From the Guidelines
Erectile dysfunction should be treated with oral phosphodiesterase type 5 (PDE5) inhibitors as the first-line treatment, as they have been shown to be effective in improving sexual intercourse and erectile function in patients with ED. The American College of Physicians recommends that clinicians initiate therapy with a PDE-5 inhibitor in men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use 1.
Some key points to consider when treating erectile dysfunction include:
- The choice of a specific PDE-5 inhibitor should be based on the individual preferences of men with erectile dysfunction, including ease of use, cost of medication, and adverse effects profile 1
- Lifestyle modifications, such as regular exercise, maintaining a healthy weight, quitting smoking, limiting alcohol, and managing stress, can also help improve erectile function
- For those who don't respond to medications, alternatives include vacuum erection devices, penile injections (like alprostadil), urethral suppositories, or penile implants
- It's essential to consult a healthcare provider as ED can be a symptom of underlying health conditions like heart disease, diabetes, or hormonal imbalances that may require specific treatment
The most recent and highest quality study, which is from 2016, also recommends lifestyle modifications and oral agents such as phosphodiesterase type 5 (PDE5) inhibitors as first-line treatment options for erectile dysfunction 1.
In terms of specific medications, options include:
- Sildenafil (Viagra, 25-100mg taken 30-60 minutes before sex)
- Tadalafil (Cialis, 5-20mg as needed or 2.5-5mg daily)
- Vardenafil (Levitra, 10-20mg)
- Avanafil (Stendra, 50-200mg)
It's crucial to review the risks and benefits and proper use of PDE5 inhibitors with patients, as they can have adverse effects and interact with other medications 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. 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.
- Erectile Dysfunction Treatment: Tadalafil is indicated for the treatment of erectile dysfunction (ED) in men.
- Mechanism of Action: Tadalafil helps increase blood flow to the penis, which may help men with ED get and keep an erection satisfactory for sexual activity.
- Clinical Trials: The efficacy and safety of tadalafil in the treatment of ED have been evaluated in 22 clinical trials involving over 4000 patients.
- Key Finding: Tadalafil was shown to be effective in improving erectile function in men with ED 2.
From the Research
Definition and Prevalence of Erectile Dysfunction
- Erectile dysfunction (ED) is a common medical disorder whose prevalence is increasing worldwide 3.
- It is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.
Risk Factors and Lifestyle Modifications
- Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome, and excessive alcohol consumption 3.
- Lifestyle modifications such as smoking cessation, weight reduction, dietary modification, physical activity, and psychological stress reduction have been recognized as foundational to the prevention and treatment of ED 4.
- These modifications can improve erectile function by decreasing low-grade clinical inflammation and increasing the availability of nitric oxide (NO), which is essential for blood genital flow 3.
Treatment Options
- Phosphodiesterase type 5 inhibitors (PDE5Is) are the first-line therapeutic option for ED, while second-line therapy includes alprostadil 5.
- Combination therapy with PDE5I and topical alprostadil has been shown to be effective in patients with ED who are non-responders to PDE5I alone 5.
- PDE5Is have been found to be safe and effective in many patient groups, and may be effective as part of combination therapy in non-responders to PDE5I 6.
Patient Preference and Adherence to Treatment
- Patient preference and adherence to ED treatment with PDE5 inhibitors can vary, and a significant percentage of men initiating treatment may switch between inhibitors or discontinue therapy 7.
- Strategies to improve compliance and satisfaction with treatment include educating patients about the available treatment options and their potential benefits and risks 7.