ED Pharmacology

ED Pharmacology33-36

Drug

Dosing

Onset/Duration

Drug Specific Issues

Patient education

Avanafil

50-100 mg once per day (50 mg if concurrent alpha-blocker use) 15 min prior to sexual activity. Max dose 200 mg.

 

● Onset: 15-30 minutes

● Duration: Up to 6 hours

 

● Delay nitrate treatment at least 12 hours

● Longer delay in case of renal or hepatic dysfunction with nitrate treatment.

● Caution if CHF class II-IV NYHA

Not affected by food

Sildenafil

25-50 mg once per day as needed one hour prior to sexual intercourse. Max dose 100 mg

● Onset 30-60 minutes

●Duration: Up to 12 hours

● Delay nitrate treatment at least 24 hours.

● Longer delay in case of renal or hepatic dysfunction.

● Blue vision side effect

● 25 mg dose in hepatic impairment.

 

A high fat-meal decreases absorption

Vardenafil

5-20 mg daily as needed one hour prior to sexual intercourse

ODT: 10 mg one hour prior to sexual intercourse once daily

● Onset: 30-60 minutes

● Duration: Up to 10 hours

● Delay nitrate treatment at least 24 hours.

● Longer delay in case of renal or hepatic dysfunction.

● Caution in patients with phenylketonuria

● Caution in prolonged QT interval

 

A high fat-meal decreases absorption

Tadalafil

Once daily dosing: 2.5-5 mg daily at approximately the same time.

PRN dosing: 5-20 mg once daily 30 minutes prior to sexual activity

● Onset: 60-120 minutes

● Duration: Up to 36 hours

● Delay nitrate treatment at least 48 hours.

● Longer delay in case of renal or hepatic dysfunction.

 

Not affected by food

 

 

Side Effects

●      Flushing

●      Headaches

●      Dyspepsia

●      Dizziness

●      Nasal congestion

●      Hearing loss

●      Priapism

●      Extremely rare: Vision loss (Nonarteritic anterior ischemic optic neuropathy)

●       

Contraindications

●      Concurrent use of nitrate-containing medications

●      Anatomical penis deformation (Angulation, Cavernosal Fibrosis, and Peyronie Disease)

 

Cautions

●      Alpha-adrenergic antagonists: (Terazosin, Doxazosin, Tamsulosin, Alfuzosin, and Silodosin) - Do not take within 4 hours of these medications due to the risk of hypotension

●      Bleeding disorders

●      In cardiovascular disease and hypo or hypertension (<90/50 mm Hg for hypotension and >170/110 mm Hg for hypertension)

●      Patients with left ventricular outflow obstruction

●      Prior history of priapism and conditions that may dispose the patient to it (sickle cell anemia, multiple myeloma, leukemia)

●      Peptic ulcer disease.

●      Pulmonary veno-occlusive disorders.

 

 

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