Erectile dysfunction
persistent inability to attain and maintain an erection
Treatment
- phosphodiesterase type 5 inhibitor
MOA for PD-5i
PDE5 inhibition = increase CGMP
release of NO in corpus cavernous = increase cGMP = smooth muscle relaxation = inflow of blood
Short acting PD-5i
avanafil
sildenagil
vardenafil
occasional use prn
Longer acting PD-5i
tadalafil
prn or as a regular lower daily dose to allow for spontaneous sexual activity
Maximum dose
6 dose maximum before being classified as a non responder
Second line treatment
Intracernosal, intraurethral or topical alprostadil
under medical supervision
lifestyle changes
smoking cessation
reduce alcohol intake
side effects
flushing
dizziness
nasal congestion
migraine
Counselling
- Take before food
- Onset of effect may be delayed if taken with food
Contraindication
hypotension
unstable angina/ stoke
angina during intercourse
Priapism
erection lasting longer than 4 hours
seek medical attention
Alprostadil counselling
wear condom if patient is of child bearing age, pregnant or lactation
Interactions
nitrates
alpha blockers - hypotensive effect
