þ˸CialisĽ÷¿ְų÷»Ͼ°죬þ˸ PDE5phosphodiesterase type 5Ǽ̵Ǻؾմϴ١̷÷°÷»ǿ̵ɼִºýŰNon-arteritic anterior ischemic optic neuropathy, NAIONιҼֽϴ١ PDE5̷κǰֽϴ١ýŰ 50̻dz 100,000 2.5-11.8ϰ PDE5ѻ 2ߺȮ̳κǰֽϴ١ýŰξҴǰþ˸ PDE5Ǻ뿡ǰʿϸ磬ص쿡ؾմϴ١
ߵǽְִȯڿ뷮ʿʴ´١ѽȯڿŸٶ 1 1ȸ뷮ʴ´١ǻ 3.2 11.2ൿƯ.
ǽְִȯڿ뷮ʿʴ´١ѽȯڿŸٶ 1 1ȸ뷮ʴ´١ [ǻ 3.3 11.2ൿƯ.
̾ 18̸ǻԻؼ¾ȵȴ١
þ˸ǻ
1.
1̾ϰϴȯڴ¾ฮοϱ߱ϰαٿοϱϿк£medical historyü˻磨physical examinationǽϿѴ١
2μݵǴ½忡輺ֱ߱ġḦϱǻȯǽ¸ϿѴ١Ľȯõȯڴ´̻Ǽﰡ̸ǻ翡Ծ˷Ѵ١
3̰迭Ǿ 4ð̻ӵȹ߱ӹ߱6ð̻ѹ߱⣩̵幰ԺǾ١ 4ð̻߱Ⱑӵɰǻǵmedical assistance϶ȯڿԾ˷־ϸ磬ӹ߱ġǼջ߱ǿʷҼִ١
4̾ϱ̳ϴµȹĸ꿰Ǵ NO Ʈα۸ƹгƮƮ̼ҼҸ壩ϴ°аۿǾϰ̶Ƿǻ̾óϱȯڰ꿰 NO ʾҴȮϿϸ磬̾߹꿰 NO ʵǽŲ١
5ɱٰҾunstable angina pectorisɽǺƣventricular arrhythmiaߣϰۣtransient ischemic attacks룬ɰߴѽػʣcardiovascular events̾ӻ/Ǵ½߿Ͽ١ӻ迡аУüԣ幰ԳŸ١̷ػʵ̳ŸȯڵǴκͽڵ飨pre-existing cardiovascular risk factors־١̷ػʵ̽ڵǴ̾Ǵ¼Ǵ̷ڵնǴ´ٸڵοִºиʾҴ١
6Ÿٶ 612 25mg/kg/ϣ20mgǴȸ뷮üȳ⺸ּ 3踦Ѵ³⡼ 3.718.6] ʷױ̻ǿ뷮ΰϺΰspermatogenesisǰҸǣseminiferous tubular epitheliumࣨregression־١
̾spermatogenesisοϱأ 10mg 6Ϻϰų 20mg 6Ǵ 9Ϻѳ鿡 3ӻ̽ǽõǾ١ 2ǿŸٶġͰϿӻŸ缺̴ڼڿͳǰҰǾ١ڿ£ڱȣfollicle stimulating hormoneǴٸôǺȭ°ʾҴ١11. 1Ư.
