Table 52.3

Table 52.3—Treatment Options for Erectile Dysfunction

Treatment	Administration	Applicable Conditions	Onset	Duration of Action	Dosage	Selected Side Effects
Sildenafil*	Oral	N, A?, V?	60 min	4 hours	25–100 mg	Headache, flushing, rhinitis, dyspepsia, transient color blindness; contraindicated with nitrate use; precaution with α-blockers
Vardenafil*	Oral	N, A?, V?	45 min	4 hours	5–20 mg	Headache, flushing, rhinitis, dyspepsia; contraindicated with nitrate use and precaution with α-blockers
Tadalafil*	Oral	N, A?,V?	45–60 min	24–36 hours	5–20 mg	Headache, dyspepsia, flushing, rhinitis; contraindicated with nitrate use and precaution with α-blockers (except tamsulosin)
Vacuum device	External	P, N, V, A?	< 5 min	30 min	—	Petechiae, bruising, painful ejaculation
Papaverine^OL	Intracavernosal	N, A?, V?	10 min	30–60 min	15–60 mg	Prolonged erection, fibrosis, ecchymosis
Alprostadil	Intracavernosal	N, A?, V?	10 min	40–60 min	5–20 μg	Prolonged erection, pain, fibrosis
Phentolamine^OL	Intracavernosal	N, A?, V?	10 min	30–60 min	0.5–1 mg	Prolonged erection, fibrosis, headache, facial flushing
MUSE	Intraurethral	N, A?, V?	10–15 min	60–80 min	250–1000 μg	Penile pain or burning, hypotension
Penile prosthesis	Surgical	N, A, V		replacement in 5–10 years		Infection, erosion, mechanical failure
Sex therapy	Counseling	P	weeks	years	weekly	Anxiety

NOTE: A = arteriogenic; min = minutes; MUSE = medicated urethral system for erection; N = neurogenic; P = psychogenic; V = venogenic; ? = possibly.

* On July 8, 2005 the U.S. Food and Drug Administration issued a statement approving label changes for all three PDE5 inhibitors that reflect a small number of cases of nonarteritic ischemic optic neuropathy (NAION) that were reported postmarketing. It is not possible at this time to determine causality of PDE5 inhibitors and NAION since other factors are associated with NAION, such as underlying anatomic or vascular risk factors, including but not necessarily limited to: low cup-to-disc ratio (“crowded disc”), age over 50, diabetes mellitus, hypertension, coronary artery disease, hyperlipidemia, and smoking. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors, to the patient’s underlying vascular risk factors or anatomical defects, to a combination of these factors, or to other factors. Men who experience visual changes or loss of vision in one or both eyes are advised to stop the medication and contact their doctor or health care provider immediately.