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

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.