Erectile dysfunction (ED) affects up to 50% of men between the ages of 40 and 70 years of age. Sildenafil, vardenafil and tadalafil have all been shown to be similarly effective in the treatment of men with ED of vary etiologies, to have similar adverse effects profiles, and to improve quality-of-life by similar amounts. As these phosphodiesterase 5 (PDE5) inhibitors all increase the hypotensive effects of nitrates, they are not suitable for use in patients taking nitrates for the treatment of ischaemic heart disease. All three inhibitors must be used with caution in patients taking α1-adrenoceptors antagonists for benign prostatic hyperplasia. Although nonarteritic anterior ischaemic neuropathy has been reported in some users of the PDE5 inhibitors, there is no conclusive evidence that PDE5 inhibitors cause this rare effect. Tadalafil has a longer half-life than sildenafil or vardenafil, and a longer duration of action than sildenafil and vardenafil. Most preference studies have shown tadalafil to be preferred, but there are serious limitations to some of these studies. One approach to treatment is to give each patient a short- and long-acting agent, and for individuals to decide their preference.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Rent or buy this article
Prices vary by article type
Prices may be subject to local taxes which are calculated during checkout
NIH consensus development panel on impotence. Impotence. JAMA 1993; 270: 83–90.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, Mckinlay JB . Impotence and its medical and psychological correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.
Johannes CB, Araujo AB, Felman HA, Derby CA, Kleinman KP, McKinlay JB . Incidence of erectile dysfunction in men 40–69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol 2000; 163: 460–463.
Banker FL . The preservation of potency after external beam irradiation for prostate cancer. Int J Radiat Oncol Biol Phys 1988; 15: 219–220.
Stock RG, Stone NN, Iannuzzi C . Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys 1996; 35: 267–272.
Rosas SE, Joffe M, Franklin E, Strom BL, Kotzker W, Brensinger C et al. Prevalence and determinants of erectile dysfunction in hemodialysis patients. Kidney Int 2001; 59: 2259–2266.
Rosen RC, Lane RM, Menza M . Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 1999; 19: 67–85.
Boolell M, Allen MJ, Ballard SA . Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erection dysfunction. Int J Impot Res 1996; 8: 47–52.
Bischoff E, Niewoehner U, Haning H . Vardenafil a potent and selective inhibitor of phosphodiesterase type 5 increases cGMP in rabbit corpus cavernosum. Int J Impot Res 2000; 12 (Suppl 3): 65.
Daugan A, Grondin P, Ruault C, Le Monnier de Gouville AC, Coste H et al. The discovery of tadalafil: a novel and highly selective PDE5 inhibitor. 2: 2,3,6,7,12,12a-hexahydropyrazino[1′,2′:1,6]pyrido[3,4-b]indole-1,4-dione analogues. J Med Chem 2003; 46: 4533–4542.
Ballard SA, Gingell CJ, Tang K, Turner LA, Price ME, Naylor AM . Effects of sildenafil on the relaxation of human corpus cavernosum tissue in vitro and the activities of cyclic nucleotide phosphodiesterase isozymes. J Urol 1998; 159: 2164–2171.
Saenz De Tejada I, Angulo J, Cuevas P, Fernandez A, Moncada I, Allona A et al. The phosphodiesterase inhibitory selectivity and the in vitro and in vivo potency of the new PDE5 inhibitor vardenafil. Int J Impot Res 2001; 13: 282–290.
Wayman C, Phillips S, Lunny C, Webb T, Fawcett L, Baxendale R et al. Phosphodiesterase 11 (PDE11) regulation of spermatozoa physiology. Int J Impot Res 2005; 17: 216–223.
Weeks JL, Zoraghi R, Beasley A, Sekhar KR, Francis SH, Corbin JD . High biochemical selectivity of tadalafil, sildenafil and vardenafil for human phosphodiesterase 5A1 (PDE5) over PDE11A4 suggests the absence of PDE11A4 cross-reaction in patients. Int J Impot Res 2005; 17: 5–9.
Blount MA, Beasley A, Zoraghi R, Sekhar KR, Bessay EP, Francis SH et al. Binding of tritiated sildenafil, tadalafil, or vardenafil to the phosphodiesterase-5 catalytic site displays potency, specificity, heterogeneity, and cGMP stimulation. Mol Pharmacol 2004; 66: 144–152.
Padma-Nathan H, Stecher VJ, Sweeney M, Orazem J, Tseng LJ, Deriesthal H . Minimal time to successful; intercourse after sildenafil citrate: results of a randomized, double-blind, placebo-controlled trial. Urology 2003; 62: 400–403.
