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Erectile Dysfunction Drugs

Dr. Lisa Lawless

Dr. Lisa Lawless, CEO of Holistic Wisdom
Clinical Psychotherapist: Relationship & Sexual Health Expert

Erectile Dysfunction Drugs

PDE5 Inhibitors

About one in every ten men has some degree of erectile dysfunction (ED) and with the impact of COVID on ED even more have been experiencing it. Most erectile dysfunction has a physical cause, so PDE5 inhibitors are quite popular as they increase blood flow and address many biological inhibitors.

Men who have erectile dysfunction are often prescribed a PDE5 inhibitor (a vasodilator) that helps with getting the penis erect and is better known as drugs such as Sildenafil (Viagra), Vardenafil (Levitra, Staxyn), Tadalafil (Cialis), and Avanafil (Stendra). Intracavernosal injections, as well as testosterone supplementation, natural erectile dysfunction remedies may also be used to address ED.

How PDE5 Inhibitors Cause An Erection

Your brain responds to sexual stimulation by sending out nerve signals. These signals cause the release of a chemical called nitric oxide, which relaxes muscles in the penis to let more blood flow in and compresses the veins that normally carry blood away from your penis. More blood flows in, and less flows out. This makes the penis hard and erect. Your body also contains an enzyme called PDE5, which reduces the effect of nitric oxide in producing an erection. A PDE5 inhibitor limits the release of nitric oxide, which temporarily restores the body's natural sexual response.

These drugs are unique because they only work when a man is sexually stimulated. Sexual stimulation is necessary for these drugs to help cause an erection.


According to the manufacturer's published literature, Viagra works best when taken on an empty stomach about an hour before attempting an erection. Unfortunately, this means that sexual intercourse often must be planned at least an hour in advance. This planning process can disrupt romantic spontaneity.

It is recommended that Viagra be taken only once every 24 hours. A man must be sexually stimulated for the drug to help get an erection. If one takes Viagra but does not have sex, the body naturally eliminates the drug over 6-10 hours.

The most common side effects are headaches, facial flushing, and altered blueish vision. Viagra does not always work for erectile dysfunction so if it is not working for you or you have side effects, discuss it with your doctor.


According to the Cialis European label, Cialis can be taken without regard to food. It should be taken prior to sexual activity. The efficacy of Cialis may persist up to 24 hours after the pill is taken. The Australian label states that efficacy may continue for up to 36 hours. The manufacturer claims that current trials indicate the drug may show a response in patients in less than 30 minutes.

The most common side effects are headache, dyspepsia/upset stomach, and back pain. If these symptoms occur, discuss it with your doctor.


The manufacturer claims that Levitra stays effective for 5 - 6 hours and that the drug can take effect in as few as 15 minutes but takes about 25 minutes for most men. The manufacturer says that you can take Levitra with or without food, but preferably not after a heavy or high-fat meal, as this may delay the effect.

The most common side effects are headaches and facial flushing. For more information about side effects, discuss it with your doctor.

Results From Using PDE-5 Inhibitors

Viagra works for about 2/3rds of the men who take it. Clinical data shows that the success rates from Cialis and Levitra are similar. Combined with sexual stimulation, the drug may produce an erection.

PDE-5 inhibitors do not work as well for men with ED caused by prostate surgery, where the nerves and vascular system may be compromised. In one study, as reported by Novus Information Services, PDE-5 inhibitors helped restore potency in only 30% of men who had undergone a radical prostatectomy. Some prostate surgery patients only get a partial erection without acceptable rigidity with the drug. Sometimes the drug does not work at all.

Those prescribed blood pressure or heart medications, also known as nitrates, should not use PDE-5-inhibitors. The following medical or physical conditions also make the use of these drugs inadvisable:

  • Severe heart or liver problems.

  • Recent stroke, heart attack, or low blood pressure.

  • Certain rare inherited eye diseases such as retinitis pigmentosa.

  • Bleeding disorders or stomach ulcers.

  • A doctor must prescribe PDE-inhibitors. Certain prescription and over-the-counter drugs can interact with PDE-5-inhibitors. It is always important to tell your doctor about all your medications.

PDE-5 Inhibitor Advantages

  • Non-invasive

  • Easy to use

  • Safe with only some side effects

  • Must incorporate sexual stimulation for predictable and long-lasting erections

  • Allows more spontaneity than penile injections, urethral suppositories, or vacuum erection devices

PDE-5 Disadvantages

  • Erections may not be as rigid, predictable, or long-lasting as desired

  • It takes time to work; a delay that can dampen spontaneity

  • High cost per dose

  • Side effects from PDE-5-inhibitors

In Closing

Using PDE5 inhibitors can be an excellent solution for those with erectile dysfunction. However, learning about erectile dysfunction can help you determine if there are other things you can do to enhance your health and your sexual health. Please explore our helpful guides for more information:

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