ED Treatment - Medications

It’s been over two decades since the FDA approved sildenafil (Viagra) as the first drug to treat erectile dysfunction (ED). Since then, other drugs such as tadalafil (Cialis) and vardenafil (Levitra), have been developed. Together, these drugs often serve as first-line therapy for men with ED and generally work well in that role.

Sildenafil, tadalafil, and vardenafil are all phosphodiesterase type 5 inhibitors and work in similar ways to enhance blood flow to the penis so a man with ED can get an erection firm enough for sex.

Given the success of these drugs for men who can take them, we may think that men would be eager to comply with therapy. But this is not always the case. The drugs aren’t effective for every man and their length of effectiveness can vary. Some men are dissatisfied with their results or have unrealistic expectations.

How can we help patients adhere to their medication plan? To answer this question, it’s helpful to consider reasons why they don’t.

Men’s Adherence Study
In a recent study published in The Journal of Sexual Medicine, European scientists examined men’s adherence to three different types of ED medication regimens: tadalafil taken once daily, tadalafil taken on demand, and sildenafil taken on demand. (Vardenafil was not included in this study.)

Seven hundred seventy patients were randomly assigned to one of the three treatment plans. For eight weeks, the patients took their designated medication with no changes, except for adjustments in dosage when necessary. After this period, the men were allowed to continue their current treatment, switch to another regimen, or stop treatment completely.

Men who took tadalafil (once a day or on demand) tended to stay with their treatment plan longer than the men taking sildenafil. Overall, 44% of the men continued with their assigned plan. Forty-two percent switched plans at least once.

Why? Efficacy played a role in the two most common reasons. Men either felt that their erections were not hard enough or did not last long enough. Some men did not like taking a pill every day; others did not like taking medication on demand.

Helping Patients Choose an ED Drug
When choosing an ED drug, much depends on a man’s preferences. Some helpful questions to ask include the following:

• How do you feel about taking an ED drug? Some men in the above study cited “feel medication controls my sexual life” as their reason for switching or discontinuing a regimen. Men with this concern may want to choose a different approach to treating ED.
• How do you prefer to take this drug? Some men prefer once a day because it’s easier to remember. Others may not like the idea of taking a daily pill and choose the on-demand route.
• How important is spontaneity? In some regimens, the drug must be taken 30-60 minutes before sex. But often, a couple may not know when they’ll feel inspired. They may prefer to take advantage of unplanned moments, which might make another regimen more suitable for them.
• How important is length of effectiveness? Each drug is effective for a different amount of time. According to the Mayo Clinic, sildenafil and vardenafil may be effective for up to 5 hours. Tadalafil may last up to 36 hours. This can be an important factor.

Being Realistic About Adherence and Usage
Advertising often portrays happy couples whose sexual problems are solved by a pill. But patients need to know that the situation can be more complicated than that.

Sometimes, adjustments are needed. The dose may need to be increased or decreased. Or the drug itself may need to be changed because of side effects. What works for one man may not work for another. It can take some time to find the right fit.

Helping patients and their partners understand their options is just one step. They may also need to think about their relationship and talk openly about their expectations. It often takes time, effort, patience, and understanding to work through ED.