Therapy of Erectile Dysfunction

Therapy of Erectile Dysfunction (ED)
B, Risk Factor Modifications
1, Diabetes Control
Level of HbA1c was significantly higher with declining degrees of potency (P-value=0.003), and there was a significant association between potency degree and glycemic control (P=0.002) 1.
Glycemic control and other metabolic covariates were associated with ED risk, whereas higher level of physical activity was protective 2.

(n=203,Ø 65,5 yr, 45-74 yr.)
ED was strongly associated with depression symptoms after controlling for potential confounding factors using logistic regression.
ED is significantly associated with highly depressive symptoms, regardless of age, health habit or concomitant comorbidity. Our results demonstrate that multidisciplinary approaches are important for the successful treatment of ED.

Oral Drug Therapy With PDE 5 Inhibitors: Pharmacoki- netic Characteristics of PDE 5 Inhibitors Licensed in Europe Drug
(Authors) TMax
(min) Onset of Action (min)
Earliest >50% pt.response T1/2
( h ) Duration of Efficacy
h (% succesf. coitus) CMax
ng/ml
1-4Sildenafil 100 mg 70
(30-120) 14 20 3,82
± 0,84 8 (85 %) 327
± 236
1,,4,5-7Tadalafil 20 mg 120
(30-720) 16 30 17,5 36 (59 and 62 %) 378
1,4,7-10Vardenafil 20 mg 40
(15-180) 11 25 3,94
± 1,31 8±2 (69 %) 20,9
± 1,83

1.Re-counselling of the patients/couples in the appropriate use of PDE 5 inhibitors including early dose adjustment especially the use of the highest doses with salvage rates of up to 60 % depending on the study-population under investigation.

Regarding Efficacy and Safety of Medical Treatment of ED a broad level 1a and 1b evidence unanimously exists for the following treatment options:

•On demand („as needed“) therapy:
with the PDE 5 inhibitors Sildenafil (ViagraTM), Tadalafil (CialisTM) ,Vardenafil (LevitraTM) ,Udenafil (ZydenaTM ),
Avanafil (Spedra TM Stendra TM,) ,Lodenafil (HellevaTM )
Efficacy rates are between 60 and 75 % SEP 3 Rates
depending on the investigated populations
Medical Therapy of ED

Oral Drug Therapy With PDE 5 Inhibitors:
Drug-Related Adverse Events (On Demand Therapy) Side-effect Sildenafil 1
(n = 5.918) Vardenafil 2
(n= 2.203) Tadalafi3
(n = 804)
Headache 14,6 % 14,5 % 14 %
Flush 14,1 % 11,1 % 4 %
Dyspepsia 6,2 % 3,7 % 10 %
Rhinitis 2,6 % 9,2 % 5 %
Back pain 0 % 0 % 6 %
Color visual disturbances 5,2 % 0 % 0 %

Intracavernous injection therapy with
•1. PGE 1,syn. Alprostadil-(CaverjectTM , ViridalTM,EdexTM)5-40μg
•2. Combination of Papaverine/Phentolamine (AndroskatTM)
15-60mg/0,5-2mg
•3. Mixture of Papaverine/Phentolamine/PGE1 – Trimix

(no commercial product available)
•4. Mixture of VIP/Phentolamine (InvicorpTM) 25μg/1-2mg

Medical Therapy of ED
Porst,H:Oral Pharmacotherapy of Erectile Dysfunction and