Role of Cilostazol in Vascular Causes of Erectile Dysfunction
Cilostazol has no established role in treating vascular causes of erectile dysfunction, as its primary indication is for peripheral arterial disease with intermittent claudication. 1, 2
Mechanism of Action and Primary Indications
- Cilostazol is a phosphodiesterase type 3 inhibitor that increases cyclic adenosine monophosphate, providing vasodilator and platelet inhibitory properties 1
- The American College of Cardiology/American Heart Association guidelines strongly recommend cilostazol (100 mg orally twice daily) to improve leg symptoms and increase walking distance in patients with peripheral arterial disease and claudication 1
- Cilostazol improves maximal walking distance by 40-60% compared with placebo after 12-24 weeks of therapy in patients with intermittent claudication 1, 2
Why Cilostazol is Not Used for Erectile Dysfunction
- Unlike phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil which are first-line treatments for erectile dysfunction, cilostazol inhibits PDE-3 and has not been studied or approved for erectile dysfunction 3, 4
- PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) specifically target the penile vasculature and are the established first-line pharmacotherapy for vascular erectile dysfunction 4, 5
- No clinical guidelines recommend cilostazol for the treatment of erectile dysfunction, despite its vasodilatory properties 1, 2
Important Safety Considerations
- Cilostazol is absolutely contraindicated in patients with heart failure of any severity due to increased mortality risk associated with phosphodiesterase III inhibitors in this population 1, 6
- The FDA has mandated a black box warning against cilostazol use in heart failure patients 1, 6
- Common side effects of cilostazol include headache (25%), diarrhea (14%), abnormal stools, palpitations, and dizziness (12%) 1, 2
Appropriate Management of Vascular Erectile Dysfunction
- PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) are the first-line pharmacotherapy for erectile dysfunction with vascular causes 3, 5
- PDE-5 inhibitors are effective in up to 80% of patients with erectile dysfunction, depending on etiology 3
- The only major contraindication to PDE-5 inhibitors is concurrent use of nitrates or nicorandil due to synergistic hypotensive effects 3, 7
- Patients with erectile dysfunction should be assessed for cardiovascular disease risk factors, as ED can be a marker of underlying vascular disease 3, 5
Conclusion
While cilostazol is an effective treatment for peripheral arterial disease with intermittent claudication, there is no evidence supporting its use for erectile dysfunction. Phosphodiesterase type 5 inhibitors remain the established treatment for vascular causes of erectile dysfunction.