Erectile dysfunction (ED) is simply the inability to obtain or maintain an erection sufficient for satisfactory sexual activity. That definition is very patient specific, meaning ED is not the same for everybody. It ranges from just not getting as hard as it used too, or inability to maintain an erection through intercourse, all the way to complete inability to maintain any erection. Erectile function is a complex interplay of neural, vascular, hormonal and psychological factors. Disruption in any of these pathways may lead to ED. This can be related to chronic medical conditions such as Diabetes, Hypertension, Heart Disease, as well as, the medications used to treat these conditions. Other causes can be from surgery to your prostate, bladder, or abdominal organs. The good news is that there are excellent treatment options available to help restore your sexual function. In this blog we will focus on oral medication therapy.
The most popular oral medications for treatment of ED are Sildenafil, the active ingredient in Viagra and Tadalafil, the active ingredient in Cialis.
The most common, and the American Urologic Association recommended first-line treatment for ED is oral medication. This means tablets that are swallowed or lozenges that dissolve in your mouth. The most popular oral medications for treatment of ED are sildenafil, the active ingredient in brand name Viagra and tadalafil, the active ingredient in brand name Cialis. These oral medications are in a class called Phosphodiesterase type 5 inhibitors (PDE5i). They work to enhance the normal erectile response. They will not spontaneously cause an erection, but along with sexual stimulation may improve your erection.
Sildenafil’s affects can be seen as quickly as 30 minutes and can last around 4 hours.
All PDE5i medications work on the same pathway, but have slight differences. Sildenafil is taken on an as-needed basis. The starting dose is 20mg (1 tablet), but can be increased up to 100mg (5 tablets), depending upon the response. It is recommended to start at a low dose, and then work up as needed. Going beyond 100mg does not improve the response and just leads to more side effects. Its affects can be seen as quickly as 30 minutes and can last around 4 hours.
Tadalafil stays in your system longer then the sildenafil, which can provide you with more flexibility in the timing of intercourse.
Tadalafil can be taken on an as-needed basis or daily. The daily dose is 5mg. Daily tadalafil has been shown to not only improve your erections, but can also improve your urinary flow. The as-needed dose is 5mg to 20mg depending on the severity of dysfunction. Tadalafil stays in your system longer then the sildenafil, which can provide you with more flexibility in the timing of intercourse. Absorption of Sildenafil is improved when taken on an empty stomach. In contrast, tadalafil is less affected by meals.
The most common side effects of the PDE5i medications include headache, flushing, dizziness, rash, upset stomach, diarrhea, nasal congestion, abnormal vision, back pain, and muscle pain. Less common side effects are lightheadedness or blood pressure drop / fainting upon standing.
These medications are not for everybody and are contra-indicated (should not be used) in patients who take nitrates such as nitroglycerine, isosorbide mononitrate, isosorbide dinitrate, and any other nitrate preparations for cardiac conditions. Please let your physician know if you are on any of these medications.
As with any medication for ED there is a small risk of an erection lasting longer than 4 hours, which is called Priapism. It is an extremely low risk in this class of medications, but if this were to occur it’s very important to seek immediate treatment at the emergency department.
If you are at early stages of ED or just had a radical prostatectomy for prostate cancer, PDE5i’s have a role in your recovery of erectile dysfunction and I encourage you to speak to your physician about starting therapy.
Aram B. Loeb, MD
UH Urology Institute Clinical Assistant Professor of Urology
Case Western Reserve University, Cleveland, OH
Phone: (440) 887-9139