Intermittent dosing of PDE5 inhibitors
Oral phosphodiesterase type 5 (PDE5) inhibitors are first-line therapy for erectile dysfunction in males, unless contraindicated (eg current treatment with a nitrate, high risk of death or serious morbidity from sexual exertion). PDE5 inhibitors do not produce an erection without sexual stimulation and activity.
The efficacy of the various PDE5 inhibitors seems similar, but no blinded head-to-head randomised controlled trials have been performed. Choice should be based on patient preference, taking into account pharmacokinetic properties (ie duration of action and rapidity of onset), adverse effects, cost and potential drug interactions.
Adjust the dose of PDE5 inhibitor according to response and adverse effects. Higher doses may be needed for males with:
- arterial vascular disease
- peripheral autonomic nerve damage (caused by radical prostatectomy or other pelvic surgery)
- autonomic neuropathy (especially in people with long-term diabetes).
For pharmacokinetic properties and intermittent doses of PDE5 inhibitors, see #srg2-c33-s4-1__tsrg2-c33-tbl2.
Use:
1 sildenafil 50 mg orally, 1 hour before sexual activity. Maximum of one dose per 24 hours. Adjust dose according to efficacy and tolerability; usual dose 25 to 100 mg erectile dysfunction sildenafil
OR
1 avanafil 100 mg orally, 15 to 30 minutes before sexual activity. Maximum of one dose per 24 hours. Adjust dose according to efficacy and tolerability; usual dose 50 to 200 mg erectile dysfunction avanafil
OR
1 tadalafil 10 mg orally, at a time before sexual activity that the patient has determined is optimal1. Maximum of one dose per 24 hours. Adjust dose according to efficacy and tolerability; usual dose 5 to 20 mg erectile dysfunction, intermittent dosing tadalafil
OR
1 vardenafil 10 mg orally, 30 to 60 minutes before sexual activity. Maximum of one dose per 24 hours. Adjust dose according to efficacy and tolerability; usual dose 5 to 20 mg. erectile dysfunction vardenafil