What is the rate of erectile dysfunction (ED) associated with midoxinil?

Midoxinil is Not Associated with Erectile Dysfunction

There is no documented rate of erectile dysfunction associated with midoxinil, as this medication does not appear in the medical literature as a cause of erectile dysfunction. Based on comprehensive review of the available evidence, midoxinil is not mentioned in any of the clinical guidelines or research studies examining medications associated with erectile dysfunction 1.

Understanding Medication-Induced Erectile Dysfunction

Erectile dysfunction (ED) can be caused by various medications, but the most commonly implicated drugs include:

1. 5-α reductase inhibitors (5-ARIs) - These have the highest reporting rates of ED, with finasteride and dutasteride showing the highest Proportional Reporting Ratios (PRRs) of 110.03 and 9.40 respectively 2

2. Neuropsychiatric medications - Account for approximately 40% of medication-related ED reports 2

3. Antihypertensives - Particularly thiazide diuretics and beta-blockers 3

4. Selective serotonin reuptake inhibitors (SSRIs) - Commonly associated with sexual dysfunction 3

Medications With Known ED Association

The FDA Adverse Event Reporting System (FAERS) data from 2010-2020 identified over 6,000 reports of ED associated with the top 20 medications, with 5-ARIs and neuropsychiatric medications accounting for 86% of these reports 2.

Common medication classes associated with ED:

• Antihypertensives (especially thiazide diuretics and beta-blockers)
• Psychotropic medications (particularly SSRIs)
• 5-alpha reductase inhibitors (finasteride, dutasteride)
• NSAIDs
• Antacids

Clinical Approach to Medication-Induced ED

When evaluating ED potentially caused by medication:

1. Review medication history thoroughly, focusing on the classes mentioned above
2. Consider temporal relationship between medication initiation and onset of ED
3. Evaluate for dose-dependent effects as many medications cause ED in a dose-related fashion 3
4. Consider alternative medications within the same therapeutic class that may have lower ED risk

Treatment Options for ED

If a patient requires treatment for ED, several options are available:

• PDE-5 inhibitors - High-quality evidence shows these improve successful sexual intercourse in 68-69% of cases compared to 33-36% with placebo 1

  • Sildenafil
  • Vardenafil
  • Tadalafil (may be preferred due to longer duration of action) 4

• Topical agents - Alternative for patients who cannot take oral PDE-5 inhibitors 5

  • Topical alprostadil (effective in 67-75% of patients)
  • Glyceryl trinitrate (MED2005)
  • MED3000 (over-the-counter formulation)

Key Points to Remember

• Medication-induced ED accounts for approximately 25% of ED cases 3
• ED caused by medications is typically reversible upon discontinuation or substitution of the offending agent 3
• Always consider medications as a potential cause of ED before pursuing extensive investigations
• No evidence suggests midoxinil is associated with erectile dysfunction

When evaluating a patient with ED, carefully review their medication list for known ED-inducing drugs rather than focusing on medications like midoxinil that have no documented association with erectile dysfunction.