiesterase (PDE5) gene expression is regulated during rat pulmonary development. Pediatr Res 1998; 43: 163–168.

    Article  CAS  PubMed  Google Scholar 

  37. Guazzi M, Tumminello G, Di Marco F, Fiorentini C, Guazzi MD . The effects of phosphodiesterase-5 inhibition with sildenafil on pulmonary hemodynamics and diffusion capacity, exercise ventilatory efficiency, and oxygen uptake kinetics in chronic heart failure. J Am Coll Cardiol 2004; 44: 2339–2348.

    Article  CAS  PubMed  Google Scholar 

  38. Lepore JJ, Maroo A, Pereira NL, Ginns LC, Dec GW, Zapol WM et al. Effect of sildenafil on the acute pulmonary vasodilator response to inhaled nitric oxide in adults with primary pulmonary hypertension. Am J Cardiol 2002; 90: 677–680.

    Article  CAS  PubMed  Google Scholar 

  39. Michelakis E, Tymchak W, Lien D, Webster L, Hashimoto K, Archer S . Oral sildenafil is an effective and specific pulmonary vasodilator in patients with pulmonary arterial hypertension: comparison with inhaled nitric oxide. Circulation 2002; 105: 2398–2403.

    Article  CAS  PubMed  Google Scholar 

  40. Palmieri EA, Affuso F, Fazio S, Lembo D . Tadalafil in primary pulmonary arterial hypertension. Ann Intern Med 2004; 141: 743–744.

    Article  PubMed  Google Scholar 

  41. Ghofrani HA, Schermuly RT, Rose F, Wiedemann R, Kohstall MG, Kreckel A et al. Sildenafil for long-term treatment of nonoperable chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 2003; 167: 1139–1141.

    Article  PubMed  Google Scholar 

  42. Humbert M, Sitbon O, Simonneau G . Treatment of pulmonary arterial hypertension. N Engl J Med 2004; 351: 1425–1436.

    Article  CAS  PubMed  Google Scholar 

  43. Michelakis ED, Tymchak W, Noga M, Webster L, Wu XC, Lien D et al. Long-term treatment with oral sildenafil is safe and improves functional capacity and hemodynamics in patients with pulmonary arterial hypertension. Circulation 2003; 108: 2066–2069.

    Article  CAS  PubMed  Google Scholar 

  44. Corbin J, Rannels S, Neal D, Chang P, Grimes K, Beasley A et al. Sildenafil citrate does not affect cardiac contractility in human or dog heart. Curr Med Res Opin 2003; 19: 747–752.

    Article  CAS  PubMed  Google Scholar 

  45. Herrmann HC, Chang G, Klugherz BD, Mahoney PD . Hemodynamic effects of sildenafil in men with severe coronary artery disease. New Engl J Med 2000; 342: 1662–1666.

    Article  Google Scholar 

  46. Barry AB, Vojtech M, Tricia M, Patricia F, David AK . Sildenafil Inhibits-adrenergic–stimulated cardiac contractility in humans. Circulation 2005; 112: 2642–2649.

    Article  Google Scholar 

  47. Mahmud A, Hennessy M, Feely J . Effect of sildenafil on blood pressure and arterial wave reflection in treated hypertensive men. J Hum Hypertens 2001; 15: 707–713.

    Article  CAS  PubMed  Google Scholar 

  48. Emmick JT, Stuewe SR, Mitchell M . Overview of the cardiovascular effects of tadalafil. Eur Heart J 2002; 4: H32–H37.

    Article  CAS  Google Scholar 

  49. Pomara G, Morelli G, Pomara S, Taddei S, Ghiadoni L, Dinelli N et al. Cardiovascular parameter changes in patients with erectile dysfunction using PDE-5i: a study with sildenafil and vardenafil. J Androl 2004; 25: 625–629.

    Article  CAS  PubMed  Google Scholar 

  50. Bocchi EA, Guimaraes G, Mocelin A, Bacal F, Bellotti G, Ramires JF . Sildenafil effects on exercise, neurohormonal activation, and erectile dysfunction in congestive heart failure: a double-blind, placebo-controlled, randomized study followed by a prospective treatment for erectile dysfunction. Circulation 2002; 106: 1097–1103.

    Article  PubMed  Google Scholar 

  51. Webster L, Michelakis E, Davis T, Archer S . Use of sildenafil for safe improvement of erectile function and quality of life in men with New York Heart Association classes II and III congestive heart failure. Arch Intern Med 2004; 164: 514–520.

    Article  CAS  PubMed  Google Scholar 

  52. Katz SD . Potential role of type 5 phosphodiesterase inhibition in the treatment of congestive heart failure. Congest Heart Failure 2003; 9: 9–15.

