PDE5 Inhibitors (pills)
PDE5 inhibitors are drugs like sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These drugs work by stopping the body from breaking down chemicals that are needed to obtain an erection. Currently, there is insufficient evidence to suggest that any of these drugs work more effectively than the other. They are all oral drugs that need to be taken 30-60 minutes prior to intercourse. Sexual stimulation is still needed to achieve an erection even when taking these medications. The response rate is approximately 65% in men with moderate ED.
PDE5 Inhibitors may fail due to inadequate dosing. Doses higher than 100mg increase the occurrence of side effects; therefore, it is recommended to seek alternative methods of treatment when you reach maximum dosage.
It is not recommended to take PDE-5 Inhibitors if you:
- Take nitrates
- Take high blood pressure medications (alpha blockers)
- Have low blood pressure
- Have uncontrolled hypertension
- Have cardiac failure
- Have angina
The side effects of the three drugs are very similar. Side effects may include facial flushing, nasal congestion, blurred vision, headaches, or heartburn. The monitoring of patients using PDE5 inhibitors should include a follow-up to analyze efficacy, side effects, or changes in health care such as additional medications.
Inefficacy may be the result of hormonal abnormalities, food or drug interactions, timing and frequency of dosing, lack of sexual stimulation, alcohol usage, or partner/relationship issues. If you are not completely satisfied with the results of this treatment, patients are advised to discuss the various alternative therapies available including alprostadil/injection therapy medications, intraurethral gels, vacuum devices, testosterone replacement, and penile prostheses.
Sildenafil citrate was the first oral PDE5 inhibitor for ED approved by the Food and Drug Administration in the United States in March 1998. Since the release, sildenafil has become the first-line therapy for ED with over 12,000 patient-years of experience with sildenafil demonstrating positive safety and efficacy data. Sildenafil use has markedly increased the number of men seeking treatment for ED and has shifted first-line management from the urologist and psychologist to the primary care physician.