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病人用藥教育:性不幸福藥關心~藥物引起性功能失調及改善建議(下)

   資料來源:藥師週刊(第1777期)
   記者:三軍總醫院臨床藥學部 葉爵榮 藥師
   日期:
 
   

 

 

 

性功能障礙的影響因素很多,評估藥物相關性同時,亦不能排除年齡、疾病、老化等其他加乘因子,多數藥物引起的性功能障礙,在停藥後可獲得改善,少部份尚需靠口服藥物、陰莖注射劑(alprostadil、papaverine + phentolamine)、睾丸激素、陰莖輔具及心理治療等介入。目前用於勃起功能障礙的主流藥物為選擇性第五亞型磷酸雙酯?(phosphodiesterase 5;PDE5)抑制劑,已核准上市的有sildenafil(Viagra?;威而鋼)、vardenafil (Levitra? ;樂威壯)、tadalafil (Cialis?;犀利士 )三種口服劑型,其中sildenafil(50-100毫克)六星期治療,在改善SSRIs抗鬱劑引起的性功能障礙(勃起功能、興奮、射精、性高潮)有顯著的臨床成果(54.5% vs 4.4%)。嚴重肝腎功能障礙、大於65歲男性、併用α受體阻斷劑或正服用肝臟CYP3A4抑制代謝藥物等,可能會增加PDE5抑制劑血中濃度,需降低初始劑量。且PDE5抑制劑在治療勃起功能障礙時,可能造成暫時性全身血管擴張,降低血壓,不可與心血管藥物併用,特別是硝酸鹽類。治療決定應以原先疾病控制為優先考量,再納入病人對副作用改善期望,尋求較佳療效並減少不良反應傷害之折衷解決方案。(全文完)

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