Topics / Men's Sexual Health / Erectile Dysfunction
Subtopic
Erectile Dysfunction
PDE5 inhibitor therapy, dosing strategies, and cardiovascular counseling for erectile dysfunction.
8 published deep analyses
Published deep analyses
Evidence in this subtopic
Why are PDE5 inhibitors contraindicated with
Why are PDE5 inhibitors contraindicated with nitrates?
Combined PDE5 inhibition and nitric oxide donor therapy can produce profound synergistic vasodilation and symptomatic hypotension. Nitrates and PDE5 inhibitors should not be used together; allow appropriate washout intervals when switching between agents in acute coronary care.
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How effective are PDE5 inhibitors for
How effective are PDE5 inhibitors for erectile dysfunction?
PDE5 inhibitors substantially improve erectile function versus placebo across broad ED populations, with landmark trials showing clinically meaningful IIEF improvements. On-demand dosing before sexual activity is standard; response rates are high though not universal.
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What are the common side effects
What are the common side effects of PDE5 inhibitors?
Headache, flushing, dyspepsia, and nasal congestion are common and usually dose-related. Visual disturbances and back pain occur with agent-specific frequency; non-arteritic anterior ischemic optic neuropathy is rare. Counsel on timing, alcohol, and when to stop and seek care.
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Is erectile dysfunction a marker of
Is erectile dysfunction a marker of future cardiovascular disease?
Erectile dysfunction often precedes symptomatic cardiovascular disease and shares endothelial dysfunction pathways with atherosclerosis. Men presenting with ED warrant cardiovascular risk assessment and conventional prevention strategies independent of PDE5 therapy decisions.
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Do sildenafil, tadalafil, and vardenafil differ
Do sildenafil, tadalafil, and vardenafil differ in effectiveness for erectile dysfunction?
All three major PDE5 inhibitors improve erectile function versus placebo with broadly similar efficacy in meta-analyses. Differences in onset, duration, food interactions, and side-effect profiles often matter more than marginal efficacy differences for most patients.
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Is daily low-dose tadalafil better than
Is daily low-dose tadalafil better than on-demand dosing for erectile dysfunction?
Both daily low-dose and on-demand tadalafil improve erectile function. Daily dosing may improve spontaneity and lower urinary symptom scores in men with comorbid LUTS, while on-demand dosing minimizes drug exposure for men with infrequent sexual activity.
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Are PDE5 inhibitors safe for cardiovascular
Are PDE5 inhibitors safe for cardiovascular disease in men with erectile dysfunction?
In stable cardiovascular disease, PDE5 inhibitors do not appear to increase major adverse cardiac events when used appropriately and nitrate co-administration is avoided. Sexual activity itself carries modest cardiovascular demand; individualized assessment remains important after recent events.
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What options exist for men who
What options exist for men who do not respond to PDE5 inhibitors?
Optimize dosing timing, adherence, and comorbidity management before labeling true non-response. Switching PDE5 agents, adding lifestyle and vascular risk-factor control, vacuum devices, intracavernosal therapy, or referral for specialized evaluation are evidence-supported pathways when oral therapy fails.
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