From the Guidelines
Erectile dysfunction (ED) should be treated with phosphodiesterase type 5 (PDE5) inhibitors as the first-line treatment, including sildenafil, tadalafil, vardenafil, and avanafil, due to their high efficacy and safety profile, as supported by the most recent and highest quality study 1. The treatment of ED typically starts with lifestyle modifications, such as regular exercise, weight management, and reducing alcohol consumption.
- PDE5 inhibitors are the most commonly used medications for ED, and they work by enhancing blood flow to the penis by relaxing smooth muscles and blood vessels, but require sexual stimulation to be effective.
- The choice of a specific PDE5 inhibitor should be based on individual preferences, ease of use, and cost of medication, as well as the patient's medical history and potential side effects, as recommended by the American College of Physicians 1.
- The most recent study from 2018 1 provides strong evidence for the use of PDE5 inhibitors, including sildenafil, tadalafil, vardenafil, and avanafil, with similar efficacy in the general ED population.
- It's also important to address underlying conditions like diabetes, hypertension, or heart disease, as these often contribute to erectile dysfunction, and psychological counseling can be beneficial when anxiety, depression, or relationship issues are factors.
- Alternative treatments, such as alprostadil injections, alprostadil urethral suppositories, vacuum erection devices, or penile implants, may be considered for patients who do not respond to PDE5 inhibitors or have contraindications to their use.
- Testosterone replacement may be considered for patients with low testosterone levels, but the evidence for its effectiveness in treating ED is still limited, and individualized decisions should be made based on clinical presentation and physical findings, as recommended by the American College of Physicians 1.
From the FDA Drug Label
Tadalafil tablets are a prescription medicine taken by mouth for the treatment of: men with erectile dysfunction (ED) Tadalafil tablets helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Vardenafil has not been evaluated in patients with severe hepatic impairment (Child-Pugh C) The safety and efficacy of LEVITRA used in combination with other treatments for erectile dysfunction have not been studied. LEVITRA should be taken approximately 60 minutes before sexual activity.
Treatment Options for Erectile Dysfunction (ED)
- Tadalafil (PO): helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity 2
- Vardenafil (PO): should be taken approximately 60 minutes before sexual activity 3 Key Considerations
- Patients should be counseled regarding the dosing of LEVITRA and advised to contact their healthcare provider for dose modification if they are not satisfied with the quality of their sexual performance with LEVITRA or in the case of an unwanted effect 3
- The safety and efficacy of LEVITRA used in combination with other treatments for erectile dysfunction have not been studied 3
From the Research
Treatment Options for Erectile Dysfunction (ED)
The treatment options for ED include:
- Oral pharmacotherapy with phosphodiesterase type 5 (PDE-5) inhibitors, such as sildenafil, tadalafil, and vardenafil 4, 5, 6, 7, 8
- Patient-administered intracorporal injection therapy using vasodilator drugs such as alprostadil 5
- Surgical treatment with multicomponent inflatable penile implants 5
- Penile arterial revascularisation and venous ligation surgery 5
- Lifestyle modification and reduction of comorbid vascular risk factors 5
- Psychosexual therapy alone or in combination with pharmacotherapy 5, 6
Phosphodiesterase Type 5 (PDE-5) Inhibitors
PDE-5 inhibitors are recognized as efficacious and well tolerated, and are the first-line treatment for ED 4, 6, 7, 8. The choice of PDE-5 inhibitor depends on various factors, including the patient's profile, medical history, and personal preferences 6, 8. The main PDE-5 inhibitors used for the treatment of ED are:
- Sildenafil (Viagra, Pfizer) 4, 7
- Tadalafil (Cialis, Lilly ICOS) 4, 7
- Vardenafil (Levitra, Bayer/GlaxoSmithKline) 4, 7
- Avanafil 5
Efficacy and Safety of PDE-5 Inhibitors
PDE-5 inhibitors have been shown to be effective in treating ED in the general population, as well as in selected patient categories, such as those with diabetes mellitus and those who have undergone bilateral nerve-sparing retropubic radical prostatectomy 4, 5, 7. The efficacy and safety profiles of the different PDE-5 inhibitors are similar, but each has unique features 4, 7.