From the Guidelines
Erectile dysfunction (ED) medications should primarily include PDE5 inhibitors like sildenafil, tadalafil, vardenafil, and avanafil, as they have been shown to be effective in treating ED with a favorable risk-benefit profile 1.
Key Considerations
- The choice of PDE5 inhibitor should be based on individual patient preferences, including ease of use, cost of medication, and adverse effects profile 1.
- These medications work by enhancing blood flow to the penis when sexually aroused, and their dosing regimens vary:
- Sildenafil: 50mg taken 30-60 minutes before sexual activity (range 25-100mg), with effects lasting 4-6 hours.
- Tadalafil: daily doses (2.5-5mg) or as-needed (10-20mg), with effects lasting up to 36 hours.
- Vardenafil: 5-20mg taken 30-60 minutes before sex, lasting 4-5 hours.
- Avanafil: 50-200mg, works within 15-30 minutes and lasts 6 hours.
Important Safety Considerations
- These medications should not be used with nitrates due to dangerous blood pressure drops.
- Common side effects include headache, flushing, indigestion, and nasal congestion.
- Men with cardiovascular disease, uncontrolled hypertension, or recent stroke/heart attack should consult their doctor before use.
Additional Recommendations
- Lifestyle modifications like exercise, weight management, smoking cessation, and reduced alcohol consumption can also help improve erectile function.
- The dose of PDE5 inhibitors should be titrated to provide optimal efficacy, and instructions should be provided to maximize benefit/efficacy 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 answer to the question about ED meds is that tadalafil is a prescription medicine used to treat erectile dysfunction (ED) in men. It works by increasing blood flow to the penis, helping men with ED to get and keep an erection. 2 2
From the Research
ED Medications
- Phosphodiesterase type 5 inhibitors (PDE5-i) are used for the oral treatment of erectile dysfunction (ED) 3, 4.
- Examples of PDE5-i include sildenafil, tadalafil, vardenafil, udenafil, avanafil, and mirodenafil, which are equally effective and safe for the treatment of ED 3.
- The choice of PDE5 inhibitor depends on various factors, including the patient's profile, clinical, demographic, and relational factors 5.
Comparison of PDE5 Inhibitors
- Sildenafil, vardenafil, and tadalafil have similar efficacy and toxicity profiles, but differ in their pharmacokinetic profiles 4.
- Tadalafil has a longer half-life (17.5 h) compared to sildenafil and vardenafil (approximately 4 h) 4.
- Food, especially fatty food, affects the pharmacokinetic profiles of sildenafil and vardenafil, but not tadalafil 4.
Lifestyle Modifications
- Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome, and excessive alcohol consumption 6, 7.
- Lifestyle modifications, such as smoking cessation, weight reduction, dietary modification, physical activity, and psychological stress reduction, can improve erectile function in men with ED 6, 7.
- Promoting healthful lifestyles can yield great benefits in reducing the burden of sexual dysfunction 6.