Montorsi F, Padman-Nathan H, Buvat J, Schwaibold H, Beneke M, Ulbrich E et al. Earliest time to onset of action leading to successful intercourse with vardenafil determined in an at-home setting: a randomized, double-blind, placebo-controlled trial. J Sex Med 2004; 1: 168–178.
Rosen RC, Padma-Nathan H, Shabish R, Saikali K, Watkins V, Pullman W . Determining the earliest time within 30 min to erectogenic effect after tadalafil 10 and 20 mg: a multicenter, randomized, double-blind, placebo-controlled, at-home study. J Sex Med 2004; 1: 193–200.
Porst H . IC351 (tadalafil, Cialis): update on clinical experience. Int J Impot Res 2002; 14 (Suppl 1): S57–S64.
Shabsigh R, Burnett AL, Eardley I, Sharlip ID, Ellsworth PI, Garcia CS et al. Time from dosing to sexual intercourse attempts in men taking tadalafil in clinical trials. BJU Int 2005; 96: 857–863.
Porst H, Padma-Nathan H, Giuliano F, Anglin G, Varanese L, Rosen R . Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 h after dosing: a randomized controlled trial. Urology 2003; 62: 121–125.
Young JM, Feldman RA, Auerback SM, Kaufman JM, Garcia CS, Shen W et al. Tadalafil improved erectile function at twenty-four and thirty-six hours after dosing in men with erectile dysfunction: US Trial. J Androl 2005; 26: 310–318.
Moncada I, Jara J, Subira D, Castano I, Hernandez C . Efficacy of sildenafil citrate at 12 h after dosing: re-exploring the therapeutic window. Eur Urol 2004; 46: 357–360.
Porst H, Sharlip ID, Hatzichristou D, Rubio-Aurioles E, Gittelman M, Stancil BN et al. Extended duration of efficacy of vardenafil when taken 8 h before intercourse: a randomized, double-blind, placebo-controlled study. Eur Urol 2006 (E-pub ahead of print).
Gupta M, Kovar A, Meibohm B . The clinical pharmacokinetics of phosphodiesterase-5 inhibitors for erectile function. J Clin Pharmacol 2005; 45: 987–1003.
Rajagopalan P, Mazzu A, Xia C, Dawkins R, Sundaresan P . Effect of high-fat breakfast and moderate-fat evening meal on pharmacokinetics of vardenafil, an oral phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction. J Clin Pharmacol 2003; 43: 260–267.
Forgue ST, Patterson BE, Bedding AW, Payne CD, Phillips DL, Wrishko RE et al. Tadalafil pharmacokinetics in healthy subjects. Br J Clin Pharmacol 2006; 61: 280–288.
Deveci S, Peskircioglu L, Aygun C, Tekin MI, Dirim A, Ozkardes H . Sublingual sildenafil in the treatment of erectile dysfunction: faster onset of action with less dose. Int J Urol 2004; 11: 989–992.
Jackson G, Benjamin N, Jackson N, Allen AJ . Effects of sildenafil citrate on human hemodynamics. Am J Cardiol 1999; 83: 13C–20C.
Hermann HC, Chang G, Klugherz BD, Mahoney PD . Hemodynamic effects of sildenafil in men with severe coronary artery disease. N Engl J Med 2000; 342: 1622–1626.
Arruda-Olson AM, Mahoney DW, Nehra A, Leckel M, Pellikka PA . Cardiovascular effects of sildenafil during exercise in men with known or probably coronary artery disease: a randomized crossover trial. JAMA 2002; 287: 719–725.
Bocchi EA, Guimaraes G, Mocelin A, Bacal F, Bellotti G, Ramires JF et al. Sildenafil effects on exercise, neurohormonal activation, and erectile dysfunction in congestive heart failure: a double-blind, placebo-controlled, randomized study followed by a prospective treatment for erectile dysfunction. Circulation 2002; 106: 1097–1103.
Padma-Nathan H, Eardley L, Kloner RA, Laties AM, Montorsi F . A 4-year update on the safety of sildenafil citrate (Viagra). Urology 2002; 60 (2Suppl2): 67–90.
Webb DJ, Freestone S, Allen MJ, Muirhead GJ . Sildenafil citrate and blood-pressure-lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist. Am J Cardiol 1999; 83: 21C–28C.
