Which drug for erectile dysfunction?

(See also Overview of Sexual Function and Dysfunction in Men.) Every man occasionally has a problem achieving an erection, and such occurrences are considered normal. Erectile dysfunction (ED) occurs when a man Repeatedly achieves erection briefly but not long enough for intercourse Repeatedly achieves erection briefly but not long enough for intercourse ED is called primary if the man has never been able to attain or sustain an erection.

Drug Name	Typical Duration of Effect	Peak Effect Time	Notes
Sildenafil	4-6 hours	1 hour	Needs sexual stimulation
Tadalafil	Up to 36 hours	2 hours	Suitable for spontaneous activity
Vardenafil	4-5 hours	1 hour	Onset can vary depending on food intake
Avanafil	About 6 hours	30 minutes	Fastest onset among PDE5 inhibitors

ED is called secondary if it is acquired later in life by a man who was previously able to attain erections.

Addressing underlying health conditions and minimizing stress can also reduce symptoms of ED

One important clue is whether erections are present at night or on awakening. When erections are present, a physical cause is less likely than a psychological cause because physical causes typically inhibit erections at all times. Other factors that suggest a psychological cause are sudden development in a young healthy man, occurrence of symptoms only in certain situations, and resolution fildena purple pill of ED without any treatment. Claudication or coolness or a blue color in the toes or feet may indicate a problem with the blood vessels such as peripheral vascular disease or vascular disease caused by diabetes. Common Causes and Features of Erectile Dysfunction Some Commonly Used Medications That Can Cause Erectile Dysfunction Laboratory tests include the measurement of the level of testosterone in the blood.

Cost of erectile dysfunction pills

If the testosterone level is low, doctors measure additional hormones. Depending on the results of the history and physical examination, blood tests may also be done to check for previously unrecognized diabetes, thyroid disorders, and lipid disorders. Usually, these tests provide doctors with enough information to plan treatment. Occasionally, doctors inject a medication into the penis that stimulates erection and then use ultrasonography to assess blood flow in the arteries and veins of the penis. Rarely, doctors may recommend the use of a home monitor that detects and records erections during sleep. Secondary ED is much more common than primary ED. In the United States, ED is very common and increases in prevalence with age, with the majority of men over the age of 50 being affected. However, ED can be successfully treated at any age. To achieve an erection, the penis needs an adequate amount of blood flowing in, a slowing of blood flowing out, proper function of nerves leading to and from the penis, adequate amounts of the male sex hormone testosterone, and sufficient sex drive (libido).

Product	Dosage	Quantity + Bonus	Price
Kamagra 100 mg	100 mg	12 Pills	55.64€ 52.99€	Buy
Viagra Generic	25mg	360 + 10 Pills	213.68€ 203.50€	Buy
Levitra Generic	20mg	120 + 10 Pills	224.15€ 213.48€	Buy
Tadalista Super Active	20mg	60 + 8 Pills	230.32€ 219.35€	Buy
Levitra Original	20mg	8 Pills	65.05€ 61.95€	Buy
Viagra Oral Jelly	100mg	90 + 8 Sachets	258.02€ 245.73€	Buy
Cialis Original	20mg	34 + 2 Pills	183.99€ 175.23€	Buy
Kamagra Soft Tabs	100mg	60 + 4 Pills	180.59€ 171.99€	Buy
Levitra Professional	20mg	20 Pills	101.00€ 96.19€	Buy
Cialis Generic	10mg	180 + 8 Pills	236.88€ 225.60€	Buy
Kamagra 100 mg	100 mg	180 + 6 Pills	436.79€ 415.99€	Buy
Kamagra Gold	100 mg	20 Pills	86.09€ 81.99€	Buy

A disorder of any of these systems may lead to erectile dysfunction (ED). Most cases of ED are caused by abnormalities of the blood vessels or nerves of the penis.

How oral medicines differ

Hormonal disturbances (such as abnormally low levels of testosterone) tend to decrease sex drive but can also result in ED. In Peyronie disease, scar tissue develops inside the penis, resulting in curved and often painful erections and causing ED. Drugs, including alcohol and illicit drugs such as cocaine and amphetamines, can also cause or contribute to ED. including alcohol and illicit drugs such as cocaine and amphetamines, can also cause or contribute to ED. Sometimes psychological problems (such as performance anxiety or depression) or factors that decrease a man's energy level (such as illness, fatigue, or stress) cause or contribute to ED.

Main Classes of ED Drugs

Erectile dysfunction may be situational, involving a particular place, time, or partner. Prolonged, painful erection (priapism) may damage the erectile tissue of the penis, leading to ED. An occasional episode of erectile dysfunction (ED) is not uncommon, but men who are consistently unable to achieve or maintain an erection should see their doctor because ED may be a sign of a serious health problem, such as atherosclerosis or a nerve disorder. The following information can help men know when to see a doctor and what to expect during the evaluation. In men with ED, certain symptoms and characteristics are cause for concern. Other possible causes include hormonal disorders, structural disorders of the penis, use of certain medications, and psychological problems (see table ). Hardening of the arteries (atherosclerosis) that affects the arteries to the penis Hardening of the arteries (atherosclerosis) that affects the arteries to the penis Complications of prostate surgery (such as robotic prostatectomy for prostate cancer) Complications of prostate surgery (such as robotic prostatectomy for prostate cancer) Certain medications, such as those used to treat high blood pressure or an enlarged prostate and those that act on the central nervous system, such as medications used to treat depression Certain medications, such as those used to treat high blood pressure or an enlarged prostate and those that act on the central nervous system, such as medications used to treat depression For example, a man with a slight decrease in erectile function caused by diabetes or peripheral vascular disease can develop severe ED after starting a new medication or if stress increases.