7½ɽ : 뵿Ưļ뵿Ϻִȯڴ PDE5 Ȯۿ뿡ΰҼִ١
2.ȯڿ
1꿰organic nitrate/Ǵ°κϴȯڿԴ̾ݱ̴١1. 6.ȣۿ.ӻ迡Ÿٶʣtadalafil꿰nitrateۿ۰γŸ١ŸٶȮ强ǷΣϽణҽŰ硼11. 1Ưװ꿰ۿŲ١̰һȭnitric oxide/cGMP ο꿰ŸٶǺȿǰǴܵȴ١
2̾ѹ߱erectile dysfunctionġϴ¾ʴ½ȯcardiac diseaseִ³Իؼ¾ȵȴ١ǻͽȯִȯڿν裨cardiac riskϿѴ١
3ȯִ´ȯڱӻ迡ԵʾǷ̾ǻ̱ݱ̴١ :
ֱ 90̳ɱٰmyocardial infarction־ȯ
Ҿunstable anginaǴ¼sexual intercourse߿angina־ȯ
ֱ 6 New York Heart Association Class 2 Ǵ±̻ǽɺheart failure־ȯ
ʴ£uncontrolledƣarrhythmiasУ90/50mmHgǴʴ°У170/100mmHgȯ
ֱ 6̳ߣstroke־ȯ
4ҼϿ̹̾˷༺ȯڴӻ迡ԵʾǷ̾ǻ̱ʴ´١
5̾Ÿٶ̳̾Ǽпhypersensitivityִȯڿϸȵȴ١
6̾ٸ߱ġǺ뿡Ѿȿ̿ʾǷδٸ߱ġǺ±ʴ´١
7̾ϰǷΣҳgalactose intolerance Lapp ȿҰLapp lactase deficiencyǴ~֣glucose-galactose malabsorptionιִȯڿԴϸȵȴ١
8 PDE5 뿩οͰ̺ýŰNon-arteritic anterior ischemic optic neuropathy, NAIONʴǽ÷̼սǵȯڿԴ̾ϸȵȴ١
9̾ PDE5 GC ڱGuanylate Cyclase Stimulatorñѣϴ°죬 GC ڱGuanylate Cyclase StimulatorаȿųǷΣξǺ±ݱ̴١
3.ȯڿ½Ұ
1غαȯڣangulationظ鼶cavernosal fibrosisǴ Peyronies diseaseǴ氭Ǽ̵ȯڣsickle cell anemiaٹmultiple myelomaǴ¹Դ̾ѹ߱ġϿѴ١
2Ÿٶʳ⣨AUCӻڷᣬŬɷº̾ 1 1ȸѽָȯڿԴ±ʴ´١
3ɺȯڣChild-Pugh Class C̾Ǿӻڷ̹Ƿǻ½ϰͼ/輺benefit/riskϿϸ磬ߵǰȯڿ̾ǿ뷮 10mgʰؼ¾ȵȴ١
ְִȯڵ鿡Ÿٶ 1 1ȸ뷮̿밡ڷᰡǷóϴ°죬ǻ½ϰͼ/輺benefit/riskϿѴ١
4ţdoxazosinģ1alpha1 blockersϴȯڿ̾ϸϺȯڿ̳Ÿִ١6.ȣۿ.Ÿٶʰalpha blockersǺʴ´١
5 CYP3A4 ritonavir, saquinavir, ketoconazole, itraconazole, erythromycinϴȯڿ̾Ÿٶdz⣨AUCǾǷϿѴ١6.ȣۿ.̾ CYP3A4 Ұ쿡̾뷮ְ 10mgʰʵϸ磬̾ 72ðϿ¾ȵȴ١
