
Viagra, the brand name for Sildenafil, and Cialis, the brand name for Tadalafil, are very popular drugs approved to treat erectile dysfunction, most often caused by obstruction of blood flow to the penis. These drugs, known as phosphodiesterase 5 (PDE5) inhibitors, are exceptionally effective in helping men achieve an erection because they relax the muscles lining the arteries that supply the penis (and elsewhere in the body) with oxygen-rich blood.
Generally, when ED is diagnosed as a vascular concern related to aging, or even after a prostatectomy, these drugs are the first line of attack to restore erectile function. At the first sign of erectile dysfunction, men may do very well with a relatively low dose of Sildenafil or Tadalafil – 25mg and 5mg respectively. However, erectile dysfunction only worsens with time, and most patients eventually experience a progression of the condition which broadly translates to less blood flow into the penis from continued buildup of arterial plaque. As the condition worsens, men take larger doses up to the maximum – 20 mg for Cialis/tadalafil and 100 mg for Viagra/sildenafil. Ultimately, these doses are tolerable for most patients; above that, the drug is not approved.
The short answer is that while both drugs are very safe at their prescribed levels, even at their maximum, there can be problematic side effects beyond these limits including:
Because of the longer half-life of tadalafil, these risks are heightened and may occur for longer.
There is a point at which these drugs cease to have a substantial effect on erections. However, patients should not be frustrated or concerned, as there are several treatment options when pills no longer work.
After drug therapy, many patients move on to penile injections. A substance known as Tri-Mix is injected into the shaft of the penis, offering a strong and virtually immediate erection. This is a safe and very effective option, which does have a small risk for priapism, the four-hour erection. However, when trained to inject appropriately, as they are at our office, most patients can avoid this possible risk.
For some, these medical options, even injections, may not offer sufficient effect to give a man an erection suitable for sexual intercourse. At this point, a penile implant, also known as an inflatable penile prosthesis, can be considered. While this may seem like a drastic option, our patients are typically thrilled with the results. The implant is a discrete and predictable option for maintaining an erection, without compromising the sensation and even ejaculatory volume that they once had.
Be sure to speak to a specialist men’s health urologist like Dr. Grant to learn more about these options and take the next steps to treatment.
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