From the Guidelines
For a patient with erectile dysfunction (ED), I strongly recommend starting with lifestyle modifications and addressing underlying causes before considering medication, with first-line pharmacological treatment typically involving phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil, tadalafil, vardenafil, or avanafil, as supported by high-quality evidence from the American College of Physicians 1.
Key Considerations
- The choice of a specific PDE5 inhibitor should be based on individual patient preferences, including ease of use, cost of medication, and adverse effects profile, as recommended by the American College of Physicians 1.
- It is essential to evaluate and treat underlying conditions like diabetes, hypertension, or depression that may contribute to ED, as these conditions can significantly impact erectile function.
- Patients should also be counseled on reducing alcohol consumption, quitting smoking, maintaining a healthy weight, and managing stress, as these factors can significantly impact erectile function.
Treatment Options
- First-line pharmacological treatment: PDE5 inhibitors such as sildenafil (Viagra) 50mg taken 1 hour before sexual activity, tadalafil (Cialis) 10mg as needed or 2.5-5mg daily, vardenafil (Levitra) 10mg, or avanafil (Stendra) 100mg.
- Second-line options: vacuum erection devices, intracavernosal injections (alprostadil 5-20mcg), or intraurethral suppositories.
- For patients with hormonal deficiencies, testosterone replacement may be beneficial if levels are low, as supported by the management of erectile dysfunction guidelines from the American Urological Association 1.
Patient Education
- Patients and their partners should be informed of the relevant treatment options and their associated risks and benefits, as recommended by the American Urological Association 1.
- The choice of treatment should be made jointly by the physician, patient, and partner, when possible, taking into consideration patient preferences and expectations and the experience and judgment of the physician.
From the FDA Drug Label
In all four fixed-dose efficacy trials, LEVITRA showed clinically meaningful and statistically significant improvement in the EF Domain, SEP2, and SEP3 scores compared to placebo. LEVITRA (5 mg, 10 mg, and 20 mg) was effective in all age categories (<45 to <65, and ≥65 years) and was also effective regardless of race (White, Black, Other) LEVITRA significantly improved the rates of achieving an erection sufficient for penetration (SEP2) at doses of 5 mg, 10 mg, and 20 mg compared to placebo LEVITRA demonstrated a clinically meaningful and statistically significant increase in the overall per-patient rate of maintenance of erection to successful intercourse (SEP3)
Vardenafil (LEVITRA) is effective for the treatment of Erectile Dysfunction (ED), with significant improvements in erectile function, penetration, and maintenance of erection, as demonstrated in multiple clinical trials 2.
From the Research
Treatment Options for Erectile Dysfunction (ED)
- Phosphodiesterase type 5 inhibitors (PDE5Is) such as sildenafil, tadalafil, and vardenafil are available for the treatment of ED 3, 4, 5
- Lifestyle modifications, including smoking cessation, increased physical activity, and a healthy diet, can also improve erectile function 6, 7
Risk Factors for ED
- Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome, and excessive alcohol consumption 6
- Other risk factors for ED include cardiovascular disease, hypertension, diabetes mellitus, hyperlipidemia, hypogonadism, lower urinary tract symptoms, and depression 7
Choosing the Right Treatment for ED
- The choice of PDE5 inhibitor should be based on individual patient factors, including clinical, demographic, and relational factors 5
- A patient-centered care model should be used to increase efficacy and safety of treatments for ED 4