6߱γѿΣpotential underlying causeǷġȮϿѴ١̺̾Ű溸ġradical non-nerve-sparing prostatectomyȯڿȿΰ˷ʴ١
4.̻
1ӻ
ӻپǿǽõǹǷΣѾӻ迡Ǵ̻ٸӻ迡ǹҼӻǴºݿҼִ١
Ÿٶνǽӻ迡 9,000̻dzǾ١ 1 1ȸ̾ӻ迡 1434, 905, 115ּ̰ 6 1⣬ 2⵿Ҵ١ʿúϴ¿ؼ£ 1300 1000̻̰ 6 1⵿Ҵ١
߱ʿú
12ֵȽǽõ 8ֿӻ迡̾ȯտ 5922-88̾ 10 Ǵ 20mgȯڿ̻ߴܷ 3.1%ιݸ飬౺ 1.4%١
ӻ迡ȹٿʿúϴ¿̾Ͽ̻̺Ǿ٣ǥ 1
ǥ 1: ߱ʿú 8ֿӻ迡索ȯڿѽԣ̾ࣨ10 Ǵ 20mgȯ 2%̻ǰؾϰԺȾġ̻
̻ | (N=476) | Ÿٶ 5mg(N=151) | Ÿٶ 10mg(N=394) | Ÿٶ 20mg(N=635) |
| 5% | 11% | 11% | 15% |
ȭҷ | 1% | 4% | 8% | 10% |
| 3% | 3% | 5% | 6% |
| 1% | 1% | 4% | 3% |
| 1% | 2% | 3% | 3% |
ȫ* | 1% | 2% | 3% | 3% |
ȴٸ | 1% | 1% | 3% | 3% |
*ȫǿ¾ȸȫȫԡ
߱ 1 1ȸ
12 Ǵ 24ֵȽǽõ 3ӻ迡̾ȯտ 5821-82̾ȯڿ̻ߴ 4.1%ιݸ飬ȯڿ 2.8%١
12ֵȽǽõӻ鿡̻̺Ǿ٣ǥ 2
ǥ 2: ߱̾ 1 1ȸ 12ֵ 3ֿ 3ӻ迡索ȯڿѽԣ̾ 1 1ȸ2.5 Ǵ 5mgȯ 2%̻ǰؾϰԺȾġ̻
̻ | (N=248) | Ÿٶ 2.5mg(N=196) | Ÿٶ 5mg(N=304) |
| 5% | 3% | 6% |
ȭҷ | 2% | 4% | 5% |
εο | 4% | 4% | 3% |
| 1% | 3% | 3% |
| 1% | 3% | 3% |
ȫ | 1% | 1% | 3% |
| 1% | 2% | 2% |
ħ | 0% | 4% | 2% |
| 0% | 1% | 2% |
| 0% | 2% | 2% |
ȴٸ | 0% | 1% | 2% |
| 0% | 2% | 0% |
ĵ ȯ | 0% | 2% | 1% |
| 0% | 2% | 1% |
̻ 1ӻ迡 24ֿĺȰ̴٣ǥ 3
ǥ 3: ߱̾ 1 1ȸ 24ֵ 1ӻ迡̾ 1 1ȸ루2.5 Ǵ 5mgȯ 2%̻ǰؾϰԺȾġ̻
̻ | (N=94) | Ÿٶ 2.5mg(N=96) | Ÿٶ 5mg(N=97) |
εο | 5% | 6% | 6% |
忰 | 2% | 3% | 5% |
| 3% | 5% | 2% |
| 0% | 3% | 4% |
ȭҷ | 1% | 4% | 1% |