Webb DJ, Muirhead GJ, Wulff M, Sutton JA, Levi R, Dinsmore WW . Sildenafil citrate potentiates the hypotensive effects of nitric oxide donor drugs in male patients with stable angina. J Am Coll Cardiol 2000; 36: 25–31.
Zusman RM, Prisant LM, Brown MJ . Effect of sildenafil citrate on blood pressure and heart rate in men with erectile dysfunction taking concomitant antihypertensive medication. Sildenafil Study Group. J Hypertension 2000; 18: 1865–1869.
Kloner RA, Brown M, Prisant LM, Collins M . Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group. Am J Hypertension 2001; 14: 70–73.
Thadani U, Smith W, Nash S, Bittar N, Glasser S, Narayan P et al. The effects of vardenafil, a potent and highly selective phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, on the cardiovascular response to exercise in patients with coronary artery disease. J Am Coll Cardiol 2002; 40: 2006–2012.
Patient Information Sheet for Vardenafil. Available at http://www.fda.gov/cder/drug/infopage/vardenafil/default.htm.
Van Ahlen H, Wahle K, Kupper W, Yassin A, Reblin T, Neureither M . Safety and efficacy of vardenafil, a selective phosphodiesterase 5 inhibitor, in patients with erectile dysfunction and arterial hypertension treated with multiple antihypertensives. J Sex Med 2005; 2: 856–864.
Kloner RA, Mitchell M, Emmick JT . Cardiovascular effects of tadalafil. Am J Cardiol 2003; 92 (9A): 37M–346M.
Kloner RA, Mitchell M, Emmick JT . Cardiovascular effects of tadalafil in patients on common antihypertensive therapies. Am J Cardiol 2003; 92 (9A): 47M–457M.
Kloner RA, Hunter AM, Emmick JT, Mitchell MI, Denne J, Jackson G . Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol 2003; 42: 1855–1860.
Patterson D, Kloner R, Effron M, Emmick J, Bedding A, Warner M et al. The effect of tadalafil on the time to exercise-induced myocardial ischaemia in subjects with coronary artery disease. Br J Clin Pharmacol 2005; 60: 459–468.
Dustan Sarazan R, Crumb Jr WJ, Beasley Jr CM, Emmick JT, Ferguson KM, Strnat CA et al. Absence of clinically important HERG channel blockade by three compounds that inhibit phosphodiesterase 5 – sildenafil, tadalafil, and vardenafil. Eur J Pharmacol 2004; 502: 163–167.
Carson III C . Cardiac safety in clinical trials with phosphodiesterase 5 inhibitors. Am J Cardiol 2005; 96: 37M–341M.
Hattenhauer MG, Leavitt JA, Hodge DO, Grill R, Gray DT . Incidence on nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 1997; 123: 103–107.
Pomeranz HD, Smith KH, Hart WM, Egan RA . Sildenafil-associated nonarteritic anterior ischemic optic neuropathy. Ophthalmology 2002; 109: 584–587.
Pomeranz HD, Bhavsar AR . Nonarteritic ischemic optic neuropathy developing soon after use of sildenafil (Viagra): a report of seven new cases. J Neuroophthalmol 2005; 25: 9–13.
FDA Alert at http://www.fda.gov/cder/drug/infopage/cialis/default.htm.
McGwin G, Vaphiades MS, Hall TA, Owsley C . Non-arteritic anterior ischaemic optic neuropathy and the treatment of erectile dysfunction. Br J Ophthalmol 2006; 90: 154–157.
Gorkin L, Hvidsten K, Sobel RE, Siegel R . Sildenafil citrate use and the incidence of nonarteritic anterior ischemic optic neurophathy. Int J Clin Pract 2006; 60: 500–503.
Kloner RA . Cardiovascular effects of the 3 phosphodiesterase-5 inhibitors approved for the treatment of erectile dysfunction. Circulation 2004; 110: 3149–3155.
Kloner RA, Jackson G, Emmick JT, Mitchell MI, Bedding A, Warmer MR et al. Interaction between the phosphodiesterase 5 inhibitor, tadalafil and 2 alpha-blockers, doxazosin and tamsulosin in healthy normotensive men. J Urol 2004; 172: 1935–1940.
Giuliano F, Kaplan SA, Cabanis MJ, Astruc B . Hemodynamic interaction study between the alpha1-blocker alfuzosin and phosphodiesterase-5 inhibitor tadalafil in healthy male subjects. Urology 2006; 67: 1199–1204.
Boolell M, Gepi-Atee S, Gingell JC, Allen MJ . Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 1996; 78: 257–261.
Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA . Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group. N Eng J Med 1998; 338: 1397–1404.
Tan HM, Moh CL, Mendoza JB, Gana T, Albana GJ, de la Cruz R et al. Asian sildenafil efficacy and safety study (ASSESS-1): a double-blind, placebo-controlled, flexible-dose study of oral sildenafil in Malaysian, Singaporean, and Filipino men with erectile dysfunction. The Assess-1 Study Group. Urology 2000; 56: 635–640.
Meuleman E, Cuzin B, Opsomer RJ, Hartmann U, Bailey MJ, Maytom MC et al. A dose-escalation study to assess the efficacy and safety of sildenafil citrate in men with erectile dysfunction. BJU Int 2001; 87: 75–81.
Choi HK, Ahn TY, Kim JJ, Kim SC, Paick JS, Suh JK et al. A double-blind, randomised- placebo, controlled, parallel group, multicentre, flexible-dose escalation study to assess the efficacy and safety of sildenafil administered as required to male outpatients with erectile dysfunction in Korea. Int J Impot Res 2003; 15: 80–86.
Montorsi F, McDermott TE, Morgan R, Olsson A, Schultz A, Kirkeby HJ et al. Efficacy and safety of fixed-dose oral sildenafil in the treatment of erectile dysfunction of various etiologies. Urology 1999; 53: 1011–1018.
Jarow JP, Burnett AL, Geringer AM . Clinical efficacy of sildenafil citrate based on etiology and response to prior treatment. J Urol 1999; 162: 722–725.
Christiansen E, Guirguis WR, Cox D, Osterloh IH . Long-term efficacy and safety of oral Viagra (sildenafil citrate) in men with erectile dysfunction and effect of randomised treatment withdrawal. Int J Impot Res 2000; 12: 177–182.
Park K, Ku JH, Kim SW, Paick JS . Risk factors in predicting a poor response to sildenafil citrate in elderly men with erectile dysfunction. BMJ Int 2005; 95: 366–370.
Morales A, Gingell C, Collins M, Wicker PA, Osterloh IH . Clinical safely of oral sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction. Int J Impot Res 1998; 10: 69–73.
Muller MJ, Ruof J, Graf-Morgenstern M, Porst H, Benkert O . Quality of partnership in patients with erectile dysfunction after sildenafil treatment. Pharmacopsychiatry 2001; 34: 91–95.
Dinsmore WW, Hodges M, Hargreaves C, Osterloh IH, Smith MD, Rosen RC et al. Sildenafil citrate (Viagra) in erectile dysfunction in men with broad-spectrum erectile dysfunction compared with age-matched healthy controls subjects. Urology 1999; 53: 800–805.
Giuliano F, Pena BM, Mishra A, Smith MD . Efficacy results and quality-of-life measures in men receiving sildenafil citrate for the treatment of erectile dysfunction. Qual Life Res 2001; 10: 359–369.
O’Leary MP, Althof SE, Cappelleri JC, Crowley A, Sherman N, Duttagupta S . Self-esteem, confidence and relationship satisfaction of men with erectile dysfunction treated with sildenafil citrate: a multicentre, randomized, parallel group, double-blind, placebo controlled study in the United Sates. J Urol 2006; 175: 1058–1062.
Cappelleri JC, Bell SS, Althof SE, Siegel RL, Stecher VJ . Comparison between sildenafil-treated subjects with erectile dysfunction and control subjects on the Self-Esteem And Relationship questionnaire. J Sex Med 2006; 3: 274–282.
McMahon CG . High dose sildenafil citrate as a salvage therapy for severe erectile dysfunction. Int J Impot Res 2002; 14: 533–538.
Hatzichristou D, Moysidis K, Apostolidis A, Bekos A, Tzortzis V, Hatzimouratidis K et al. Sildenafil failures may be due to inadequate patients instructions and follow-up: a study on 100 non-responders. Eur Urol 2005; 47: 518–522.
Gruenwald T, Shenfeld O, Chen J, Raviv G, Richter S, Cohen A et al. Positive effect of counselling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil. Eur Urol 2006 (E-pub ahead of print).
Giuliano F, Montorsi F, Mirone V, Rossi D, Sweeney M . Switching from intracavernous prostaglandin E1 injections to oral sildenafil citrate in patients with erectile dysfunction: results of a multicenter European Study. The Sildenafil Multicentre Study Group. J Urol 2000; 164: 708–711.
