An Overview of Medications for Erectile Dysfunction (ED)

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By Dr. Michael J. Dimitrion, M.D.

Many of the drugs used to treat erectile dysfunction (ED) are household names. But how well do you know what these drugs actually do? Do all of your options come in the form of a “little blue pill”?

Oral Medications (phosphodiesterase type-5 inhibitors)

  • Sildenafil (Viagra)
  • Tadalafil (Adcirca, Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)

The most common erectile dysfunction drugs all work by blocking an enzyme found in blood vessels, phosphodiesterase type-5. When this enzyme is blocked it causes vessels to relax, improving blood flow to the penis.

70% of men who take these treatments have better overall erections, though the success rates may be lower for those with moderate to severe diabetics and those who have undergone certain cancer treatment.

These drugs all start working in 15 and 30 minutes, and their effects may last between 4 and 6 hours. Cialis’ effects can last up to 36 hours.

Although these drugs can be taken after a meal, they all work best on an empty stomach: eating a heavy meal high in fat beforehand dampens their effectiveness.

Self-administered injection – Alprostadil (Caverject, Edex)

If oral medications don’t work, the vasodilator drug alprostadil is approved for use as an injection into the base of the penis. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment.

The multi-drug versions of this medication are called bi-mix (alprostadil mixed with phentolamine or phentolamine mixed with papaverine); and tri-mix (a mixture of phentolamine, papaverine and alprostadil).

The needle used to administer alprostadil is very short and thin, so the pain associated with these injections is very low.

Penile Suppository – Alprostadil

The pill form of Aprostadil can be placed as a suppository into the urethra prior to sexual activity. Most men who use ED suppositories report minimal discomfort.

Hormone Replacement Therapy

For men who experience the loss of sexual desire alongside ED, low testosterone levels may be the culprit. When used in conjunction with phosphodiesterase type-5 inhibitors, testosterone replacement therapy is effective in bringing back sexual performance. It is important to maintain continued follow up with your health care professional should you be on testosterone so that you may optimize your level of testosterone together.

Can I combine several ED treatments?

Only combine treatments following assessment and consultation with your healthcare provider. Taking multiple drugs simultaneously can lead to erections lasting for an extended period of time which could lead to dangerous consequences. If you’re not seeing improvement in sexual satisfaction after changing medication regimes, discuss it with your HCP. You may want to consider alternative treatments including drug-free ED treatments.

What are the side-effects of oral medications?

The most common mild side-effects of oral medications include headaches, dizziness, muscle aches and an upset stomach.

If your erection lasts longer than 4 hours, please seek immediate medical attention. Vision and hearing loss are rare but serious side effects to watch out for.

How do I know which ED treatment option is best for me?

Your healthcare provider or a men’s health specialist can help you come up with a personalized treatment plan that is best suited for you and your specific situation and needs.