From the Guidelines
When patients don't respond to Cialis or Viagra for erectile dysfunction, the next step should be to consider alternate interventions, such as a vacuum erectile device (VED), medicated urethral system for erection, or intracavernosal injection, as recommended by the most recent guideline 1.
Key Considerations
- The American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline recommends the use of phosphodiesterase type 5 inhibitor (PDE5i) medications as the first line of treatment for erectile dysfunction, but for those who do not respond, alternate interventions should be considered 1.
- A vacuum erectile device (VED) is a non-invasive option that creates negative pressure to draw blood into the penis, and can be an effective alternative for patients who do not respond to PDE5i medications.
- Intracavernosal injections, such as alprostadil (Caverject, Edex), can also be considered, with doses starting from 2.5-5 mcg and titrated as needed.
- Intraurethral suppositories (MUSE) containing alprostadil are another alternative for patients who do not respond to oral medications.
Additional Options
- For patients with low testosterone, hormone replacement therapy might help when combined with other treatments.
- Penile implants represent a more permanent surgical solution for those who do not respond to less invasive options.
- Lifestyle modifications, including weight loss, increased physical activity, smoking cessation, and reduced alcohol consumption, can also improve erectile function.
Underlying Causes
- It is essential to address underlying causes like cardiovascular disease, diabetes, psychological factors, or medication side effects, as these can contribute to erectile dysfunction.
- A comprehensive approach that takes into account the patient's overall health and well-being is crucial in managing erectile dysfunction, as recommended by the Journal of the National Comprehensive Cancer Network 1 and the Journal of Urology 1.
From the Research
Next Steps for Patients Who Don't Respond to Cialis or Viagra for ED
When patients do not respond to Cialis or Viagra for erectile dysfunction (ED), there are several next steps that can be considered:
- Alternative PDE5 inhibitors: Other phosphodiesterase type 5 (PDE5) inhibitors such as tadalafil, vardenafil, or avanafil can be tried, as they may have different efficacy and safety profiles 2, 3.
- Dose adjustment: Increasing the dose of the current PDE5 inhibitor or switching to a different dosing regimen, such as taking the medication on alternate days, may be effective 4.
- Combination therapy: Combining PDE5 inhibitors with other treatments, such as alprostadil or vacuum erection devices, may be considered for patients who do not respond to monotherapy.
- Addressing underlying conditions: Identifying and treating underlying medical conditions, such as diabetes, hypertension, or depression, that may be contributing to ED can improve treatment outcomes.
- Lifestyle modifications: Encouraging patients to make lifestyle changes, such as increasing physical activity, losing weight, and quitting smoking, can also improve ED symptoms.
Safety Considerations
When considering alternative treatments or dose adjustments, it is essential to weigh the potential benefits against the risks:
- Adverse events: PDE5 inhibitors can cause adverse events, such as headache, facial flushing, and nausea, although these are generally mild and well-tolerated 3, 5.
- Drug interactions: PDE5 inhibitors can interact with other medications, such as nitrates and alpha-blockers, which can increase the risk of adverse events 5.
- Oncologic outcomes: There is ongoing debate about the potential association between PDE5 inhibitor use and increased risk of melanoma or prostate cancer recurrence, although the evidence is weak and controversial 5.