Oral medications for ED are called PDE-5 inhibitors. The drugs in this class include medications like Viagra (sildenafil), Levitra (vardenafil), Cialis (tadalafil), Stendra (Avanafil) and more. This class of drug is considered first line therapy for those men presenting with ED.
In simple terminology, there are chemicals in the penis that produce an erection and chemicals that inhibit the erection. PDE-5 inhibitor medications increase the amount of “pro-erection chemicals.” These drugs don’t cause an erection, but they allow the produced erection to be enhanced with improved blood flow to the penis which results in a harder erection that is better sustained. These medications still require either mental or physical stimulation to work. Thus, if you take an oral ED medication, you will not immediately have an erection without any sort of sexual stimulation.
Success rates for improvement in erections are approximately 70-80%. The drugs are more effective in men with mild ED. Men with severe ED may not respond to these pills.
When Should I Take These Medications? How Long Are They Effective For?
Sildenafil (Viagra) and vardenafil (Levitra) start working at 30-60 minutes after taking them. Tadalafil (Cialis) peaks its action at about 1-2 hours from administration. One of the newer agents, avanafil (Stendra) has a shorter onset of about 15-30 minutes. We recommend that you take these medications on an empty stomach for best absorption.
The main difference between these medications is how long they are active in the body. Sildenafil (Viagra), vardenafil (Levitra), and avanafil (Stendra) are most effective the first 4-8 hours, however tadalafil (Cialis) is effective for 18-36 hours.
What Are the Advantages of Oral ED Medications?
The advantages of these medications include the ease of just taking a pill to help with ED as well as their effectiveness. They are also very safe medications for most people.
What Are the Most Common Side Effects?
The most common side effects from oral ED medications include:
- Headache
- Lower blood pressure
- Dizziness
- Skin Flushing/Redness
- Sinus congestion
- Stuffy nose
- Heartburn
Aside from the possible side effects listed above, Sildenafil (Viagra) has a possible side effect seen in 5-10% of patients who experience a blue coloration to their vision that goes away as soon as the drug is out of their system. There are no long term problems with this side effect.
Tadalafil (Cialis) has a rare side effect specific to this medication in this class that produces temporary muscular pain (like a muscle cramp or back ache). Often this side effect goes away with time and sometimes it may be reduced with more hydration.
The most talked about risk with oral ED drugs that is actually very rare is called a priapism, which is a painful erection that lasts longer than 4 hours.
What Are Some Common Drug Interactions When Taking Oral ED Medications?
Drug interactions may change how your medications work or increase your risk for serious side effects. We do not list all possible drug interactions. Please keep an updated list of all the prescription/nonprescription drugs and supplements to share with our office as well as your pharmacist.
CAUTION: If you experience any chest pain within 24 hours of taking Viagra, Levitra or Stendra, or within 3 days of taking Cialis, please call 911 or go to the Emergency Room at the closest hospital immediately. The common treatment for chest pain is giving a nitroglycerin tablet or patch. Mixing nitroglycerin with oral ED drugs can cause a serious drop in your blood pressure. A serious drop in blood pressure can lead to dizziness, fainting, and rarely heart attack or stroke, so nitroglycerin should only be administered by a doctor if you have taken a PDE5 Inhibitor medication.
- Drugs used to treat chest pain/angina (nitrates such as nitroglycerin, isosorbide)
- Recreational drugs called “poppers” containing amyl nitrate, amyl nitrite, or butyl nitrite
- Medications for enlarged prostate such as doxazosin, tamsulosin, when combined with oral ED drugs may cause a drop in your blood pressure. Consider skipping a dose of the prostate medication when using something like Viagra that night.
- ED drugs may be used at low doses with the following medications: antifungal medications (such as itraconazole, ketoconazole), macrolide antibiotics (such as clarithromycin, erythromycin), HIV medications (such as ritonavir, saquinavir), hepatitis C virus protease inhibitors (such as boceprevir, telaprevir), mifepristone, and rifampin
- Do not mix different oral ED medications at the same time.
- Do not drink alcohol to excess (> 5 drinks) when taking this medicine. When taken in excess, alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate or lowering your blood pressure.
- Do not eat grapefruit or drink grapefruit juice while taking oral ED medications as they may cause the medication to build up in your body and lead to increase risk of side effects.
- Do not take a higher than prescribed dose.
When Is It Dangerous to Take Oral ED Medications?
The FDA has urged caution in patients who have suffered heart attacks, strokes, or serious disturbances of the heart’s pumping rhythm (atrial fibrillation) in the previous 6 months, in men with a history of congestive heart failure or unstable angina, and in men with low blood pressure or uncontrolled high blood pressure (above 170/110 mm Hg).
We do not recommend the use of oral ED medications in patient with severe eye / vision problems. There have been rare reports of blindness in patients with severe eye problems prior to taking these medications. If you have any eye problems especially previous history of eye surgery, please consult with your eye doctor prior to trying these medications.
Oral ED medications are not known to cause heart attacks. However, vigorous sexual activity, like any exercise is known to cause major vascular events such as heart attacks. If you are not in good physical shape and have not had sex in a while, you MUST get a check up by your primary doctor to see if your heart may tolerate sexual activity.
What Is the Cost of Oral ED Medications?
The biggest disadvantage of these drugs has been the cost. Most insurance companies are not covering Men’s Health medications. However, generic options are becoming more accessible at lower prices. Broward Urology Center works with various venders to get our patients competitive pricing. Please ask us about all available options.
Other ED Treatment Options
- Platelet rich plasma therapy (P-shot)
- Low intensity shockwave therapy (LiST)
- Penile injection therapy
- Urethral pellet therapy
- Vacuum erectile device
- Penile implant surgery
