Pharmacotherapy for erectile dysfunction

Introduction: Pharmacotherapy is the usual initial therapy for most men with erectile dysfunction. Aim: To review the current data relating to the efficacy, tolerability and safety of drugs used in the treatment of men with erectile dysfunction. Methods: A critical review of the literature relating to the use of pharmacotherapeutic agents was undertaken by a committee of eight experts from five countries, building on prior reviews. Main Outcome Measures: Expert opinion and recommendations were based on grading of evidence-based literature, internal committee dialogue, open presentation, and debate. Results: Almost all currently available evidence relates to sildenafil, tadalafil, and vardenafil. Phosphodiesterase type 5 (PDE5) inhibitors are first-line therapy for most men with erectile dysfunction who do not have a specific contraindication to their use. There is no evidence of significant differences in efficacy, safety, and tolerability between the PDE5 inhibitors and apomorphine. Intracavernosal injection therapy with alprostadil should be offered to patients as second line therapy for erectile dysfunction. Intraurethral alprostadil is a less effective treatment than intracavernosal alprostadil for the treatment of men with erectile dysfunction. Conclusions: PDE5 inhibitors are effective, safe, and well-tolerated therapies for the treatment of men with erectile dysfunction. Apomorphine, intracavernosal injection therapy with alprostadil, and intraurethral alprostadil are all effective and well-tolerated treatments for men with erectile dysfunction. We recommend some standardization of the assessment of psychosocial outcomes within clinical trials in the field of erectile dysfunction. © 2010 International Society for Sexual Medicine.