    Article  CAS  Google Scholar 

  53. Milan DP, Stuart DK . Phosphodiesterase 5 inhibition in chronic heart failure and pulmonary hypertension. Am J Cardiol 2005; 96: 47M–51M.

    Google Scholar 

  54. Dunkern TR, Hatzelmann A . The effect of sildenafil on human platelet secretory function is controlled by a complex interplay between phosphodiesterases 2, 3 and 5. Cellular Signalling 2005; 17: 331–339.

    Article  CAS  PubMed  Google Scholar 

  55. Cheitlin M, Hutter Jr AM, Brindis RG, Ganz P, Kaul S, Russell Jr RO et al. ACC/AHA expert consensus document. Use of sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association. J Am Coll Cardiol 1999; 33: 273–282.

    Article  CAS  PubMed  Google Scholar 

  56. Araujo PV, Clemente CM, da Graca JR, Rola FH, de Oliveira RB, dos Santos AA et al. Inhibitory effect of sildenafil on rat duodenal contractility in vitro: putative cGMP involvement. Clin Exp Pharmacol Physiol 2005; 32: 191–195.

    Article  CAS  PubMed  Google Scholar 

  57. Zhang X, Tack J, Janssens J, Sifrim DA . Effect of sildenafil, a phosphodiesterase-5i, on oesophageal peristalsis and lower oesophageal sphincter function in cats. Neurogastroenterol Motil 2001; 13: 325–331.

    Article  CAS  PubMed  Google Scholar 

  58. Sarnelli G, Sifrim D, Janssens J, Tack J . Influence of sildenafil on gastric sensorimotor function in humans. Am J Physiol Gastrointest Liver Physiol 2004; 287: G988–G992.

    Article  CAS  PubMed  Google Scholar 

  59. Jones OM, Brading AF, McC Mortensen NJ . Phosphodiesterase inhibitors cause relaxation of the internal anal sphincter in vitro. Dis Colon Rectum 2002; 45: 530–536.

    Article  PubMed  Google Scholar 

  60. Rastogi S, Rodriguez JJ, Kapur V, Schwarz ER . Why do patients with heart failure suffer with erectile dysfunction? A critical review and suggestions on how to approach this problem. Int J Impot Res 2005; 17: S25–S36.

    Article  PubMed  Google Scholar 

  61. Ahn GJ, Yu JY, Choi SM, Kang KK, Ahn BO, Kwon JW et al. Chronic administration of phosphodiesterase 5i improves erectile and endothelial function in a rat model of diabetes. Int J Androl 2005; 28: 260–266.

    Article  CAS  PubMed  Google Scholar 

  62. Gori T, Sicuro S, Dragoni S, Donati G, Forconi S, Parker JD . Sildenafil prevents endothelial dysfunction induced by ischemia and reperfusion via opening of adenosine triphosphate-sensitive potassium channels: a human in vivo study. Circulation 2005; 111: 721–723.

    Article  Google Scholar 

  63. Rosano GM, Aversa A, Vitale C, Fabbri A, Fini M, Spera G . Chronic treatment with tadalafil improves endothelial function in men with increased cardiovascular risk. Eur Urol 2005; 47: 214–220.

    Article  CAS  PubMed  Google Scholar 

  64. Dishy V, Harris PA, Pierce R, Prasad HC, Sofowora G, Bonar HL et al. Sildenafil does not improve nitric oxide-mediated endothelium-dependent vascular responses in smokers. Br J Clin Pharmacol 2004; 57: 209–212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Vlachopoulos C, Tsekoura D, Alexopoulos N, Panagiotakos D, Aznaouridis K, Stefanadis C . Type 5 phosphodiesterase inhibition by sildenafil abrogates acute smoking-induced endothelial dysfunction. Am J Hypertens 2004; 17: 1040–1044.

    Article  CAS  PubMed  Google Scholar 

  66. Katz SD, Balidemaj K, Homma S, Wu H, Wang J, Maybaum S . Acute type 5 phosphodiesterase inhibition with sildenafil enhances flow-mediated vasodilation in patients with chronic heart failure. J Am Coll Cardiol 2000; 36: 845–851.

    Article  CAS  PubMed  Google Scholar 

  67. Laties A, Sharlip I . Ocular safety in patients using sildenafil citrate therapy for erectile dysfunction. J Sex Med 2006; 3: 12–27.

    Article  CAS  PubMed  Google Scholar 

  68. Cunningham AV, Smith KH . Anterior ischemic optic neuropathy associated with Viagra. J Neuroophthalmol 2001; 21: 22–25.

    Article  CAS  PubMed  Google Scholar 

  69. Donahue SP, Taylor RJ . Pupil-sparing third nerve palsy associated with sildenafil citrate (Viagra). Am J Ophthalmol 1998; 126: 476–477.