Montorsi F, Althof SE, Sweeney M, Menchini-Fabris F, Sasso F, Giuliano F . Treatment satisfaction in patients with erectile dysfunction switching from prostaglandin E(1) intracavernosal injection therapy to oral sildenafil citrate. Int J Impot Res 2003; 15: 444–449.
Hatzimouratidis K, Hatzichristou DG . A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient? Drugs 2005; 65: 1621–1650.
Pavone C, Curto F, Anello G, Serretta V, Almasio PL, Pavone-Macaluso M . Prospective, randomized, crossover comparison of sublingual apomorphine (3 mg) with oral sildenafil (50 mg) for male erectile dysfunction. J Urol 2004; 172: 2347–2349.
Eardley I, Wright P, MacDonagh R, Hole J, Edwards A . An open-label, randomized, flexible-dose, crossover study to assess the comparative efficacy and safety of sildenafil citrate and apomorphine hydrochloride in men with erectile dysfunction. BJU Int 2004; 93: 1271–1275.
Safarinejad MR . Salvage of sildenafil failures with cabergoline: a randomized, double-blind, placebo-controlled study. Int J Impot Res 2006 (E-pub aheadof print).
Price DE, Gingell JC, Gepi-Attee S, Wareham K, Yates P, Boolell M . Sildenafil: study of a novel oral treatment for erectile dysfunction in diabetic men. Diabet Med 1998; 15: 821–825.
Rendell MS, Raifer J, Wicker PA, Smith MD . Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA 1999; 281: 421–426.
Stuckey BG, Jadzinsky MN, Murphy LJ, Montorsi F, Kadioglu A, Fraige F et al. Sildenafil citrate for treatment of erectile dysfunction in men with type 1 diabetes: results of a randomized controlled trial. Diabet Care 2003; 26: 279–284.
Perimenis S, Markou S, Gyftopoulos K, Athanasopoulos A, Giannitsas K, Barbalias G . Switching from long-term treatment with self-injections to oral sildenafil in diabetic patients with severe erectile dysfunction. Eur Urol 2002; 41: 387–391.
Debusk RF, Pepine CJ, Glasser DB, Shpilsky A, DeRiesthal H, Sweeney M . Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease. Am J Cardiol 2004; 93: 147–153.
Katz SD, Parker JD, Glasser DB, Bank AJ, Sherman N, Wang H et al. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and chronic heart failure. Am J Cardiol 2005; 95: 36–42.
Zelefsky MJ, Mckee AB, Lee H, Leibel SA . Efficacy of oral sildenafil in patients with erectile dysfunction after radiotherapy for carcinoma of the prostate. Urology 1999; 53: 775–778.
Merrick GS, Butler WM, Lief JH, Stipetich RL, Abel LJ, Dorsey AT . Efficacy of sildenafil citrate in prostate brachytherapy patients with erectile dysfunction. Urology 1999; 53: 1112–1116.
Incrocci L, Koper PC, Hop WC, Slob AK . Sildenafil citrate (Viagra) and erectile dysfunction following external beam radiotherapy for prostate cancer: a randomized double-blind, placebo-controlled, cross-over study. Int J Radiat Oncol Biol Phys 2001; 51: 1190–1195.
Zippe CD, Kedia AW, Kedia K, Nelson DR, Agarwal A . Treatment of erectile dysfunction after radical prostatectomy with sildenafil citrate (Viagra). Urology 1998; 52: 963–966.
Lowentritt BH, Scardino PT, Miles BJ, Orejuela FJ, Schatte EC, Slawin KM et al. Sildenafil citrate after radical retropubic prostatectomy. J Urol 1999; 162: 1614–1617.
Zagaja GP, Mhoon DA, Aikens JE, Brendler CB . Sildenafil in the treatment of erectile dysfunction after radical prostatectomy. Urology 2000; 56: 631–634.
Montorsi F, McCullough A . Efficacy of sildenafil citrate in men with erectile dysfunction following radical prostatectomy: a systematic review of clinical data. J Sex Med 2005; 2: 658–667.
Shenfield OZ, Gofrit OD, Gdor Y, Landau I, Katz R, Pode D . The role of sildenafil in the treatment of erectile dysfunction with pelvic fracture urethral disruption. J Urol 2004; 172: 2350–2352.
Eardley I, Morgan R, Dinsmore W, Yates P, Boolell M . Efficacy and safety of sildenafil citrate in the treatment of men with mild to moderate erectile dysfunction. Br J Psychiatry 2001; 178: 325–330.
Seidman SN, Roose SP, Menza MA, Shabsigh R, Rosen RC . Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001; 158: 1623–1630.
