Epidemiological data link erectile dysfunction (ED) and benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS), two highly prevalent conditions in aging men, assuming common pathophysiological pathways. Tadalafil 5 mg once daily has been approved for the treatment of men with LUTS with or without comorbid ED. The aim of this review is to provide an overview of current knowledge on the epidemiological and pathophysiological links between ED and LUTS and to focus on tadalafil as a new treatment option in men with BPH-associated LUTS. A Medline search was completed using the Medical Subject Headings (MESH® keywords) ‘prostatic hyperplasia’ and ‘phosphodiesterase inhibitors’. This search revealed 125 relevant references (entire Medline database up to 11 March 2014). The efficacy of tadalafil 5 mg once daily for the treatment of LUTS has been reported by several well-designed studies. Tadalafil improves significantly the total International Prostate Symptom Score (IPSS), the voiding and storage subscores, the IPSS Quality of Life (QoL) and the BPH Impact Index (BII). Its efficacy is irrelevant to the erectile function status of the patients. However, in the majority of these studies tadalafil is not associated with improvement in maximum urine flow or post-void residual volume (PVR). Its safety profile is well established and no new or unexpected adverse events other than those reported in ED studies have been recorded. Tadalafil is today a new treatment alternative to other established drugs for LUTS such as the α-adrenergic antagonists or 5α-reductase inhibitors. However, it is not just an alternative, since sexual adverse events associated with these drugs are avoided and tadalafil is the only drug that can treat both ED and LUTS at the same time.
If you have mild to moderate Crohn’s, your doctor may give you antibiotics to help keep your disease under control.
You may need to take the antibiotics even after you feel better to keep your symptoms from getting worse again.
There are two ways these drugs treat the inflammation in your gut from Crohn’s. Researchers believe they might help control symptoms by reducing bacteria levels in your intestine and by curbing the intestine’s immune system.
You’ll also get them to treat specific infections and complications.
Antibiotics for Crohn’s Complications
Abscesses. These are pockets of pus that, in Crohn’s, often form near the anus.
Fistulas. These are abnormal tunnels that go from one part of your intestine to another or to nearby areas, such as the bladder, vagina, anus, or skin.
Pouchitis. For some people, Crohn’s disease is so severe that they need an operation to have their colon removed. The surgeon makes an internal pouch to hold solid waste before it leaves your body. If this area becomes inflamed — known as “pouchitis” — you’ll need antibiotics for treatment.
Antibiotics for Crohn’s Disease
The most common ones used for Crohn’s are:
Side Effects of Antibiotics
Side effects of metronidazole may include:
Loss of appetite
Side effects are more common at higher doses.
With metronidazole, you may also have numbness or tingling in your hands. If you do, you’ll need to stop taking it. Although this side effect is rare, sometimes it doesn’t go away. Seizures are another rare, serious side effect.
Avoid alcohol if you’re taking metronidazole. It can interact with the drug to cause a rare but severe reaction. The symptoms are nausea, vomiting, and shortness of breath.
These side effects of ciprofloxacin are rare, but may include:
Headache and severe dizziness
Nausea, stomach pain, and diarrhea
Sensitivity to sun
Rupture of a tendon (very rare)
You’re also at greater risk for a severe type of colitis. If you get it, you’ll need treatment with another type of antibiotic.
Do not take ciprofloxacin within a couple of hours of taking:
Vitamin or mineral supplements that contain calcium, iron, or zinc
This combination can make the antibiotic less effective.
No matter which antibiotic you’re taking:
Let your doctor know if you’re pregnant before starting the medication.
Wear sunscreen during daylight hours.
Know that antibiotics can make birth control pills less effective.
Be aware that antibiotics can make bleeding more likely if you’re also taking anticoagulants (drugs that curb blood clots).
For men who don’t respond to on-demand tadalafil (Cialis), a low daily dose may do the trick, researchers said here.
About 40% of men who took up to 5 mg of tadalafil every day were able to achieve normal erectile function even if they’d failed as-needed treatment, Edward Kim, MD, of the University of Tennessee Medical Center in Knoxville, and colleagues reported at the World Meeting on Sexual Medicine.
Although on-demand treatment with phosphodiesterase 5 (PDE5) inhibitors is highly effective for most men, Kim said, some don’t achieve normal erectile function, even with maximum doses.
To assess whether men for whom on-demand treatment didn’t work would do any better on daily tadalafil, the researchers conducted two double-blind, randomized, controlled trials in 623 men who had a mean age of 58.
All of the men had no response to as-needed treatment over the course of a month. After an additional one-month washout period, they were randomized to one of three groups: tadalafil 2.5 mg titrated to 5 mg, 5 mg, or placebo every day for 12 weeks.
Erectile function, as measured on the International Index of Erectile Function (IIEF-EF) significantly improved over the study period for men who had taken either dose of tadalafil compared with placebo — a score of at least 26 was achieved by 39% of those on the 2.5 mg titrated to 5, 40% of those on 5 mg daily, and 12% of those on placebo (P<0.001).
On average, men treated with either dose of daily tadalafil had an 8-point increase in IIEF-EF domain scores by the end of the trial compared with only a 2-point increase for men on placebo (P<0.001).
They also had significantly greater improvements on the Sexual Encounter Profile (SEP-3) questionnaire with either dose of tadalafil compared with placebo (38% and 40% versus 12%, P<0.001).
Kim added that both daily doses of the drug were well tolerated, and that any adverse events were consistent with those seen in previous trials.
He cautioned, however, that the study was limited because it didn’t include an arm for a daily tadalafil dose of only 2.5 mg, and because it involved only a 4-week as-needed dosing period.
Still, he concluded that taking tadalafil once a day “may be a viable option for men with erectile dysfunction that could help restore normal erectile function.”