疑似trichlormethiazide引起勃起功能障礙之案例報告

A Case Report on Erectile Dysfunction Likely Induced by Trichlormethiazide

10.3966/168232812020093003006

林佳慧(Chia-Hui Lin)；陳佩君(Pei-Chun Chen)；曾啟庭(Chi-Ting Tseng)

trichlormethiazide ； thiazide利尿劑 ； 高血壓藥物 ； 勃起功能障礙 ； antihypertensive agents ； erectile dysfunction ； thiazide diuretic ； trichlormethiazide

台灣家庭醫學雜誌

30卷3期（2020 / 09 / 01）

177 - 184

繁體中文

Thiazide利尿劑為原發性高血壓首選用藥之一，本文敘述一位男性高血壓患者，在服用trichlormethiazide後，維持勃起時間縮短，進而影響性交活動，自行停藥後，恢復正常勃起功能。經查藥物仿單、Micromedex與UpToDate之trichlormethiazide藥物不良反應後，發現trichlormethiazide無勃起功能障礙之相關報告，但是進一步搜尋一級文獻，發現有相關藥物不良反應之研究。因此本文針對男性高血壓患者之勃起功能障礙盛行率、高血壓用藥與勃起功能障礙之關係，以及勃起功能障礙之治療方式，進行文獻回顧，建議當醫療人員懷疑病人發生高血壓用藥引發勃起功能障礙時，可考慮停用發生風險較高之thiazide利尿劑、β-blockers（BB）等，並且優先使用勃起功能障礙風險較中性甚至有益處之angiotensin- converting enzyme inhibitors（ACEI）、angiotensin receptor blockers（ARB）或α-1 blockers。

Thiazide diuretics are one of the first-line antihypertensive agents for primary hypertension. In this report, a hypertensive male patient using trichlormethiazide complained about inability to maintain sufficient erection time. After the patient discontinued trichlormethiazide, the problem disappeared. Search focusing on package inserts, Micromedex and UpToDate found no report of trichlormethiazide-induced erectile dysfunction. Not until our search was expanded to include original articles and studies were reports on trichlormethiazide-induced sexual dysfunction discovered. We reviewed the studies about the prevalence of erectile dysfunction in hypertensive men, antihypertensive agents induced male sexual dysfunction, and the treatment for erectile dysfunction. When antihypertensive agents are suspected to induce erectile dysfunction, healthcare professionals should consider discontinuing thiazide diuretics or β-blokcers. Instead, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) or α-1 blockers which have neutral or even beneficial effects on erectile function should be used.

1. (1993).NIH Consensus Development Panel on Impotence: Impotence.JAMA,270,83-90.
2. Bauer, GE,Baker, J,Hunyor, SN,Marshall, P(1978).Side-effects of antihypertensive treatment: A placebo-controlled study.Clin Sci Mol Med,55(s4),341s-14054s.
3. Baumhäkel, M,Schlimmer, N,Kratz, M,Hackett, G,Jackson, G,Böhm, M(2011).Cardiovascular risk, drugs and erectile function-a systematic analysis.Int J Clin Pract,65,289-298.
4. Brindis, RG,Kloner, RA(2003).Sildenafil in patients with cardiovascular disease.Am J Cardiol,92(9A),26M-36M.
5. Burgess, ED,Lacourciere, Y,Ruilope-Urioste, L(2003).Long-term safety and efficacy of the selective aldosterone blocker eplerenone in patients with essential hypertension.Clin Ther,25,2388-2404.
6. Chang, SW,Fine, R,Siegel, D,Chesney, M,Black, D,Hulley, SB(1991).The impact of diuretic therapy on reported sexual function.Arch Intern Med,151,2402-2408.
7. Chrysant, SG(1998).Vascular remodeling: the role of angiotensin-converting enzyme inhibitors.Am Heart,135(Suppl 2),S21-S30.
8. Chrysant, SG(2015).Antihypertensive therapy causes erectile dysfunction.Curr Opin Cardiol,30,383-390.
9. Cordero, A,Bertomeu-Martinez, V,Mazon, P(2010).Erectile dysfunction in high risk hypertensive patients treated with betablockade agents.Cardiovasc Ther,28,15-22.
10. DiPiro, JT(ed.),Talbert, RL(ed.),Yee, GC(ed.),Matzke, GR(ed.)(2017).Pharmacotherapy: A Pathophylogic Approach.New York:McGraw-Hill Education.
11. Fung, MM,Bettencourt, R,Barrett-Connor, E(2004).Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study.J Am Coll Cardiol,43,1405.
12. Gagliano-Jucá, T,Napolitano, M,Del Grossi Ferraz Carvalho, F(2016).Hydrochlorothiazide potentiates contractile activity of mouse cavernosal smooth muscle.Sex Med,4,e113-e123.
13. Grimm, RH, Jr,Grandits, GA,Prineas, RJ(1997).Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women.Treatment of Mild Hypertension Study (TOMHS) Hypertension,29,8-14.
14. Hogan, MJ,Wallin, JD,Baer, RM(1980).Antihypertensive therapy and male dysfunction.Psychosomatics,21,234-237.
15. Keene, LC,Davies, PH(1999).Drug-related erectile dysfunction.Adverse Drug React Toxicol Rev,18,5-24.
16. Kirby, RS(1999).Clinical pharmacology of alpha 1-adrenoceptor antagonists.Eur Urol,36,48-53.
17. Kloner, R(2007).Erectile dysfunction and hypertension.Int J Impot Res,19,296-302.
18. Kolodny, RC(1987).Effects of alpha-methyldopa on male sexual function.Sexual Disabil,1,223-227.
19. Medical Research Council Working Party on Mild to Moderate Hypertension(1981).Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension.Lancet,2,539-543.
20. Naranjo, CA,Sellers, EM,Sandor, P(1981).A method for estimating the probability of adverse drug reactions.Clin Pharmacol Ther,30,239-245.
21. Newman, RJ,Salerno, HR(1974).Sexual dysfunction due to methyldopa.Br Med J,4,106.
22. Papatsoris, AG,Korantzopoulos, PG(2006).Hypertension, antihypertensive therapy, and erectile dysfunction.Angiology,57,47-52.
23. Parthasarathy, HK,Menard, J,White, WB(2011).A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism.J Hypertens,29,980-990.
24. Pickkers, P,Hughes, AD,Russel, FG,Thien, T,Smits, P(1999).Thiazide-induced vasodilation in humans is mediated by potassium channel activation.Hypertension,32,1071-1076.
25. Rockhold, RW(1992).Thiazide diuretics and male sexual dysfunction.Drug Dev Res,25,85-95.
26. Snyder PJ, Rosen RC: Overview of male sexual dysfunction. Post TW, ed. UpToDate, Waltham, MA: UpToDate Inc. https://www. uptodate.com Accessed March 20, 2020.
27. Suzuki, H,Tominaga, T,Kumagai, H,Saruta, T(1988).Effects of first-line antihypertensive agents on sexual function and sex hormones.J Hypertens Suppl,6,S649-S651.
28. Wu, CJ,Hsieh, JT,Lin, JS(2007).Comparison of prevalence between self-reported erectile dysfunction and erectile dysfunction as defined by five-item International Index of Erectile Function in Taiwanese men older than 40 years.Urology,69,743-747.