Drug treatments for Erectile Dysfunction

There are several oral treatments for erectile dysfunction (ED) and it is important that you find the one that works for you. If you're not completely happy with the first drug prescribed, ask your doctor about all the others.

This page includes information about the following ED treatments: Cialis (chemical name: Tadalfil), Levitra (Vardenafil), and Viagra (Sildenafil); Uprima (Apomorphime Hydrochloride); and Muse (Alprostadil). It was last updated in August 2004.

It is based on information provided by the Sexual Dysfunction Association and the research review 'Long-term treatments for erectile dysfunction' by John Dean, Men's Health Journal (Vol. 2, No.3, pp. 77-80; 2003).

Dean says of the three PDE5 inhibitor drugs (Viagra, Cialis and Levitra) that: 'generally, all three drugs are well-tolerated and few men will discontinue treatment because of adverse effects.' The side effects cited below are from his article and based the clinical trials. He concludes: 'As yet there is no good evidence that any one PDE5 is any better than the others.'

Dean suggests trying them out. 'Many men want to be able to try all three drugs and find out which one best suits their preferred patterns of sexual behaviour. In such circumstances, this is a perfectly reasonable approach for them to take and one that the physician has little cause to obstruct.' Indeed, as with all treatments, most doctors see patient preference as important.

Cialis (Tadalifil)

Cialis is a PDE5 inhibitor allowing blood to flow more easily into the sexually stimulated penis. It is a first-line treatment for men with intermittent ED and those who never get an erection

yellow, almond tablet (10mg or 20mg)

How soon it works and for how long: Speed of effectiveness varies but the majority of men are able get an erection within 30 minutes. Effectiveness lasts 36 hours. (This does not mean that you will be able to get an erection for up to 36 hours, but how long you have to respond to sexual stimulation after taking this treatment.)

Side effects (%age of users reporting problem):

• Headache 14.5%
• Indigestion 12.3%
• Back pain 6.5%
• Muscle pain 5.7%
• Stuffed nose 4.3%
• Facial flushing 4.1%
• Dizziness 2.3%

Driving: Can cause dizziness and affect sight so you need to be aware of how you react to the drug before driving.

Other points to note: Should not be prescribed to men who have an abnormally shaped penis (for example, Peyronie's Disease) or mixed with other ED treatment. Before using, you must also tell your doctor of any existing medical condition, particularly heart problems, however mild, and of any tablets you are taking for them such as nitrates for angina.

Levitra (Vardenafil)

Levitra is a PDE5 inhibitor allowing blood to flow more easily into the sexually stimulated penis. It is a first-line treatment for men with intermittent ED and those who never get an erection

round, orange tablet (5mg, 10mg or 15mg)

How soon it works and for how long: Effective within 25-60 minutes (15 minutes for some men) and lasts for about 5 hours. (This does not mean that you will be able to get an erection for up to 5 hours, but how long you have to respond to sexual stimulation after taking this treatment.) Take only once in a 24 hour period.

Side effects (%age of users reporting problem):

• Facial flushing 11%
• Headache 10.3%
• Indigestion 3.4%
• Stuffed nose 2.7%

Driving: Can cause dizziness and affect sight so you need to be aware of how you react to the drug before driving.

Other points to note: Should not be prescribed to men who have an abnormally shaped penis (for example, Peyronie's Disease) or mixed with other ED treatment. Before using, you must also tell your doctor of any existing medical condition, particularly heart problems, however mild, and of any tablets you are taking for them such as nitrates for angina.

Viagra (Sildenafil)

Viagra is a PDE5 inhibitor allowing blood to flow more easily into the sexually stimulated penis. It is a first-line treatment for men with intermittent ED and those who never get an erection

blue, diamond tablet (Doses: 25mg, 50g or 100mg)

How soon it works and for how long: Effective within 20-60 minutes and lasts for 4-6 hours.

Side effects (%age of users reporting problem):

• Headache 12.8%
• Facial flushing 10.4%
• Indigestion 4.6%
• Sight problems 1.9%
• Dizziness 1.2%
• Stuffed nose 1.1%

Driving: Can cause dizziness and affect sight so you need to be aware of how you react to the drug before driving.

Other points to note: Should not be prescribed to men who have an abnormally shaped penis (for example, Peyronie's Disease) or mixed with other ED treatment. Before using, you must also tell your doctor of any existing medical condition, particularly heart problems, however mild, and of any tablets you are taking for them such as nitrates for angina.

Uprima (Apomorphime Hydrochloride)

First line treatment for men with intermittent ED which works on the central nervous system to affect erection response rather than on the penis iself. Tablet dissolves on tongue in 10-20 minutes. Don't swallow.

light brown pentagon tablet (2mg) or triangle (3mg)

When it works: Effective within 10-20 minutes.

Side effects: The most common side effects are nausea, headache and dizziness.

Driving: Don't drive for at least two hours afterwards.

Other points to note: Should not be prescribed to men who have an abnormally shaped penis (for example, Peyronie's Disease) or mixed with other ED treatment. Before using, you must also tell your doctor of any existing medical condition, particularly heart problems, however mild, and of any tablets you are taking for them such as nitrates for angina.

Muse (Alprostadil)

Muse is an updated way of taking an ED treatment that has been around since 1994 as an injection. It is a second-line treatment used after the above have failed in which a small pellet is introduced directly into the urthera though the penis opening using a special applicator.

When it works: Effective within 5-10 minutes and lasts for up to an hour. Can be used twice within 24 hours but not one after the other.

Side effects: Rarely it causes light-headedness, dizziness, fainting, rapid pulse and swelling of the leg veins. It can cause vaginal itching in a female partner.

Driving: Don't drive for at least an hour afterwards.

Other points to note: Some men may find insertion painful and some may faint. First insertion should be in a doctor's surgery.