{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:21:32Z","timestamp":1787775692825,"version":"build-2784847793"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>\n                      The objective is to evaluate the efficacy of coadministration of garlic (as a hydrogen sulfide [H\n                      <jats:sub>2<\/jats:sub>\n                      S] donor) and tadalafil for patients with ED using a placebo-controlled, prospective, randomized, two-arm pilot study in patients responding poorly to tadalafil alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>\n                      The patients with complaints of ED (with normal penile Doppler) who failed to maintain sustained improvement in erectile function with tadalafil were recruited after excluding those with comorbidities. The study sample was randomized into two groups. Group A received garlic 5 g twice a day orally and Group B received a placebo twice daily orally for 4 weeks. Both groups continued tadalafil 5 mg in the night for 4 weeks. Their erectile function was assessed at the beginning and at the end of 4 weeks using the International Index of Erectile Function (IIEF-EF), erectile function domain and compared. A value of\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2264 0.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Nineteen patients in Group A (mean age 37.5 \u00b1 10.6 years) and 16 patients in Group B (mean age 39.6 \u00b1 9.6 years) participated in the pilot study conducted from May 2022 to August 2022. The participants treated with garlic (as an H\n                      <jats:sub>2<\/jats:sub>\n                      S donor) as a coadministrant had statistically significant improvement in IIEF-EF score (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2264 0.0001) at the end of 4 weeks compared to placebo.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>\n                      Garlic (as an H\n                      <jats:sub>2<\/jats:sub>\n                      S donor) as adjunctive therapy was beneficial in our study participants responding poorly to tadalafil alone.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijp.ijp_310_23","type":"journal-article","created":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T15:17:36Z","timestamp":1725895056000},"page":"242-247","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Prospective, randomized, placebo-controlled, two-arm study to evaluate the efficacy of coadministration of garlic as a hydrogen sulfide donor and tadalafil in patients with erectile dysfunction not responding to tadalafil alone \u2013 A pilot study"],"prefix":"10.4103","volume":"56","author":[{"given":"Gajanan Shripad","family":"Bhat","sequence":"first","affiliation":[{"name":"Department of Urology and Sexual Medicine, TSS Shripad Hegde Kadave Institute of Medical Sciences and PG Hospital, Sirsi, Uttara Kannada, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuradha","family":"Shastry","sequence":"additional","affiliation":[{"name":"Department of Urology and Sexual Medicine, TSS Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,9,10]]},"reference":[{"key":"R1-20240909","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jsxm.2015.12.019","article-title":"Definitions of sexual dysfunctions in women and men:A consensus statement from the fourth international consultation on sexual medicine 2015","volume":"13","author":"McCabe","year":"2016","journal-title":"J Sex Med"},{"key":"R2-20240909","first-page":"407","article-title":"Phosphodiesterase-5 (PDE5) inhibitors in the management of erectile dysfunction","volume":"38","author":"Huang","year":"2013","journal-title":"P T"},{"key":"R3-20240909","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1111\/andr.12255","article-title":"First-generation phosphodiesterase type 5 inhibitors dropout:A comprehensive review and meta-analysis","volume":"4","author":"Corona","year":"2016","journal-title":"Andrology"},{"key":"R4-20240909","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1136\/bmj.332.7541.589","article-title":"Treating erectile dysfunction when PDE5 inhibitors fail","volume":"332","author":"McMahon","year":"2006","journal-title":"BMJ"},{"key":"R5-20240909","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.urology.2004.10.060","article-title":"Co-administration of low doses of intranasal PT-141, a melanocortin receptor agonist, and sildenafil to men with erectile dysfunction results in an enhanced erectile response","volume":"65","author":"Diamond","year":"2005","journal-title":"Urology"},{"key":"R6-20240909","doi-asserted-by":"crossref","first-page":"H835","DOI":"10.1152\/ajpheart.00293.2015","article-title":"Analysis of erectile responses to H2S donors in the anesthetized rat","volume":"309","author":"Jupiter","year":"2015","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"R7-20240909","first-page":"8","article-title":"Garlic: Nature's panacea","volume":"8","author":"Suvarna","year":"2015","journal-title":"Asian J Pharm Clin Res"},{"key":"R8-20240909","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/j.eururo.2011.07.053","article-title":"Minimal clinically important differences in the erectile function domain of the international index of erectile function scale","volume":"60","author":"Rosen","year":"2011","journal-title":"Eur Urol"},{"key":"R9-20240909","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.4103\/0019-5545.196977","article-title":"Clinical practice guidelines for management