From the Guidelines
Erectile dysfunction (ED) should be treated with oral phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, tadalafil, vardenafil, or avanafil, as the first-line treatment option. These medications work by increasing blood flow to the penis when sexually stimulated and have been shown to be effective in improving erectile function in men with ED 1. Lifestyle modifications, such as regular exercise, maintaining a healthy weight, quitting smoking, limiting alcohol, and managing stress, are also important in managing ED. For those who do not respond to medications, alternatives include vacuum erection devices, penile injections (alprostadil), urethral suppositories, or penile implants.
Treatment Options
- Oral PDE5 inhibitors: sildenafil (Viagra, 25-100mg), tadalafil (Cialis, 5-20mg), vardenafil (Levitra, 5-20mg), or avanafil (Stendra, 50-200mg)
- Lifestyle modifications: regular exercise, maintaining healthy weight, quitting smoking, limiting alcohol, and managing stress
- Alternatives: vacuum erection devices, penile injections (alprostadil), urethral suppositories, or penile implants
Important Considerations
- Consult a healthcare provider before starting any treatment, as ED can be a symptom of underlying health conditions like heart disease, diabetes, or hormonal imbalances
- Psychological factors like anxiety, depression, or relationship issues can contribute to ED and may require counseling alongside physical treatments
- Review the risks and benefits and proper use of PDE5 inhibitors with a healthcare provider 1
Evidence-Based Recommendations
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. The European Association of Urology also suggests a stepwise therapeutic approach for erectile dysfunction, starting with lifestyle modifications and oral PDE5 inhibitors 1. The NCCN Survivorship Guidelines for Sexual Function recommend first-line treatment options for erectile dysfunction, including lifestyle modifications and oral agents such as PDE5 inhibitors 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. Results in ED Population in US Trials — The 2 primary US efficacy and safety trials included a total of 402 men with erectile dysfunction, with a mean age of 59 years (range 27 to 87 years) The treatment effect of tadalafil did not diminish over time Table 11: Mean Endpoint and Change from Baseline for the Primary Efficacy Variables in the Two Primary US Trials Study A Study B Placebo Tadalafil 20 mg Placebo Tadalafil 20 mg (N=49) (N=146) p-value (N=48) (N=159) p-value EF Domain Score Endpoint 13.5 19.5 13.6 22.5 Change from baseline -0.2 6.9 <.001 0.3 9.3 <.001 Insertion of Penis (SEP2) Endpoint 39% 62% 43% 77% Change from baseline 2% 26% <. 001 2% 32% <.001 Maintenance of Erection (SEP3) Endpoint 25% 50% 23% 64% Change from baseline 5% 34% <.001 4% 44% <.001
Tadalafil is effective in treating erectile dysfunction (ED).
- The drug has been evaluated in 22 clinical trials with over 4000 patients.
- Tadalafil improved erectile function in men with ED, with significant improvements in EF domain score, insertion of penis, and maintenance of erection.
- The treatment effect of tadalafil did not diminish over time 2. Key considerations for use:
- Patients should be evaluated for underlying cardiovascular disease before prescribing tadalafil.
- Tadalafil is not recommended for patients with certain cardiovascular conditions, such as myocardial infarction within the last 90 days or unstable angina 2.
From the Research
Definition and Prevalence of Erectile Dysfunction
- Erectile dysfunction (ED) is a common medical condition that has a negative impact on men and their partners 3.
- The prevalence of ED is increasing worldwide, and it is a multidimensional disorder affecting men worldwide 4.
Treatment Options for Erectile Dysfunction
- Phosphodiesterase type 5 (PDE5) inhibitors are the first-line treatment for ED, and they include drugs such as sildenafil, tadalafil, and vardenafil 3, 4.
- Topical alprostadil is a second-line therapy for ED, and combination therapy with PDE5 inhibitors and topical alprostadil may be effective for patients who do not respond to PDE5 inhibitors alone 5.
Lifestyle Modifications and Erectile Dysfunction
- Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome, and excessive alcohol consumption 6.
- Lifestyle modifications such as smoking cessation, weight reduction, dietary modification, physical activity, and psychological stress reduction may improve erectile function in men with ED 6, 7.
- Promotion of healthful lifestyles may yield great benefits in reducing the burden of sexual dysfunction 6.
Patient Preference and Adherence to Treatment
- Patient preference and adherence to treatment are important factors in the management of ED, and strategies to improve compliance and satisfaction with treatment should be implemented 3.
- The choice of PDE5 inhibitor should be individualized based on the patient's profile, and factors such as clinical, demographic, and relational factors should be considered 4.