Nurnberg HG, Gelenberg A, Hargreave TB, Harrison WM, Siegel RL, Smith MD . Efficacy of sildenafil citrate for the treatment of erectile dysfunction in men taking serotonin reuptake inhibitors. Am J Psychiatry 2001; 158: 1926–1928.
Nurnberg HG, Hensley PL, Gelenberg AJ, Fava M, Lauriello J, Paine S . Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA 2003; 289: 56–64.
Fava M, Nurnberg HG, Seidman SN, Holloway W, Nicholas S, Tseng L-J et al. Efficacy and safety of sildenafil in men with serotonergic antidressant-associated erectile dysfunction: results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2006; 67: 240–246.
Atmaca M, Kuloglu M, Tezcan E . Sildenafil use in patients with olanzapine-induced erectile dysfunction. Int J Impot Res 2002; 14: 547–549.
Aviv A, Shelef A, Weizman A . An open-label trial of sildenafil addition in risperidone-treated male schizophrenia patients with erectile dysfunction. J Clin Psychiatry 2004; 65: 97–103.
Gopalakrishnan R, Jacob KS, Kuruvilla A, Vasantharaj B, Johm JK . Sildenafil in the treatment of antipsychotic-induced erectile dysfunction: a randomized, double-blind, placebo-controlled, flexible-dose, two-way crossover trial. Am J Psychiatry 2006; 163: 494–499.
Hussain IF, Brady CM, Swinn MJ, Mathias CJ, Fowler CJ . Treatment of erectile dysfunction with sildenafil citrate (Viagra) in parkinsonism due to Parkinson's disease or multiple system atrophy with observations on orthostatic hypotension. J Neurol Neurosurg Psychiatry 2001; 71: 371–374.
Fowler CJ, Miller JR, Sharief MK, Hussain IF, Stecher VJ, Sweeney M . A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. J Neurol Neurosurg Psychiatry 2005; 76: 700–705.
Palmer JS, Kaplan WW, Firlit CF . Erectile dysfunction in spina bifida is treatable. Lancet 1999; 354: 125–126.
Maytom MC, Derry FA, Dinsmore WW . A two-part pilot study of sildenafil (VIAGRA) in men with erectile dysfunction caused by spinal cord injury. Spinal Cord 1999; 37: 110–116.
Guiliano F, Hulting C, El Masry WS, Smith MD, Osterloh IH, Orr M et al. Randomized trial of sildenafil for the treatment of erectile dysfunction in spinal cord injury. Sildenafil Study Group. Ann Neurol 1999; 46: 15–21.
Lindsey I, George B, Kettlewell M, Mortensen N . Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Dis Colon Rectum 2002; 45: 727–732.
Seibel I, Poli De Figueiredo CE, Teloken C, Moraes JF . Efficacy of oral sildenafil in hemodialysis with erectile dysfunction. J Am Soc Nephrol 2002; 13: 2770–2775.
Barrou B, Cuzin B, Malavaud B, Petit J, Pariente JL, Bucher M et al. Early experience with sildenafil for the treatment of erectile dysfunction in renal transplant recipients. Nephrol Dial Transplant 2003; 18: 411–417.
Klotz T, Sachse R, Heidrich A, Jockenhovel F, Rohde G, Wensing G et al. Vardenafil increases penile rigidity and tumescence in erectile dysfunction patients: a RigiScan and pharmacokinetic study. World J Urol 2001; 19: 32–39.
Stark S, Sachse R, Liedl T, Hensen J, Rohde G, Wensing G et al. Vardenafil increases penile rigidity and tumescence in men with erectile dysfunction after a single oral dose. Eur Urol 2001; 40: 181–190.
Porst H, Rosen R, Padma-Nathan H, Goldstein I, Giuliano F, Ulbrich E et al. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Int J Impot Res 2001; 13: 192–199.
Porst H, Young JM, Schmidt AC, Buvat J, International Vardenafil Study Group. Efficacy and tolerability of vardenafil for treatment of erectile dysfunction in patient subgroups. Urology 2003; 62: 519–523.
Donatucci C, Taylor T, Thibonnier M, Bangerter K, Gittelman M, Casey R, Vardenafil Study Group. Vardenafil improves patient satisfaction with erection hardness, orgasmic function, and overall sexual experience, while improving quality of life in men with erectile dysfunction. J Sex Med 2004; 1: 185–192.
Montorsi F, Hellstrom WJG, Valiquette L, Bastuba M, Collins O, Taylor T et al. Vardenafil provides reliable efficaby over time in men with erectile dysfunction. Urology 2004; 64: 1187–1195.