of sexual dysfunction","volume":"59","author":"Avasthi","year":"2017","journal-title":"Indian J Psychiatry"},{"key":"R10-20240909","first-page":"7","article-title":"Development of alcohol-free herbal mouthwash having anticancer property","volume":"2","author":"Chowdhury","year":"2013","journal-title":"Res Rev J Herb Sci"},{"key":"R11-20240909","first-page":"24","article-title":"Quantification and characterization of allicin in garlic extract","volume":"5","author":"Mansor","year":"2016","journal-title":"J Med Bioeng"},{"key":"R12-20240909","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S0090-4295(97)00238-0","article-title":"The international index of erectile function (IIEF):A multidimensional scale for assessment of erectile dysfunction","volume":"49","author":"Rosen","year":"1997","journal-title":"Urology"},{"key":"R13-20240909","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S0090-4295(99)00099-0","article-title":"Diagnostic evaluation of the erectile function domain of the international index of erectile function","volume":"54","author":"Cappelleri","year":"1999","journal-title":"Urology"},{"key":"R14-20240909","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1177\/0962280215588241","article-title":"Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable","volume":"25","author":"Whitehead","year":"2016","journal-title":"Stat Methods Med Res"},{"key":"R15-20240909","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jare.2020.05.015","article-title":"Role of hydrogen sulfide in endothelial dysfunction: Pathophysiology and therapeutic approaches","volume":"27","author":"Citi","year":"2021","journal-title":"J Adv Res"},{"key":"R16-20240909","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.bcp.2017.11.014","article-title":"A review of hydrogen sulfide (H(2)S) donors: Chemistry and potential therapeutic applications","volume":"149","author":"Powell","year":"2018","journal-title":"Biochem Pharmacol"},{"key":"R17-20240909","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1111\/j.1743-6109.2007.00561.x","article-title":"Hydrogen sulphide: A novel endogenous gasotransmitter facilitates erectile function","volume":"4","author":"Srilatha","year":"2007","journal-title":"J Sex Med"},{"key":"R18-20240909","doi-asserted-by":"crossref","DOI":"10.1111\/and.12885","article-title":"Do penile haemodynamics change in the presence of hydrogen sulphide (H(2)S) donor in metabolic syndrome-induced erectile dysfunction?","volume":"50","author":"Dayar","year":"2018","journal-title":"Andrologia"},{"key":"R19-20240909","doi-asserted-by":"crossref","first-page":"4513","DOI":"10.1073\/pnas.0807974105","article-title":"Hydrogen sulfide as a mediator of human corpus cavernosum smooth-muscle relaxation","volume":"106","author":"d'Emmanuele di Villa Bianca","year":"2009","journal-title":"Proc Natl Acad Sci U S A"},{"key":"R20-20240909","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1002\/nau.24333","article-title":"Evaluation of combined therapeutic effects of hydrogen sulfide donor sodium hydrogen sulfide and phosphodiesterase type-5 inhibitor tadalafil on erectile dysfunction in a partially bladder outlet obstructed rat model","volume":"39","author":"Yilmaz-Oral","year":"2020","journal-title":"Neurourol Urodyn"},{"key":"R21-20240909","doi-asserted-by":"crossref","first-page":"529","DOI":"10.2164\/jandrol.111.014936","article-title":"Role of hydrogen sulfide in the physiology of penile erection","volume":"33","author":"Qiu","year":"2012","journal-title":"J Androl"},{"key":"R22-20240909","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1055\/s-2006-960087","article-title":"HPLC analysis of Allicin and other thiosulfinates in garlic clove homogenates","volume":"57","author":"Lawson","year":"1991","journal-title":"Planta Med"},{"key":"R23-20240909","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1021\/jf60174a007","article-title":"Flavour components of garlic extract","volume":"19","author":"Brodnitz","year":"1971","journal-title":"J Agric Food Chem"},{"key":"R24-20240909","doi-asserted-by":"crossref","first-page":"17977","DOI":"10.1073\/pnas.0705710104","article-title":"Hydrogen sulfide mediates the vasoactivity of garlic","volume":"104","author":"Benavides","year":"2007","journal-title":"Proc Natl Acad Sci U S A"},{"key":"R25-20240909","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.2165\/00003495-200363200-00004","article-title":"Tadalafil","volume":"63","author":"Curran","year":"2003","journal-title":"Drugs"},{"key":"R26-20240909","doi-asserted-by":"crossref","first-page":"9161","DOI":"10.1073\/pnas.1202916109","article-title":"Hydrogen sulfide and nitric oxide are mutually dependent in the regulation of angiogenesis and endothelium-dependent vasorelaxation","volume":"109","author":"Coletta","year":"2012","journal-title":"Proc Natl Acad Sci U S A"}],"container-title":["Indian Journal of Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijp.ijp_310_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:39:27Z","timestamp":1787773167000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijp.ijp_310_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ijp.ijp_310_23","relation":{},"ISSN":["0253-7613","1998-3751"],"issn-type":[{"value":"0253-7613","type":"print"},{"value":"1998-3751","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]},"assertion":[{"value":"2023-05-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-12","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}