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

From the Guidelines

Men with erectile dysfunction should be treated with an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), such as sildenafil, tadalafil, vardenafil, or avanafil, unless contraindicated, as these medications have been shown to be effective and safe in improving erectile function 1. The choice of PDE5i should be based on individual patient preferences, including ease of use, cost of medication, and adverse effects profile.

• Sildenafil, tadalafil, vardenafil, and avanafil have similar efficacy in the general ED population, with dose-response effects observed across different dosing regimens 1.
• The most frequently reported adverse events associated with PDE5i use are dyspepsia, headache, flushing, back pain, nasal congestion, myalgia, visual disturbance, and dizziness, with average rates similar across medications 1.
• It is essential to instruct patients on how to maximize the benefit and efficacy of PDE5i, including proper dosing and timing of administration, as well as potential interactions with other medications, such as nitrates 1.
• If PDE5 inhibitors are ineffective, alternative treatments, such as alprostadil, vacuum erection devices, or penile implants, may be considered, and patients should be consulted to determine the most appropriate option based on their individual health status and other medications.

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) LEVITRA should be administered to these patients after careful benefit-risk assessment Treatment for erectile dysfunction should generally be used with caution by patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis, or Peyronie’s disease)

Medications for erectile dysfunction include:

• 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 administered with caution in patients with certain medical conditions, such as severe hepatic impairment or anatomical deformation of the penis 3 Key considerations:
• Patients should be counseled on the proper use of these medications and potential interactions with other drugs 2
• Treatment for erectile dysfunction should be used with caution in patients with certain medical conditions, such as heart problems or bleeding disorders 3

From the Research

Medications for Erectile Dysfunction

• Phosphodiesterase type 5 (PDE5) inhibitors are effective, safe, and well-tolerated therapies for the treatment of men with erectile dysfunction 4
• Sildenafil is an oral therapy for erectile dysfunction of a broad range of causes, and it allows corpus cavernosum smooth muscle to relax, potentiating erections during sexual stimulation 5
• PDE5 inhibitors, such as tadalafil, vardenafil, udenafil, avanafil, and mirodenafil, are equally effective and safe for the treatment of erectile dysfunction 6

Treatment Options

• On-demand use of any PDE5 inhibitor is also safe for patients with comorbid conditions 6
• Daily treatment is another option in men with erectile dysfunction and documented vascular or prostate disease 6
• Intracavernosal injection therapy with alprostadil is an effective and well-tolerated treatment for men with erectile dysfunction, and it should be offered to patients as second-line therapy 4
• Intraurethral and topical alprostadil are effective and well-tolerated treatments for men with erectile dysfunction, and they should be considered second-line therapy if available 4

Choosing the Right Medication

• The choice of PDE5 inhibitor should be based on the individual patient's profile, creating an individualized treatment plan 7
• Factors such as age, comorbid conditions, and patient preferences should be taken into account when choosing a PDE5 inhibitor 7
• Dose titration of PDE5 inhibitors to the maximum tolerated dose is strongly recommended because it increases efficacy and satisfaction from treatment 4

Combination Therapy

• Combination therapy with androgen supplementation and PDE5 inhibitor appears safe, but its efficacy is uncertain and requires further research 8
• Combination therapy with an α1-adrenoceptor antagonist and PDE5 inhibitor shows no advantageous effect on erectile dysfunction compared with PDE5 inhibitor monotherapy 8
• The efficacy of combining PDE5 inhibitor with metformin, folic acid, or 5-alpha-reductase inhibitors is uncertain and requires further research 8