What are the most effective medications for erectile dysfunction (ED)?

From the Guidelines

The best medications for erectile dysfunction are PDE5 inhibitors, with sildenafil, tadalafil, vardenafil, and avanafil being the most effective options. These medications work by increasing blood flow to the penis by relaxing smooth muscles and dilating blood vessels. According to the most recent and highest quality study, men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated 1. The FDA-approved oral phosphodiesterase type 5 inhibitors (PDE5i) available for management of ED in the U.S. include sildenafil, tadalafil, vardenafil, and avanafil.

Some key points to consider when prescribing these medications include:

• Sildenafil typically works within 30-60 minutes at doses of 25-100mg and lasts 4-6 hours
• Tadalafil offers both daily dosing (2.5-5mg) for ongoing treatment or as-needed dosing (10-20mg) with effects lasting up to 36 hours
• Vardenafil (5-20mg) works similarly to sildenafil but may be less affected by food
• Avanafil (50-200mg) has the advantage of faster onset (15-30 minutes) with fewer side effects
• Common side effects include headache, flushing, nasal congestion, and indigestion
• These medications should not be taken with nitrates due to dangerous blood pressure drops
• Men with cardiovascular disease, liver or kidney problems should consult their doctor before use
• If one medication doesn't work well, trying another PDE5 inhibitor may be beneficial as individual responses vary 1.

It's also important to note that 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 1. Additionally, the patient and, when possible, his partner should be informed of the relevant treatment options and their associated risks and benefits 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 4000 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) Tadalafil was studied in the general ED population in 7 randomized, multicenter, double-blinded, placebo-controlled, parallel-arm design, primary efficacy and safety studies of 12-weeks duration. The primary efficacy and safety trial included a total of 287 patients, with a mean age of 59 years (range 25 to 82 years) Tadalafil, when taken once daily, was shown to be effective in improving erectile function in men with erectile dysfunction (ED). The treatment effect of tadalafil did not diminish over time

Best Medications for Erectile Dysfunction:

• Tadalafil is effective in improving erectile function in men with erectile dysfunction (ED) 2
• Tadalafil can be taken as needed up to once per day or once daily
• The treatment effect of tadalafil does not diminish over time
• Tadalafil is effective at improving erectile function in the general ED population, including patients with diabetes mellitus
• Tadalafil has been studied in multiple clinical trials, involving over 4000 patients, and has been shown to be effective in improving erectile function in men with ED 2 2

From the Research

Best Medications for Erectile Dysfunction

The following medications are commonly used to treat erectile dysfunction:

• Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, tadalafil, and vardenafil, which are recognized as efficacious and well tolerated, and are the first-line treatment for ED 3, 4, 5
• These medications work by increasing blood flow to the penis, allowing for an erection to occur 5
• Other treatment options, such as intraurethral and intracavernosal alprostadil, vacuum pump devices, and surgically implanted penile prostheses, may be considered when PDE5 inhibitors fail 4

Factors to Consider When Choosing a Medication

When choosing a medication for erectile dysfunction, the following factors should be considered:

• The individual patient's profile, including their medical history and current medications 3
• The patient's lifestyle and preferences, such as the frequency of sexual activity and the desire for spontaneity 3
• The potential side effects and interactions of the medication, such as the risk of priapism or interactions with other medications 4, 5

Combination Therapy

Combination therapy, such as the use of PDE5 inhibitors with other medications, may be considered for patients who do not respond to PDE5 inhibitor monotherapy:

• The combination of PDE5 inhibitors with androgen supplementation may be safe and effective for some patients 6
• The combination of PDE5 inhibitors with other medications, such as metformin or folic acid, may also be considered, but further research is needed to determine their efficacy 6