Are you having problems with your sexual health? Is there something bothering you or holding you back to live a happy and healthy sex life?
Erectile dysfunction (ED) is a common but significant medical condition which affects the overall quality of life. The prevalence of the disease increases as the age group affected also increases. Approximately, 10% of men aged 4-70 years old suffer from severe ED while 22% of men are diagnosed at the age of 70. Younger men may also be affected but the incidence is lower, which is 5%.
Risk Factors Associated with Erectile Dysfunction
There are a lot of factors that are to be considered related to ED when it comes to both the physical and psychological well-being of the patient. Some of the major risk factors of ED are hypertension, decreased HDL levels and increased LDL levels, diabetes mellitus, and heart disease. Some medications may also contribute to the occurrence of erectile dysfunction. This includes drugs for hypertension, diabetes, heart disease, and antidepressants. In addition, men who have undergone radiation therapy and those who have neurological disorders have a higher chance of being affected with ED. Moreover, lifestyle is also a big indicator which includes smoking, sedentary lifestyle, alcohol consumption, and depression. In spite of being a common disease among men, erectile dysfunction is still considered to be an inevitable phenomenon in the aging process of men.
Currently, there are a lot of available therapies indicated for the treatment of erectile dysfunction. This includes Intra penile injections of alprostadil, intraurethral suppositories, penile implants, and oral treatment of phopodiesterase-5 inhibitors (PDE-5). Among all the available therapies, oral PDE-5 inhibitors are considered to be the first line therapy because of the efficacy, safety, and ease of use of the said medications. There are four PDE-5 inhibitors currently approved for the treatment of ED. The said drugs are Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra, Staxyn OD), and Avanafil (Stendra).
All four PDE-5 inhibitors are equally effective in alleviating the symptoms of erectile dysfunction. The adverse effect profiles are also similar. However, these drugs differ in the onset and duration of action, plus the effects of food on the drug’s absorption.
Mechanism of ED Drugs Action
Before we discuss the differences of the four main active ingredients, how do PDE-5 inhibitors work?
Phosphodiesterase inhibitor type 5 (PDE-5) is an enzyme that increases the flow of blood in the corpus cavernosum regardless of the level of sexual stimulation. During sexual stimulation, the corpus cavernosum of the penis produces nitric oxide. Apart from being the mediator of this response, nitric oxide also activates guanylyl cyclase, which then forms the enzyme cyclic guanosine monophosphate (cGMP). The said enzyme produces smooth muscle relaxation by decreasing the intracellular concentration of calcium. PDE-5 inhibitors work by interfering with the action of PDE-5, which normally breaks down cGMP in the penile tissue. Thus, this action leads to preventing erection.
Side Effects of ED Drugs
The side effects associated with PDE-5 inhibitors are generally mild. Patients rarely report and do not discontinue their ED treatment because of the occurrence of these side effects. Some of the most frequent adverse effects of PDE-5 inhibitors are nasal congestion, dyspepsia, flushing, headache, and disturbances in color vision or loss of blue and green discrimination. Back pain and myalgias have also been reported, but more common with the use of Tadalafil. Patients with a history of cardiovascular disease and those with high-risk factors associated with heart disease should take precaution when taking PDE-5 inhibitors because of the cardiac risk linked with sexual activity. Moreover, all PDE-5 inhibitors should only be taken once a day. These drugs have the potential to cause priapism, a painful prolonged erection. This is a rare side effect but considered to be a fatal medical emergency.
Patients already undergoing other medication therapy should also take precaution when starting a PDE-5 inhibitor. Administration of nitroglycerin products such as isosorbide dinitrate or isosorbide mononitrate is contraindicated. Moreover, PDE-5 inhibitors may produce additive blood pressure lowering effect for patients also taking a-adrenergic antagonists such as Terazosin, Doxazosin, Alfuzosin, and Tamsulosin, which are used to treat hypertension and alleviate symptoms of Benign Prostatic Hyperplasia (BPH).
With all the data gathered about the drug profile of PDE-5 inhibitors, which is the most effective or best treatment for erectile dysfunction?
The Most Effective Treatment for Erectile Dysfunction
As previously mentioned, all PDE-5 inhibitors are all equally effective in alleviating the symptoms associated with erectile dysfunction. Our judgment on which drug is the best treatment of ED would only depend on the onset and duration of action of each drug.
Based on their drug properties, Stendra is the drug of choice if the patient wants a quicker onset of action. The drug peaks as fast as 15-30 minutes once absorbed in the body. Although most popular among the PDE-5 inhibitors, Sildenafil (Viagra) normally takes effect between 30-60 minutes. This is the reason why the drug is usually taken 30-60 minutes prior to sexual intercourse. On the other hand, the PDE-5 inhibitor of choice when the patient wants a long and sustainable sexual erection, Tadalafil (Cialis) may be the best choice. It lasts continuously or up to 24-36 hours. Food interaction is also less likely to interfere with Avanafil and Tadalafil. However, it is strongly advised to reduce the intake of high-fat meals when taking PDE-5 inhibitors. Some patients take the drug on an empty stomach to maximize and potentiate the drug’s effects.
When it comes to deciding which among the PDE-5 inhibitors the best is, I think the decision would most likely depend on the physician and the patient. The price of the drug also plays an important role in the decision making. The effects and drug profile of each treatment are equally similar, so the choice would depend on the prescriber and the patient’s needs. If the patient needs a quick onset of action, Stendra would be the best choice. Its effect could last up to 6-12 hours. However, if the patient is after the optimal duration of sexual erection, Cialis would be a perfect choice.
Personally, when it comes to the efficiency of the product, I think that Cialis is the best choice. Although the time to peak before the drug takes effect may reach 30-45 minutes, the duration of the action is really worth it. However, it is only considered to be second in terms of popularity. Viagra, which is manufactured by Pfizer, is still the most popular among the ED drugs. This PDE-5 inhibitor is very common and popular in your local pharmacies and even in online drugstores. Ever since it gained its popularity, the price for the innovator drug is also skyrocketing. There are many online stores in the industry that offers generic alternatives of Viagra at a lower price.
Rxdownunder.com is one of the many virtual pharmacies that offer generic brands of Sildenafil. They are an online pharmacy located in Australia. Looking at their prices, 1 tablet of the 100mg strength only costs $1-2 USD. This is a better choice compared to the innovator brand which costs more than $10 USD per pill.
Hence, patients should take into consideration that the cost of the medication should compensate well with its duration of effect. Cialis might be a good choice, but its popularity and the available generic alternatives are not as star rated as those of Viagra. In that case, Sildenafil (Viagra) is still one of the leading and most popular brand of ED treatment.