Erection Problems (Erectile Dysfunction): Medications

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Medications

Medicines that can help produce an erection may be used to treat erection problems (erectile dysfunction) that are caused by blood vessel (vascular), hormonal, nervous system, or psychological problems. They also may be used along with counseling to treat erection problems that have psychological causes.

If erection problems could be caused by a prescribed medicine, it may be possible to change the dose or try another medicine. Do not change or stop taking any medicine without first talking with your health professional.

Medication Choices

Commonly used oral medicines include:

• Phosphodiesterase-5 inhibitors (PDE-5 inhibitors) such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).

Other medicines that may be used include:

• Injected medications.
• Intraurethral alprostadil (MUSE).

Hormones and other medicines may be prescribed for men who have low testosterone or high prolactin levels.

For more information on medication choices, see:

Should I use a phosphodiesterase-5 inhibitor (such as sildenafil [Viagra], tadalafil [Cialis], or vardenafil [Levitra]) for erection problems?

Should I use injections for erection problems?

What To Think About

PDE-5 inhibitors and heart problems

Health experts have debated the use of PDE-5 inhibitors in men with heart disease, because deaths have been reported after use of sildenafil (Viagra). The 1999 American College of Cardiology/American Heart Association (ACC/AHA) Expert Consensus Document noted that PDE-5 inhibitors may be dangerous for people who:⁴

• Have coronary artery disease (CAD).
• Have heart failure and low blood pressure.
• Are taking many different drugs for high blood pressure.

But several more recent studies have reported that some men with heart problems may be able to take PDE-5 inhibitors safely. Talk to your health professional about whether PDE-5 inhibitors are appropriate for you.

• One study found no evidence of increased risk for heart attack or CAD in men who use sildenafil (Viagra).⁵
• Another study in men with CAD reported that sildenafil (Viagra) does not lead to heart attack and that heart attacks and other cardiovascular problems reported after taking Viagra may be related more to the physical activity of intercourse than to the medicine.⁶
• A study of 35 men found that Viagra is safe for men with moderate heart failure.⁷

Sexual activity is exercise. If you have a heart condition and have not been sexually active for a while, talk with your health professional to make sure you can engage in sexual activity safely.

PDE-5 inhibitors should never be used if you may need to take a nitrate-containing medication, such as nitroglycerin. Taking nitroglycerin and a PDE-5 inhibitor within 24 hours of each other may greatly lower your blood pressure, which could lead to a heart attack, stroke, or death.

If you are taking a PDE-5 inhibitor and are going to have a test for heart disease, be certain your doctor knows you are taking it. You should not take sildenafil (Viagra) or vardenafil (Levitra) for 24 hours before the test. Do not take tadalafil (Cialis) for at least 48 hours before the test. Then if you develop a problem during the test, it will be safe to use nitrate-containing medicines such as nitroglycerin.

Although oral medicines for erection problems can be purchased over the Internet, you should still talk with your health professional before using this medicine. This is especially important if you have a heart problem.

If you are using a combination of drugs for high blood pressure, PDE-5 inhibitors could result in low blood pressure (hypotension). Also for this reason, you should not take alpha blockers—used to lower blood pressure and to treat an enlarged prostate—with these medicines without talking to your health professional; the combination could cause a dangerous drop in blood pressure.

Last updated:	May 21, 2008
Author:	Monica Rhodes
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Christopher G. Wood, MD, FACS - Urology/Oncology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC