Joseph R. Anticaglia MD
Medical Advisory Board
Just watch the countless ads on television and you will realize that erectile dysfunction affects millions of Americans. It is caused by many factors — including physical, psychological and lifestyle choices — but oral medical treatments are available. Which treatment is best for you depends on your overall (metabolic) health and medical history. What choices do you have?
- Pills
- Testosterone
- Herbal Remedies
- Combination of above
Pills
Pills are the first line treatment for the majority of men with Erectile Dysfunction. The FDA has approved four main prescription drugs for ED.
- Viagra — * Sildenafil in1998
- Cialis — * Tadalafil in 2003
- Levitra — * Vardenafil in 2003; (Staxyn — Vardenafil in 2010)
- Stendra — * Avanafil in 2012
The above drugs, PDE5 inhibitors, work in a similar fashion by promoting smooth muscle relaxation in the walls of blood vessels which leads to an increase in blood flow to the penile area. They may differ as to the time of onset, how long they are effective, side effects and interactions with other medications. These pills are not a cure for ED, but have been shown to be beneficial in otherwise healthy men.
Medical History
Let your Doctor know if you have:
- Heart or blood pressure problems
- Liver disease
- Blood cell or bleeding disorders, such as leukemia or hemophilia
- Stomach ulcer
- Hearing loss
- Problems with vision
- Peyronie’s disease
Side Effects
PDE 5 inhibitors can cause a variety of side effects such as flushing, headache, nasal congestion and an upset stomach. They can also cause:
- Visual problems
- Hearing loss
- Heart problems
- Back pain
- Priapism
Viagra and Levitra work best on an empty stomach, takes about 60 minutes to become effective and its effectiveness lasts about 6 hours.
Cialis can be taken with or without food. It takes about 5 hours to become effective and stays in your system between 24–36 hours. It has been approved for BPH — Benign Prostatic Hypertrophy. Stendra can be taken with or without food. It becomes effective in 15–30 minutes and works for about 5 hours.
PDE 5 Inhibitors
| Food | Time of onset. Amt. of time it takes to begin working | Half Life — Amt. of time the drug is still working |
| Viagra — Empty stomach | About 60 minutes | About 6 hours |
| Cialis — With or without food | About 5 hours | 24–36 hours |
| Levitra — Empty stomach | About 60 minutes | About 6 hours |
| Stendra — With or without food | 15 to 30 minutes | About 5 hours |
Avoid drinking alcohol and using grapefruit products while taking these medications. One may have to take the medication on three to eight different occasions before concluding it’s a medical failure. Periodic follow up is recommended to evaluate the efficacy and side effects of the treatment. Also, inform your physician of any change in the medications you’re taking.
Testosterone
Testosterone is a sex hormone, a steroid compound (androgen) produced by men and women. A blood test is used to measure the level of testosterone in the body and it can be low in men with ED. Improving a man’s low “T” level to the normal range may improve a man’s sex drive but is no guarantee to reverse erectile dysfunction. A complete Urologic workup is needed to rule out other causes of ED.
Herbal remedies
According to a report by Mayo Clinic — DHEA, L-arginine and Ginseng show “some evidence” of improvement in men with erectile dysfunction. They recommend that you “Find out the facts before trying one.” L-carnitine when combined with Viagra “might improve erectile function better than Viagra alone.” Other combinations with PDE 5 inhibitors are on the horizon.
A note of caution — herbal use can predispose to bleeding, others are harmful and some just do not work. Finding out the facts is good advice for anyone facing an important medical decision.
References
Drogo, K. et al; AUA Practice Guidelines, The Management of Erectile Dysfunction; 2005
Mohit Khera; Advances in the Treatment of Erectile Dysfunction; Perspectives in Urology; November13, 2015
Mohit, Khera; Advances in the treatment of Sexual Dysfunction and Testosterone; Men’s Wellness Seminar; HC Smart — Services
Anticaglia; Joseph R.; Erectile Dysfunction and Metabolic Health; HC Smart, 2016
Mayo Clinic; Erectile Dysfunction; Jan. 17, 2016
Glossary:
- PDE5 inhibitors — phosphodiesterase type 5 inhibitors are metabolized by the liver.
- Peyronie’s disease — a curvature of the penis causing painful erection
- Priapism — unwanted, sustained, painful erection
- DHEA (Dehydroepiandrosterone) — a hormone that leads to the production of male and female sex hormones.
- Propionyl-L-carnitine is an amino acid produced by the body.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.