What are the treatment options for erectile dysfunction (ED)?

From the Guidelines

Erectile dysfunction can be effectively treated with oral phosphodiesterase type 5 inhibitors (PDE5i), such as sildenafil, tadalafil, vardenafil, or avanafil, as the first-line treatment option. These medications have been extensively studied, with nearly a quarter of a million men evaluated from the general ED population and approximately 25,000 men evaluated from various special populations, including those with specific underlying conditions [ 1 ]. The choice of a specific PDE5i should be based on the individual preferences of men with erectile dysfunction, including ease of use, cost of medication, and adverse effects profile [ 1 ].

Key Considerations

• PDE5i medications have similar efficacy in the general ED population, with dose-response effects across on-demand dosing versus daily dosing for tadalafil producing the same level of efficacy [ 1 ].
• Men with diabetes and men who are post-prostatectomy have more severe ED at baseline and respond less robustly to PDE5i [ 1 ].
• The most frequently reported adverse events (AEs) in men using PDE5i are dyspepsia, headache, flushing, back pain, nasal congestion, myalgia, visual disturbance, and dizziness [ 1 ].

Treatment Approach

• First-line treatment typically involves oral medications like sildenafil (Viagra, 25-100mg), tadalafil (Cialis, 5-20mg), vardenafil (Levitra, 5-20mg), or avanafil (Stendra, 50-200mg), taken 30-60 minutes before sexual activity [ 1 ].
• For best results, take these medications on an empty stomach (except tadalafil) [ 1 ].
• If oral medications aren't effective, second-line treatments include vacuum erection devices, penile injections with medications like alprostadil, or urethral suppositories [ 1 ].
• Lifestyle modifications are also important: maintain healthy weight, exercise regularly, quit smoking, limit alcohol, manage stress, and control chronic conditions like diabetes or hypertension [ 1 ].

From the FDA Drug Label

Tadalafil tablets are indicated for the treatment of 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.

• Erectile Dysfunction Treatment: Tadalafil tablets are a prescription medicine taken by mouth for the treatment of men with erectile dysfunction (ED).
• Mechanism of Action: Tadalafil tablets help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity.
• Important Considerations: Some form of sexual stimulation is needed for an erection to happen with tadalafil tablets. Tadalafil tablets do not cure ED, increase a man’s sexual desire, protect a man or his partner from sexually transmitted diseases, or serve as a male form of birth control 2, 2, 2.

From the Research

Treatment Options for Erectile Dysfunction

• Phosphodiesterase type 5 (PDE5) inhibitors are a common treatment for erectile dysfunction, including sildenafil, tadalafil, and vardenafil 3, 4, 5, 6
• These medications work by reducing the degradation of cyclic guanosine monophosphate, allowing for relaxation of penile smooth muscle and improved erectile function 3
• PDE5 inhibitors have been shown to be effective in special clinical populations, such as those with prostate cancer, diabetes, and cardiovascular disease 3, 4, 6

Choosing the Right Treatment

• The choice of PDE5 inhibitor should be based on individual patient factors, including medical history, lifestyle, and personal preferences 5
• Factors to consider when choosing a PDE5 inhibitor include duration of action, potential interactions with other medications, and side effects 3, 4, 5
• A systematic approach to selecting a PDE5 inhibitor can help ensure the best possible outcome for each patient 5

Other Treatment Options

• Patient-administered intracorporal injection therapy using vasodilator drugs such as alprostadil is an effective treatment for men who fail to respond to oral pharmacological agents 6
• Surgical treatment of erectile dysfunction with multicomponent inflatable penile implants is associated with high satisfaction rates 6
• Penile arterial revascularisation and venous ligation surgery are associated with relatively poor outcome results in men with penile atherosclerotic disease or corporal veno-occlusive dysfunction 6

Safety and Efficacy

• PDE5 inhibitors have been shown to be safe and effective in the treatment of erectile dysfunction, with a low risk of serious side effects 3, 4, 6
• However, there is a risk of hypotension if nitrates are given concurrently, and increased QTc intervals have been reported with some PDE5 inhibitors 3
• Common side effects of PDE5 inhibitors include headache, facial flushing, nasal congestion, and dyspepsia 3