    Article  CAS  PubMed  Google Scholar 

  70. Gorkin L, Hvidsten K, SObel RE, Siegel R . Sildenafil citrate use and the incidence of nonarteritic anterior ischemic optic neuropathy. Int J Clin Prac 2006; 60: 500–503.

    Article  CAS  Google Scholar 

  71. Giordano D, De Stefano ME, Citro G, Modica A, Giorgi M . Expression of cGMP-binding cGMP-specific phosphodiesterase (PDE5) in mouse tissues and cell lines using an antibody against the enzyme amino-terminal domain. Biochim Biophys Acta 2001; 1539: 16–27.

    Article  CAS  PubMed  Google Scholar 

  72. Kruuse C, Rybalkin SD, Khurana TS, Jansen-Olesen I, Olesen J, Edvinsson L . The role of cGMP hydrolysing phosphodiesterases 1 and 5 in cerebral artery dilatation. Eur J Pharmacol 2001; 420: 55–65.

    Article  CAS  PubMed  Google Scholar 

  73. Arnavaz A, Aurich A, Weissenborn K, Hartmann U, Emrich HM, Schneider U . Effect of sildenafil (Viagra) on cerebral blood flow velocity: a pilot study. Psychiatry Res 2003; 122: 207–209.

    Article  CAS  PubMed  Google Scholar 

  74. Schermuly RT, Kreisselmeier KP, Hossein A, Hüseyin GY, Butrous G, Ermert L et al. Chronic sildenafil treatment inhibits monocrotaline-induced pulmonary hypertension in rats. Am J Respir Crit Care Med 2004; 169: 39–45.

    Article  PubMed  Google Scholar 

  75. Fisher PW, Salloum F, Das A, Hyder H, Kukreja RC . Phosphodiesterase-5 inhibition with sildenafil attenuates cardiomyocyte apoptosis and left ventricular dysfunction in a chronic model of doxorubicin cardiotoxicity. Circulation 2005; 111: 1601–1610.

    Article  CAS  PubMed  Google Scholar 

  76. Takimoto E, Champion HC, Li M, Belardi D, Ren S, Rodriguez ER et al. Chronic inhibition of cyclic GMP phosphodiesterase 5A prevents and reverses cardiac hypertrophy. Nat Med 2005; 11: 214–222.

    Article  CAS  PubMed  Google Scholar 

  77. Ferrini MG, Kovanecz I, Nolazco G, Rajfer J, Gonzalez-Cadavid NF . Effects of long-term vardenafil treatment on the development of fibrotic plaques in a rat model of Peyronie's disease. Br J Urol 2006; 97: 625–633.

    Article  CAS  Google Scholar 

  78. Stiebellehner L, Petkov V, Vonbank K, Funk G, Schenk P, Ziesche R et al. Long-term treatment with oral sildenafil in addition to continuous IV epoprostenol in patients with pulmonary arterial hypertension. Chest 2003; 123: 1293–1295.

    Article  PubMed  Google Scholar 

  79. Barreto AC, Franchi SM, Castro S, Lopes AA . One-year follow-up of the effects of sildenafil on pulmonary arterial hypertension and veno-occlusive disease. Braz J Med Biol Res 2005; 38: 185–195.

    Article  CAS  PubMed  Google Scholar 

  80. Knoderer CA, Ebenroth ES, Brown JW . Chronic outpatient sildenafil therapy for pulmonary hypertension in a child after cardiac surgery. Pediatr Cardiol 2005; 26: 859–861.

    Article  CAS  PubMed  Google Scholar 

  81. Preston IR, Klinger JR, Houtches J, Nelson D, Farber HW, Hill NS . Acute and chronic effects of sildenafil in patients with pulmonary arterial hypertension. Resp Med 2005; 99: 1501–1510.

    Article  Google Scholar 

  82. Kloner RA, Mitchell M, Emmick JT . Cardiovascular effects of tadalafil. Am J Cardiol 2003; 92(9A): 37M–46M.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. E R Schwarz and V Kapur: These two authors contributed equally to the paper.

Authors and Affiliations

  1. Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA, USA

    E R Schwarz, V Kapur, J Rodriguez, S Rastogi & S Rosanio

Authors
  1. E R Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V Kapur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Rastogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Rosanio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E R Schwarz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schwarz, E., Kapur, V., Rodriguez, J. et al. The effects of chronic phosphodiesterase-5 inhibitor use on different organ systems. Int J Impot Res 19, 139–148 (2007). https://doi.org/10.1038/sj.ijir.3901491

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijir.3901491

Keywords

This article is cited by

Search

Advanced search

Quick links