Erectile Dysfunction

Erectile dysfunction (ED), sometimes known as impotence, is where you fail to get and maintain a proper erection; it is more common with increasing age. It is thought that about 50% of men between the ages of 40 and 70 and about 70% of men aged 70 and above suffer with ED. The most common cause of ED is because of a narrowing of the arteries that take blood to the penis. Some men can suffer from temporary ED when they have drunk too much alcohol, are tired, stressed or distracted. If your ED has become a regular problem then taking a tablet before you plan to have sex may help. Persistent ED is commonly caused by various factors such as diabetes, diseases which affects nerves (such as Parkinson’s disease and multiple sclerosis), side effects of certain medications, decreased blood flow to the penis caused by high blood pressure, high cholesterol, smoking, diabetes or increasing age and injury to nerves going to the penis.

If you think you suffer with persistent ED then get a free consultation from one of our pharmacist prescribers or see your GP.

There are three products (called PDE-5 inhibitors) on the market which are effective in patients who suffer from ED. The modes of action and side effects are slightly different between the three drugs so the table below might help you choose the drug most suitable for you.

These drugs do not cause an erection at inappropriate times because they only act in response to sexual stimulation. If there is no sexual stimulation, the drug "stays in the background".

Cialis (tadalafil)

Levitra (vardenafil)

Viagra (Sildenafil)

Recommended dose

10mg, may be increased to 20mg if necessary

10mg, may be increased to 20mg if necessary

50mg, may be increased to 100mg or reduced to 25mg if necessary

Onset of action

16-45 minutes

25 minutes

30 minutes

Effect of food on onset of action

Effect NOT delayed by food

Effect delayed by a fatty meal

Effect delayed if taken with food

Effect of food on efficacy

Works without regard to what you eat

Less effective if taken with a high fat meal

Less effective if taken with a high fat meal

Duration of action

36 hours

4-5 hours

4-5 hours

Most common side effects

Headache, indigestion

Facial flushing, headache

Facial flushing, indigestion, headache

Less common side effects

Back pain, muscle ache, nasal congestion, facial flushing, dizziness

Indigestion, nausea, dizziness, nasal congestion

Altered vision, dizziness, nasal congestion

Cialis stays in the body longer than the other two drugs, which can allow for more spontaneity as it "stays in the background" for longer, however it could potentially prolong the side effects which might be experienced (although these are less common compared with the other drugs). Most people have no side effects with these drugs.

The drugs are not suitable for some people. They must never be taken by people taking oral nitrates. They are also not suitable for people taking drugs such as doxazosin (alpha-blockers). They should not be used in those with orthostatic hypotension (that is, a marked drop in blood pressure upon movement which can cause a light-headedness or dizziness), or in those people who may have aortic stenosis or hypotrophic obstructive cardiomyopathy.

Men who have had a heart attack or stroke within the past 6 months or a medical condition that makes sexual activity inadvisable (such as uncontrolled high blood pressure, severe low blood pressure, liver disease or unstable angina) should also not take these drugs.

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