ĵ ȯ | 0% | 3% | 2% |
| 2% | 4% | 1% |
| 0% | 1% | 3% |
| 0% | 0% | 4% |
缺缺߱ȯڿ 1 1ȸ
12ֱⰣǣ 3~ 3ӻ裨 2缺ȯڣ 1缺߱ȯڣ̾ȯտ 6344-93̻ߴ 3.6%ιݸ飬ȯڿ 1.6%١̾ 2ȯڿغġߴ̻δµ룬̴١̻̺Ǿ٣ǥ 4
ǥ4: 缺 1 1ȸ̾ 12ġⰣǣ 3~ӻ迡 1 1ȸ 5 mg ġȯǡ1%ǰຸٳγŸġ̻2Ǿ缺ӻ 1Ǿ缺߱ӻԣ
̻ | (N=576) | Ÿٶ 5mg(N=581) |
| 2.3% | 4.1% |
ȭҷ | 0.2% | 2.4% |
| 1.4% | 2.4% |
εο | 1.6% | 2.1% |
| 1.0% | 1.4% |
ȴٸ | 0.0% | 1.4% |
| 0.3% | 1.2% |
| 0.5% | 1.0% |
߰Σ缺߱缺ӻ迡̻<1%δĵɣ䣬룬ࣨmuscle spasmִ١
Ǵ±ǥ 1 4ȺκǾ١̾ӻฮ迡Ǵ±Ϲ 12-24ðĿϿϹ 48ð̳ҽǵǾ١̾Ͱõȿ/ȮϺ㸮кΣǴµ㸮Ư¡Ÿ磬ȾδؾȭǾ١ϹΣǴߵκǾġ̼ҽǵǾǿκǾ٣纸 <5%ġᰡʿҶƼƮƹ̳Ǵº̵强ҿϹȿġḦϴϺο浵Ǹ༺ڵΣǾ١Σʿÿ̾ѸǾ 0.5%/ǰߴϿ١ 1Ⱓ迡ȯǰ 5.5% 1.3%Ǿ١ջǴ½żջ˻ѱŴ¾١߱缺缺/߱̾ 1 1ȸǥ 2, 3, 4Ͽ١̾ 1 1ȸ뿡ѽ迡̻ϹΰǴߵ̾ߴ <1%١
̾Ѹ鿡ȭǺµ幰٣ȯ <0.1%
߱ʿú~ӻ鿡̾ 65̻ȯڵ鿡Լ簡ϰԺǾ١2.5%
1 1ȸǴʿÿκ̾Ǵӻ迡߰Σ̻<2%Ÿ̴١̷̻̾ΰüȮʴ١̸ϿܵȰϰðɼ̾ȮʾƼǹ̰»ʵ̴١
: ٹ£ȸǷΣʺ
: 룬Уɱٰ⸳Уɰǽţ
ȭ : ɰ˻ġϰĵ GGTP ɣ䣬ĵġ
ٰݰ : 룬
Ű : ϣҸ̻
:
ȣ : ȣεο
Ǻ :
Ȱ : þ帲̻ḷḷԣкǮ
û : ۽û°ҶǴ»ǣ̸
ı : ߱ڹ߱
2ؿܽĻ
̻̾ǽĻⰣȮεǾ١̷ѹƯũǸκڹκǾǷΣΰüȮϰų̵ǺŷҼִ°ƴϴ١̷̻ߴ뼺Ѵٸ̾Ǵ̵ڵǺҷԵǾ١
׳~̾ǻϽΰִ°δ½ɱٰ嵹磬ߣ룬ɰɽǺƹߴѽ̻̽ĺǾ١̵ȯڵδ¾ƴκбڰ־١̷̻ߴκ߶ǴĿѰκǾϺδ¼̣̾ĿѰκǾ١ٸ̻̾ļðĿѰκǾ١̷̻̾࣬ȯDZȯΰ̷ִڵǺҵִǴ´ٸڵִδȮҼ٣1.
~ε巯⣬Ƽ~ıǥǹڸǺοѰι
Ű~룬۹ߣϰü
Ȱ~þ߰գ⣬⣬÷»ѽ÷°ǿ̵ǴºýŰNon-arteritic anterior ischemic optic neuropathy [NAION]̾ PDE5 ǻñΰϿĵ幰ԺǾ١̷ȯڵδ¾ƴκ̱ѣݵ̿¾ NAIONǹغڶǴڸ־٣Ըlow cup/ disc ratio, crowded disc 50̻索Уȯ5.Ϲ
û̾ PDE5 ǻñοִ°ΰ۽ûǶǴ°ʰǾ١Ϻʿû̻߿ѿҼִ¹ױŸڵ̺Ǿ١ʿ̾١̷Ժ̻̾ǻΰִȯûǿѱڿͰ̷ִڵǺҿѰٸڿѰδȮҼ٣5.Ϲ
ıӹ߱1.
