Erectile dysfunction (ED) is a common condition affecting many men, characterised by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It can significantly impact a man’s quality of life and relationships. Fortunately, there are effective treatments available, with phosphodiesterase 5 (PDE5) inhibitors being the first-line option for many patients
What is Erectile Dysfunction?
Erectile dysfunction (ED) is when a man has difficulty getting or keeping an erection firm enough for sex. It can be caused by both physical and mental factors. In many cases, ED is an early sign of other health problems, like heart disease or kidney disease, so it’s important to pay attention to it.
Common risk factors for ED include getting older, being overweight, smoking, drinking too much alcohol, and not getting enough exercise. Health conditions like high blood pressure, high cholesterol, diabetes, depression, and anxiety also play a big role in causing ED.
Physically, ED can happen when there’s poor blood flow to the penis, damage to nerves, or hormone issues like low testosterone. Diabetes, in particular, is a major cause, as it can damage both the blood vessels and nerves needed for an erection.
On the mental side, stress, anxiety, and relationship issues can also make it harder to perform sexually. The fear of not being able to perform can lead to more stress, creating a cycle that worsens ED.
Lifestyle changes, like losing weight, quitting smoking, reducing alcohol intake, exercising more, and managing stress, can help improve erectile function. It’s also important to treat any underlying health conditions, such as high blood pressure or diabetes, which might be contributing to the problem. If needed, medications and counselling can also be effective treatments for ED.
PDE5 Inhibitors: The Main Treatment
The main treatment for erectile dysfunction (ED) is a group of medications called PDE5 inhibitors. The most common ones are sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
These medications help by boosting the effect of a natural chemical in your body called nitric oxide. Nitric oxide helps relax the muscles in the penis, allowing more blood to flow in, which makes it easier to get and keep an erection.
Sildenafil
How to take it
• One tablet approximately one hour before sexual activity
• Maximum of one tablet in 24 hours
• Dosage range: 25-100mg
Sildenafil, also known by the brand name Viagra, was the first medication of its kind to treat erectile dysfunction. It has been studied the most and has a lot of clinical data supporting its use. Its effects usually last around 4 hours because it has a short half-life, meaning it stays active in your body for about that long.
Vardenafil
How to take it
• One tablet approximately 25-60 minutes before sexual activity
• Maximum of one tablet in 24 hours
• Maximum dosage: 20mg in one dose
Vardenafil, also known by the brand name Levitra, is known for its fast-acting effects, often working within 30 minutes of taking the medication. This makes it a good option for men looking for quicker results. Compared to sildenafil (Viagra), vardenafil has a longer half-life of around 12 hours. This means it remains effective for a longer period, giving men a wider window of time to achieve an erection after taking the medication. While not as long-lasting as tadalafil (Cialis), which can work for up to 36 hours, vardenafil offers a good balance between fast onset and extended effectiveness.
Tadalafil
How to take it
• One tablet approximately 30 minutes before sexual activity
• Maximum of one tablet in 48 hours
• Maximum dosage: 20mg in one dose
• Alternative: Daily dose of 2.5mg or 5mg
Tadalafil, commonly known as Cialis, is unique among erectile dysfunction medications due to its long half-life of up to 36 hours, which is why it’s often called the “weekend pill.” This extended duration allows men more spontaneity in their sexual activity, as they don’t have to time the medication as precisely. Tadalafil can be taken either on an as-needed basis or as a low-dose daily tablet, making it a good option for men who need ED treatment more than twice a week. Even at low daily doses, tadalafil remains active in the body, providing ongoing effectiveness without the need to take a pill right before sexual activity. This flexibility and longer-lasting effect set it apart from other ED treatments.
What Are The Key Differences?
1. Duration of Action: Sildenafil has the shortest duration (4 hours), followed by vardenafil (12 hours), with tadalafil lasting the longest (36 hours).
2. Onset of Action: Vardenafil is the fastest-acting, typically working within 30 minutes. Sildenafil and tadalafil usually take effect within 30-60 minutes.
3. Dosing Flexibility: Tadalafil offers the unique option of daily dosing, which can be beneficial for men who prefer spontaneity in their sexual activity.
4. Food Interactions: Sildenafil and vardenafil may be affected by high-fat meals, potentially delaying their onset of action. Tadalafil is less affected by food intake.
5. Clinical History: Sildenafil has the longest history of clinical use and data, which may provide reassurance to some patients and healthcare providers
Choosing the Right Medication
When selecting an ED medication, consider the following factors:
- Frequency of Sexual Activity: For occasional use, any of the three medications can be suitable. For more frequent sexual activity, tadalafil’s daily dosing option might be preferable.
- Spontaneity: If spontaneity is important, tadalafil’s long-acting formulation or daily dosing might be advantageous.
- Response to Treatment: Some men may respond better to one medication than others. It’s often recommended to start with sildenafil due to its extensive clinical history, but if it’s not effective, trying another PDE5 inhibitor may yield better results.
- Side Effects: While generally well-tolerated, each medication may have slightly different side effect profiles. Discussing these with a healthcare provider can help in making an informed decision.
- Personal Preference: Some men may prefer the shorter-acting medications, while others might opt for the convenience of tadalafil’s longer duration of action.
View Erectile Dysfunction Treatment Options
Sources
- Pye, S.R., et al. (2023). Exploring the role of PDE5 inhibitors in cardiovascular health: A review. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201782/
- Ghasemi, M., et al. (2022). Erectile dysfunction and its association with cardiovascular risk factors: An updated review. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159135/
- Goldstein, I., et al. (2000). Oral sildenafil in the treatment of erectile dysfunction. PubMed. https://pubmed.ncbi.nlm.nih.gov/10845767/