Hellstrom WJ, Gittelman M, Karlin G, Segerson T, Thibonnier M, Taylor T et al. Sustained efficacy and tolerability of vardenafil, a highly potent selective phosphodiesterase type 5 inhibitor, in men with erection dysfunction: results of a randomized, double-blind, 26-week placebo-controlled pivotal trial. Urology 2003; 61 (4Suppl 1): 8–14.
Hatzichristou D, Montorsi F, Buvat J . The efficacy and safety of flexible-dose vardenafil (levitra) in a broad population of European men. Eur Urol 2004; 45: 634–641.
Mirone V, Palmieri A, Cucinotta D, Parazzini F, Morelli P, Bettocchi C et al. Flexible-dose vardenafil in a community-based population of men affected by erectile dysfunction: a 12-week open-label, multicenter trial. J Sex Med 2005; 2: 842–847.
Stief C, Porst H, Saenz De Tejada I, Ulbrich E, Beneke M et al. Sustained efficacy and tolerability with vardenafil over 2 years treatment in men with erectile dysfunction. Int J Clin Pract 2004; 58: 230–239.
Hatzichristou D, Curzin B, Martin-Morales A, Buvat J, Porst H, Laferriere N et al. Vardenafil improves satisfaction rates, depressive symptomatology, and self-confidence in a broad population in men with erectile dysfunction. J Sex Med 2005; 2: 109–116.
Fisher WA, Rosen RC, Mollen M, Brock G, Karlin G, Pommerville P et al. Improving the sexual quality of life of couples affect by erectile dysfunction: a double-bline, randomized, placebo-controlled trial of vardenafil. J Sex Med 2005; 2: 699–708.
Goldstein I, Young JM, Fischer J, Bangerter K, Segerson T, Taylor T . Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabet Care 2003; 26: 777–783.
Brock G, Nehra A, Lipshultz LI, Karlin GS, Gleave M, Seger M et al. Safety and efficacy of vardenafil for the treatment of men with erectile dysfunction after radial retropubic prostatectomy. J Urol 2003; 70: 1278–1283.
Giuliano E, Rubio-Aurioles E, Kennelly M, Montorsi F, Kim ED, Finkbeiner AE et al. Efficacy and safety of vardenafil in men with erectile dysfunction caused by spinal cord injury. Neurology 2006; 66: 210–216.
Rosen R, Shabsigh R, Berber M, Assalian P, Menza M, Rodriguez-Vela L et al. Efficacy and tolerability of vardenafil in men with mild depression and erectile dysfunction: the depression-related improvement with vardenafil for erectile response study. Am J Psychiatry 2006; 163: 79–87.
Moore RA, Derry S, MCQuay HJ . Indirect comparison of interventions using published randomised trials: systematic review of PDE-5 inhibits for erectile dysfunction. BMC Urol 2005; 5: 18.
Carson CC, Hatzichristou DG, Carrier S, Lording D, Lyngdorf P, Aliotta P et al. Erectile response with vardenafil in sildenafil nonresponders: a multicentre, double-blind, 12-week, flexible-dose, placebo-controlled erectile dysfunction clinical trial. BJU 2004; 94: 1301–1309.
Hatzichristou DG, Aliotta P, Auerback S, Barkin J, Lording D, Murdock M et al. Erectile response to vardenafil in men with a history of nonresponse to sildenafil: a time-from-dosing descriptive analysis. Clin Ther 2005; 27: 1452–1461.
Padma-Nathan H, McMurray JG, Pullman WE, Whitaker JS, Saoud JB, Ferguson KM et al. On demand IC351 (Cialis) enhances erectile function in patients with erectile dysfunction. Int J Impot Res 2001; 13: 2–9.
Brock GB, Mcmahon CG, Chen KK, Costigan T, Shen W, Watkins V et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol 2002; 168: 1332–1336.
Eardley I, Gentle V, Austoni E, Hackett G, Lembo D, Wang C, Beardsworth A . Efficacy and safety of tadalafil in a Western European population of men with erectile dysfunction. BJU Int 2004; 94: 871–877.
Seftel AD, Wilson SK, Knapp PM, Shin J, Wang WC, Ahuja S . The efficacy and safety of tadalafil in United States and Puerto Rican men with erectile dysfunction. J Urol 2004; 172: 652–657.
