The best treatment for erectile dysfunction, along with maintaining a healthy lifestyle, is a PDE5 inhibitor. This class of drugs was originally developed to treat heart conditions however during clinical trials other useful effects were discovered. Now these drugs are best known as the active ingredients in erectile dysfunction medications that are prescribed worldwide including Viagra, Cialis, and Levitra. Drugs in this class of medications are now the most commonly prescribed treatments for erectile dysfunction. A compounding pharmacy is able to provide alternatives to these commercially available PDE5 inhibitors in unique dosage forms and strengths.
History of PDE5 Inhibitors
The most well-known PDE5 inhibitor, sildenafil, was actually being developed to treat heart disease until it was discovered it could also help men maintain erections. It was approved by the FDA in 1998 for treating erectile dysfunction and marketed as Viagra. Sildenafil quickly become the most frequently prescribed treatment for ED. The other drugs in this class, tadalafil and vardenafil, were discovered at the same time but were not approved by the FDA until after Viagra. Tadalafil was approved for daily and as-needed use in 2003 and sold under the brand-name Cialis. Vardenafil was approved soon after and marketed as Levitra. PDE5 inhibitors are now widely available in generic form as tablets, and are made by compounding pharmacies in the form of orally dissolving troches. In the future these medications may even be sold over-the-counter, as they are in the U.K. However in the meantime in the U.S. they all require prescriptions from your healthcare provider.
How Do PDE5 Inhibitors Work?
Most ED treatments, including PDE5 inhibitors and nitroglycerin cream, work by improving blood flow to the smooth muscle in the corpus cavernosum of the penis. PDE5 inhibitors work by inhibiting the breakdown of cyclic guanosine monophosphate (cGMP) in the smooth muscle. The enzyme PDE5 degrades cGMP, which has vasodilatory effects and helps maintain an erection. When PDE5 is inhibited, the vasodilatory effects of cGMP are not degraded and an erection can stay firm. Because this reaction is dependent on blood flow to the penis from sexual arousal, PDE5 inhibitors will not have any effect without stimulation.
Each of the PDE5 inhibitors has a different half-life and slightly different side effect profiles. Sildenafil and vardenafil are almost identical in their effects with a few minor exceptions. Although they have differences in pharmacodynamics, studies have not demonstrated a significant difference in effects. Tadalafil stands out due to the fact that it can be taken on a daily basis instead of only “as-needed” use.
Which PDE5 Inhibitor Lasts Longer?
Tadalafil is a longer-acting ED medication than the other drugs in its class. It can be taken in smaller doses on a daily basis or in a larger dose as-needed. The smaller, daily dose provides a cumulative effect, so men who use it consistently will notice improved results over time. This type of daily dosing makes tadalafil the preferred PDE5 inhibitor for many men because it allows for spontaneity in sexual activity. Tadalafil can potentially be effective for up to 36 hours after taking the stronger, as-needed dose. Sildenafil can last up to four hours, while vardenafil may last slightly longer than that. The efficacy of sildenafil and vardenafil is affected when they are taken with a high-fat meal. The length of time they last may be decreased and the time until onset increased.
Some men find that even though tadalafil lasts longer, it does not work as well for them as sildenafil or vardenafil. They may prefer to have one strong dose of medication before sexual activity. This may make more sense if a man does not want to take the medication every day. All PDE5 inhibitors discussed here will be effective. The choice often comes down to each man’s preferences and what works for him.
Orally Dissolving PDE5 Inhibitors
With the exception of vardenafil ODT (orally dissolving tablets), the PDE5 inhibitors are commercially available only in tablet form. The tablets are meant to be swallowed and will be metabolized through the gastrointestinal system. A compounding pharmacy can make any of the PDE5 inhibitors in the form of troches (pronounced “TROH-KEYS”), which dissolve in the mouth. This may help the onset of the medication come quicker as it enters the bloodstream before needing to be digested. In general, commercially available medications are not made in troches because they are difficult to manufacture, store, and ship at a large scale. Many of the troches would melt or decrease in potency as they made the long journey from the factory to the pharmacy to you. A compounding pharmacy, on the other hand, makes each medication individually and ships it directly to your home. This method of making medication allows for greater flexibility in dosage forms.
When to Seek Medical Attention with PDE5 Inhibitors
The majority of men who take PDE5 inhibitors experience no side effects or only mild side effects. Headaches, visual sensitivity, back pain, facial redness, dizziness, and tachycardia are some of the more common side effects that dissipate after the medication leaves the body. More serious side effects that are rare are the potential for heart attacks or priapism, which is generally defined as being when an erection lasts longer than four hours. In general, the milder side effects like headache and facial redness will subside as the medication wears off. If more serious side effects present then men should be advised to seek medical attention.
Other drugs used for ED like nitroglycerin can cause severe adverse reactions when they are combined. PDE5 inhibitors should never be taken with nitrate medications or other ED medications. It is important for all men considering using a PDE5 inhibitor to discuss it with their doctor first. A full medical history that includes discussing other drugs being taken is essential.
Counterfeit ED Medication
Pay attention to where you get your PDE5 inhibitors. Viagra is the most counterfeited drug in the world, and there are task forces developed by drug manufacturers specifically for finding counterfeit makers of this one medication. When you are making a purchase online, the source of your medication is not always clear. It is very easy for a company to trick customers into purchasing something that is lower strength, made with unclear ingredients, or manufactured in an unsanitary facility. Our compounding pharmacy is FocusScript certified and accredited – demonstrating commitment to high quality standards in how we make each medication. We adhere to strict quality standards and are subject to inspection from the FDA and other state regulatory agencies. You can trust that the PDE5 inhibitors you purchase from us have met high quality standards and will be the exact potency that your doctor prescribes.