Conditions That Respond Best to PDE5 Inhibitors for Erectile Dysfunction

Patient Populations and Response Rates

The general ED population shows the highest response rates to PDE5 inhibitors, with similar efficacy across sildenafil, tadalafil, vardenafil, and avanafil 1, 2
Men with mild cardiovascular disease who are classified as "low risk" respond well to PDE5 inhibitors 3
Men with diabetes have more severe ED at baseline and respond less robustly to PDE5 inhibitors 1, 2
Post-prostatectomy patients have more severe ED at baseline and show reduced response to PDE5 inhibitors compared to the general population 1, 2

PDE5 inhibitors are contraindicated in patients taking nitrates due to potentially dangerous hypotension 5, 3
High-risk cardiac patients should not receive treatment for sexual dysfunction until their cardiac condition has stabilized, including those with unstable or refractory angina 3
High-risk cardiac patients should not receive treatment for sexual dysfunction until their cardiac condition has stabilized, including those with uncontrolled hypertension 5
High-risk cardiac patients should not receive treatment for sexual dysfunction until their cardiac condition has stabilized, including those with left ventricular dysfunction/CHF (NYHA class II or greater) 5
High-risk cardiac patients should not receive treatment for sexual dysfunction until their cardiac condition has stabilized, including those with MI or CVA within previous 2 weeks 3
High-risk cardiac patients should not receive treatment for sexual dysfunction until their cardiac condition has stabilized, including those with high-risk arrhythmias 3
High-risk cardiac patients should not receive treatment for sexual dysfunction until their cardiac condition has stabilized, including those with hypertrophic obstructive cardiomyopathies 5
High-risk cardiac patients should not receive treatment for sexual dysfunction until their cardiac condition has stabilized, including those with moderate-to-severe valvular disease 3

All FDA-approved PDE5 inhibitors (sildenafil, tadalafil, vardenafil, and avanafil) have similar efficacy in the general ED population 1, 2

For men with spinal cord injury, lower initial doses are recommended due to potential delayed metabolism 4
For men with predominantly psychogenic ED, PDE5 inhibitors are still effective as first-line therapy 2
For men with predominantly psychogenic ED, referral to a psychotherapist may be beneficial as either an alternative or adjunct to medical treatment 2

Proper patient education is essential as incorrect use accounts for many treatment failures 4
Dose titration should be performed to provide optimal efficacy 1
Periodic follow-up is necessary to assess efficacy, side effects, and any significant changes in health status or medications 5
For patients who fail initial PDE5 inhibitor therapy, evaluation should determine whether the trial was adequate before proceeding to alternative therapies 5

Most frequently reported adverse events include dyspepsia, headache, flushing, back pain, nasal congestion, myalgia, visual disturbance, and dizziness 1, 2
Dyspepsia has the lowest rates with avanafil 1, 2
Flushing has the lowest rates with tadalafil 1, 2
Myalgia has the lowest rates with vardenafil and avanafil 1, 2