PDE-5 Inhibitors as First-Line ED Treatment

Erectile dysfunction does not threaten male life but is considered a severe physical and psychological problem. More than half of men aged 40 to 70 years experience sexual dysfunction to a certain extent. At the same time, moderate or severe degree of ED was noted in 19–52% (on average, 34.8%) of men. However, 31.5 to 44.0% of men keep sexual activity at the age of 70 and 80 years. This circumstance should be taken into account when choosing a specific treatment strategy.

The last decade was marked by a breakthrough in the treatment of erectile dysfunction. According to Landa Pharmacy, this treatment includes PDE-5 inhibitors.

Current recommendations for erectile dysfunction treatment

First line therapy includes:

  • phosphodiesterase type 5 inhibitors (PDE-5) (sildenafil, tadalafil, vardenafil);
  • apomorphine (effectiveness 28.5–55% approved in a number of countries);
  • other oral medications: yohimbine hydrochloride and trazodone (effectiveness comparable to placebo in patients with organic ED), L-arginine, ginseng, limaprost, phentolamine.

PDE-5 inhibitors

At present, various PDE-5 inhibitors are used in clinical practice: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), udenafil (Zydena), avanafil (Stendra). Drugs differ in their pharmacokinetic properties, but their clinical effectiveness and safety are comparable.

The choice of PDE-5 inhibitors for the treatment of patients suffering from erectile dysfunction is explained by the following circumstances:

  • this is an adapted first-line therapy;
  • used in clinical practice for more than 30 years;
  • their effectiveness is confirmed by numerous clinical studies from the standpoint of evidence-based medication;
  • the convenience of taking PDE-5 medications.

PDE-5 inhibitors contraindications

  • Hypersensitivity to any substance in the drug composition;
  • Taking drugs containing any organic nitrates;
  • Age up to 18 years;
  • The presence of contraindications to sexual activity in patients with cardiovascular system diseases, such as myocardial infarction during the last 90 days, unstable angina, the occurrence of angina during sexual intercourse, chronic heart failure II-IV classes according to NYHA classification, uncontrolled arrhythmias, arterial hypotension, uncontrolled arterial hypertension, ischemic blood stroke in the last 6 months;
  • Loss of vision due to non-arterial anterior ischemic neuropathy of the optic nerve (regardless of the connection with the intake of PDE-5 inhibitors);
  • Simultaneous administration of doxazosin, as well as other medications for ED treatment;
  • Frequent (more than 2 times a week) use by patients suffering from chronic renal failure;
  • Lactase deficiency, lactose intolerance, glucose-galactose malabsorption.

In recent years, a new concept of ED treatment has appeared. Oral PDE-5 inhibitors have been used successfully to treat this male disorder. Unfortunately, it does not completely solve the problem of psychological discomfort associated with erectile dysfunction. One of the disadvantages is the lack of a clear idea about the time of possible sexual activity. A single-dose regimen of PDE-5 inhibitor may be an alternative for those patients who prefer spontaneous rather than planned sexual contact, or for those who conduct a fairly intensive sexual life.