Carson C, Shabsigh R, Segal S, Murphy A, Fredlund P, Kuepfer C . Efficacy, safety, and treatment satisfaction of tadalafil versus placebo in patients with erectile dysfunction evaluated at tertiary-care academic centers. Urology 2005; 65: 353–359.
Rosen RC, Shabsigh R, Kuritzky L, Wang WC, Sides GD . The efficacy of tadalafil in improving sexual satisfaction and overall satisfaction in men with mild, moderate, and sever erectile dysfunction: a retrospective pooled analysis of data from randomized, placebo-controlled clinical trials. Curr Med Res Opin 2005; 21: 1701–1709.
Montorsi F, Verheyden B, Meuleman E, Junemann KP, Moncada I, Valiquette L et al. Long-term safety and tolerability of tadalafil in the treatment of erectile dysfunction. Eur Urol 2004; 45: 339–344.
Saenz De Tejada I, Anglin G, Knoght JR, Emmick JT . Effects of tadalafil on erectile dysfunction in men with diabetes. Diabet Care 2002; 25: 2159–2164.
Forseca V, Seftel A, Denne J, Fredlund P . Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia 2004; 47: 1914–1923.
Montorsi F, Nathan HP, McCullough A, Brock GB, Broderick G, Ahuja S et al. Tadalafil in the treatment of erectile dysfunction following bilateral nerve sparing radical retropubic prostatectomy: a randomized, double-blind, placebo controlled trial. J Urol 2004; 172: 1036–1041.
Lewis RW, Sadovsky R, Eardley I, O'Leary M, Seftel A, Wang WC et al. The efficacy of tadalafil in clinical populations. J Sex Med 2005; 2: 517–531.
McMahon C . Comparison of efficacy, safety, and tolerability of on-demand tadalafil and daily dosed tadalafil for the treatment of erectile dysfunction. J Sex Med 2005; 2: 415–425.
McMahon C . Efficacy and safety of daily tadalafil in men with erectile dysfunction previously unresponsive to on-demand tadalafil. J Sex Med 2004; 1: 292–300.
Govier F, Potempa AJ, Kaufman J, Denne J, Kovalenko P, Ahuja S . A multicenter, randomized, double-blind, crossover study of patient preference for tadalafil 20 mg or sildenafil citrate 50 mg during initiation of treatment for erectile dysfunction. Clin Ther 2003; 25: 2709–2723.
Stroberg P, Murphy A, Costigan T . Switching patients with erectile dysfunction from sildenafil citrate to tadalafil: results of European multicenter, open-label study of patient preference. Clin Ther 2003; 25: 2724–2737.
Von Keitz A, Rajfer J, Segal S, Murphy A, Denne J, Costigan T et al. A multicenter, randomized, double-blind, crossover study to evaluate patient preference between tadalafil and sildenafil. Eur Urol 2004; 45: 499–507.
Del Popolo G, Li Marzi V, Mondaini N, Lombardi G . Time/duration effectiveness of sildenafil versus tadalafil in the treatment of erectile dysfunction in male spinal cord-injured patients. Spinal Cord 2004; 42: 643–648.
Eardley I, Mirone V, Montorsi F, Ralph D, Kell P, Warner MR et al. An open-label, multicentre, randomized, crossover study comparing sildenafil citrate and tadalafil for treating erectile dysfunction in men naïve to phosphodiesterase 5 inhibitor therapy. BJU Int 2005; 96: 1323–1332.
Stoberg P, Hedelin H, Ljunggren C . Prescribing all phosphodiesterase 5 inhibitors to a patient with erectile dysfunction – arealistic and feasible option in everyday clinical practice – outcomes of a simple treatment regime. Eur Urol 2006; 49: 900–907.
McMahon M . Editorial comment. Eur Urol 2006; 49: 907.
Mulhall JP . Understanding erectile dysfunction medication preference studies. Curr Opin Urol 2004; 14: 367–373.
Mulhall JP, Montorsi F . Evaluating preference trials of oral phosphodiesterase 5 inhibitors for erectile dysfunction. Eur Urol 2006; 49: 30–37.
Gilad R, Lampl Y, Eshel Y, Sadeh M . Tonic-clonic seizures in patients taking sildenafil. BMJ 2002; 325: 869.
Koussa S, Hage CS, Togme A, Riachi M . Epileptic seizures and vardenafil. Rev Neurol (Paris) 2006; 162: 651–652.
About this article
Cite this article
Doggrell, S. Do vardenafil and tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?. Int J Impot Res 19, 281–295 (2007). https://doi.org/10.1038/sj.ijir.3901525
This article is cited by
Nature Reviews Urology (2009)