Oral treatments (IPDE-5) and local treatments in erectile dysfunction

erectile dysfunction treatment

Men can have a moment of their lives trouble getting or maintaining an erection to have satisfactory sexual intercourse. If these problems can be temporary and caused by obvious events (stress …), they can become troublesome and lead to medical management.

For nearly 20 years, treatments have been developed to fight against erectile dysfunction

Oral treatments:

Inhibitors of Phosphodiesterase type 5 (IPDE-5) – first-line treatment

4 are used today:

Sildenafil
Tadalafil
Vardenafil
Avanafil

Sildenafil and tadalafil are also indicated for the treatment of pulmonary arterial hypertension. Their  mechanisms of action is complex, leading to smooth muscle relaxation of the blood vessels that supply blood to the corpora cavernosum (erectile parts of the penis). This causes an increase in blood flow into the penis and helps erection.

Differences exist concerning these treatments:

  • the price (some are generic),
  • their onset of action,
  • duration of action,
  • interactions with food (including fat, delaying and sometimes limit the effect of treatment).

Nevertheless, they share properties in common, including their common side effects:

  • flushing,
  • headaches,
  • digestive disorders …Counter-indications:
  • The use of these PDE-5 is formally against-indicated if the patient is a derivative treatment called nitro (nitroglycerin, Nati spray) or the use poppers.
  • Patients taking alpha-blockers (treatments for prostate referred) should be warned of the risks of high blood pressure drop.
  • Furthermore, orthostatic hypotension, aortic stenosis or obstructive heart disease are cons-indications to this type of treatment.
  • Patients with myocardial infarction, stroke less than 6 months should not receive this type of treatment.
  • In patients with renal or hepatic impairment, the dose of these treatments must be adapted.

    Local treatments:

    1) local alprostadil – second-line treatment

    Prostaglandin derivatives which have vasodilating effects.

    2 drugs exist:

  • Urethral cream (alprostadil, Vitaros: see dedicated page)
  • Urethral mini-tablet (alprostadil, Muse: see dedicated page)These treatments are generally less effective than PDE-5.

           2) injected alprostadil: second-line treatment

           Injected prostaglandin derivatives which have vasodilating effects.

  • 3 drugs exist:
  • Edex (alprostadil, see dedicated page)
  • Caverject and CaverjectDual  (alprostadil, see dedicated page)
Dr S.
About Dr S. 5 Articles
Urologist

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