鿪
3̾ 1 1ȸý̻ƣPrimarily sinus bradycardia౺پణԹǾ١κǽ̻̻Ͽ١
4
Ÿٶ 5mg ǽ
ܱɻ縦Ͽ 4⵿ 613ǹ߱ȯڸνǽѽػʹΰ迡 4.73%29/613 37ǣγŸ磬̾ΰ踦Ҽ¾ع 3.75%23/613 31ǣ̾١
ع 1.14%7/6137ǡ, 0.82%5/6135ǡ,ȫ 0.65%4/6134ǡ,ȸȫ 0.49%3/6133ǡ, 0.33%2/6132ǡ,̻ð֣ɰȭҷȸ 0.16%1/6131ǡǾ١
ߴѾع١
Ѿعð 0.16%1/6131ǡκǾ١
Ÿٶ 10mg, 20mg ǽ
ܱɻ縦Ͽ 6⵿ 10,500ȯڸνǽѽػʹΰ迡 3.94%414/10,500 517ǣγŸ磬̾ΰ踦Ҽ¾ع 3.47%364/10,500 461ǣ̾١
ع룬ȸȫ 1.30%136/10,500 136ǣΰ帹磬ȭҷ 0.33%35/10,500 35ǣ 0.19%20/10,500 21ǣ 0.12%13/10,500 13ǣ 0.11%12/10,500 12ǣ 0.07%7/10,500 7ǣӹ߱ 0.06%6/10,500 6ǣ 0.06%6/10,500 6ǣ 0.05%5/10,500 5ǣɰ 0.04%4/10,500 5ǣƼSGPT 0.04%4/10,500 4ǣз°䣬ĮλȿǷΰ 0.03%3/10,500 3ǣ䵵ȯǰҾȣ֣ҰҰ 0.02%2/10,500 2ǣ 0.01%1/10,500 2ǣ룬룬ȣǮα⣬ḷΰã֣ٱıȫݣ֣ȫɱٰͿ︲ڸũƼκ裬룬˷ƼSGOT 0.01%1/10,500 1ǣǼǾ١
ߴѾعȸȫ 0.02%2/10,500 2ǣ̾١
Ѿع 0.31%33/10,500 37ǣΣ 0.06%6/10,500 6ǣĮλȿ 0.03%3/10,500 3ǣҾȣ䵵Ұңǰ̰ 0.02%2/10,500 2ǣȣḷٱı֣֣ڸũƼȫ̰ 0.01%1/10,500 1ǣǾ١
5ڹۿ뺸ۿ̺ȴٸǾǰѺۿϿϰԹػ߿ػʴ´̳Ÿ١ٸ̾ΰȮεʾҴ١
ȿmedicine ineffective
:
ٰݰ :
5.Ϲ
1ȯǴʶǴ¾ʴ۽÷»̹ϴ°죬ǻ̾ phosphodiesterase type 5PDE5ǻҰȯڿԱǰϰǸ←Ѵ١̷ν÷»ѽ÷°ǿ̵ɼִ£幰ԳŸκýŰNon-arteritic anterior ischemic optic neuropathy, NAION¡İɼ磬̴½翡幰ԺǾ PDE5 λִ°γŸ١ǥȹ忡飬ýŰǿ 50̻dz 100,000 2.5-11.8̴١
~ NAION 5 ݰ̳ PED5 迭Ѱ NAION ̱پռⰣ PDE5 ѰͺϿǾ١ NAION ̾ 2ϴ°õǾ磬ġ 2.15 95% CI 1.06, 4.34١ѽ迡ϰȰǾ磬ġ 2.27 95% CI 0.99, 5.20̾١̵迡¡ȡýŰͰ NAIONDZŸ NAION ִ١ǵ幮Ǵ° PDE5 NAIONǰü PDE5 NAION ΰ踦ħ¾ʴ´٣4.̻
ǻ±ǺýŰڰִȯڵ PDE5 ѿִθؾѴ١̹̺ýŰִ»ǰ죬ýŰ̴١̷ȯڵ鿡̾ PDE5 ϴ°Ǹ←ϸ磬Ǵͼȸϴ°쿡ؾѴ٣4.̻
2̻̾ǴȰȭ˾ȯڿѰ̾١̰̾ǰڿԼðŰʴ°γŸ̻ǴȰȭ˾ȯڿԴͼ/輺ĽѴ١
3̾ڿΰȮۿǷκаۿɼִ١ǻ¸Ǿڿð̾Ǻýɹڼаң⸳Ĺ̳ŸȯڿԾ˷־Ѵ١
4۽û°Ǵ³û̸̵ݵɼ̹ϴ°죬ǻ̾ PDE5 ǻҰȯڿԱǰϰǸ←Ѵ٣̻ס硯
5Ÿٶ 5mg 1 1ȸ 2 6̻ӻ٣Ÿٶ 5mg ԣ