From the Guidelines
Treatment options for erectile dysfunction should start with oral medications like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra), which are typically the first-line treatment. These PDE5 inhibitors work by enhancing blood flow to the penis when sexually stimulated, with dosages ranging from 5-100mg depending on the specific medication, taken 30 minutes to 2 hours before sexual activity 1.
- Alternative treatments include vacuum erection devices that physically draw blood into the penis, penile injections like alprostadil (doses 5-40 mcg), urethral suppositories, testosterone replacement for men with low testosterone levels, and penile implants for severe cases.
- Lifestyle modifications are also important, including regular exercise, maintaining healthy weight, quitting smoking, limiting alcohol, managing stress, and treating underlying conditions like diabetes or heart disease 1.
- The choice of treatment depends on the underlying cause of erectile dysfunction, severity of symptoms, overall health status, and personal preferences.
- Most men can find an effective treatment option through consultation with their healthcare provider, and it is recommended that phosphodiesterase type 5 inhibitor (PDE5i) medications be used to help men with erectile dysfunction 1.
- Men who do not respond to PDE5i medications should consider alternate interventions, such as a vacuum erectile device (VED), medicated urethral system for erection, or intracavernosal injection 1.
From the FDA Drug Label
The efficacy and safety of tadalafil in the treatment of erectile dysfunction has been evaluated in 22 clinical trials of up to 24-weeks duration, involving over 4,000 patients. Tadalafil, when taken as needed up to once per day, was shown to be effective in improving erectile function in men with erectile dysfunction (ED) The recommended starting dose of tadalafil tablets for use as needed in most patients is 10 mg, taken prior to anticipated sexual activity. The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability
Treatment Options for Erectile Dysfunction:
- Tadalafil tablets for use as needed, with a recommended starting dose of 10 mg
- Tadalafil tablets for once daily use, with a recommended starting dose of 2.5 mg Key Considerations:
- Tadalafil should not be used in men for whom sexual activity is inadvisable as a result of their underlying cardiovascular status
- Patients who experience symptoms upon initiation of sexual activity should be advised to refrain from further sexual activity and seek immediate medical attention 2 2 2
From the Research
Treatment Options for Erectile Dysfunction
The treatment options for erectile dysfunction (ED) include:
- Pharmacotherapy, such as phosphodiesterase type 5 (PDE5) inhibitors, which are effective, safe, and well-tolerated therapies for the treatment of men with ED 3, 4, 5, 6
- Intracavernosal injection therapy with alprostadil, which is an effective and well-tolerated treatment for men with ED 3, 5, 6
- Intraurethral and topical alprostadil, which are effective and well-tolerated treatments for men with ED 5
- Surgical treatment, such as multicomponent inflatable penile implants, which is associated with high satisfaction rates 6
- Lifestyle modifications, such as reduction of comorbid vascular risk factors, and treatment of organic or psychosexual dysfunction with either pharmacotherapy alone or in combination with psychosexual therapy 6, 7
- Vacuum erection devices, which are a minimally invasive intervention to relieve the symptoms of ED 7
Phosphodiesterase Type 5 Inhibitors
PDE5 inhibitors are the most widely prescribed oral agents for the treatment of ED, and they have a satisfactory efficacy-safety profile in patients of all categories 3, 4. The available PDE5 inhibitors include:
- Sildenafil
- Tadalafil
- Vardenafil
- Avanafil
- Udenafil
- Mirodenafil These agents have different pharmacokinetic properties, and the choice of agent may depend on patient preference and individual characteristics 3, 4.
Patient-Reported Outcomes
The aim of ED treatment is to restore an erection satisfactory for the sexual needs of the patient, and patient-reported outcomes are the gold standard in efficacy evaluation 3. Treatment selection and follow-up should address the psychosocial profile and the needs and expectations of a patient for his sexual life, and shared decision making with the patient (and his partner) is strongly recommended 5.