• Penile Doppler ultrasound: Uses sound waves to visualize blood flow in the penis.
• Intracavernosal pharmacotesting: Injecting a drug to assess erectile response.
• Neurological testing: To assess nerve function if neurological ED is suspected.
• Hormonal panel: Tests for testosterone, prolactin, LH, FSH, and thyroid hormones.
• Vascular surgery: A rare option to repair specific arterial blockages causing ED.
• Venous ligation surgery: An older, largely abandoned surgery for venous leak.
• Acoustic wave therapy devices: For home use, though efficacy is less established.
• Red light therapy: Some devices claim to improve blood flow using specific wavelengths.
• Platelet-rich plasma (PRP) injections: An experimental treatment for ED.
• Low-intensity focused ultrasound: Another experimental modality for tissue regeneration.

Atherosclerosis may partially block blood flow to the legs (peripheral vascular disease). Usually, arteries to the penis are also blocked, decreasing the amount of blood flow to the penis and causing ED.

• Priapism: A medical emergency; an erection lasting more than 4 hours.
• Fibrosis: Scar tissue formation inside the penis from repeated injections.
• Hypotension: A severe drop in blood pressure, especially with drug interactions.
• Cardiovascular events: Risk of heart attack or stroke, especially in at-risk men.
• Hearing loss: Sudden decrease or loss of hearing, sometimes accompanied by tinnitus.
• Vision loss: Non-arteritic anterior ischemic optic neuropathy (NAION).
• Testosterone therapy risks: Acne, sleep apnea, erythrocytosis, prostate growth.
• Allergic reactions: Rash, itching, or swelling, though rare.
• Injection site reactions: Bruising, bleeding, or infection.
• Device-related risks: Infection or mechanical failure with implants or pumps.

Diabetes, high cholesterol levels, high blood pressure, and smoking contribute to atherosclerosis and therefore to ED. Sometimes blood leaks out of the veins in the penis too quickly, decreasing blood pressure in the penis and thus interfering with achieving or maintaining an erection (called veno-occlusive dysfunction or venous leak). If the nerves sending messages to the penis are damaged, ED can occur. In addition to causing atherosclerosis, diabetes can vidalista 20mg uk also affect the nerves that supply the penis. Because nerves to the penis run along the prostate gland, prostate surgery (such as for cancer or an enlarged prostate) often causes ED. Less common nerve disorders that cause ED include spinal cord injury, multiple sclerosis, and stroke. Also, prolonged pressure on the nerves in the buttocks and genital area (the so-called saddle area), as may occur during long-distance bicycle riding, can cause temporary or even permanent ED.

How effective are these drugs?

Hardening of the arteries (atherosclerosis) that affects the arteries to the penis Hardening of the arteries (atherosclerosis) that affects the arteries to the penis Complications of prostate surgery (such as robotic prostatectomy for prostate cancer) Complications of prostate surgery (such as robotic prostatectomy for prostate cancer) Certain medications, such as those used to treat high blood pressure or an enlarged prostate and those that act on the central nervous system, such as medications used to treat depression Certain medications, such as those used to treat high blood pressure or an enlarged prostate and those that act on the central nervous system, such as medications used to treat depression For example, a man with a slight decrease in erectile function caused by diabetes or peripheral vascular disease can develop severe ED after starting a new medication or if stress increases. Atherosclerosis may partially block blood flow to the legs (peripheral vascular disease). Usually, arteries to the penis are also blocked, decreasing the amount of blood flow to the penis and causing ED. Diabetes, high cholesterol levels, high blood pressure, and smoking contribute to atherosclerosis and therefore to ED. Sometimes blood leaks out of the veins in the penis too quickly, decreasing blood pressure in the penis and thus interfering with achieving or maintaining an erection (called veno-occlusive dysfunction or venous leak).

Side effects of Erectile Dysfunction Drugs

If the nerves sending messages to the penis are damaged, ED can occur. In addition to causing atherosclerosis, diabetes can vidalista 20mg uk also affect the nerves that supply the penis. Because nerves to the penis run along the prostate gland, prostate surgery (such as for cancer or an enlarged prostate) often causes ED. Less common nerve disorders that cause ED include spinal cord injury, multiple sclerosis, and stroke. Also, prolonged pressure on the nerves in the buttocks and genital area (the so-called saddle area), as may occur during long-distance bicycle riding, can cause temporary or even permanent ED. Hormonal disturbances (such as abnormally low levels of testosterone) tend to decrease sex drive but can also result in ED. In Peyronie disease, scar tissue develops inside the penis, resulting in curved and often painful erections and causing ED. Drugs, including alcohol and illicit drugs such as cocaine and amphetamines, can also cause or contribute to ED. including alcohol and illicit drugs such as cocaine and amphetamines, can also cause or contribute to ED. Sometimes psychological problems (such as performance anxiety or depression) or factors that decrease a man's energy level (such as illness, fatigue, or stress) cause or contribute to ED. Erectile dysfunction may be situational, involving a particular place, time, or partner. Prolonged, painful erection (priapism) may damage the erectile tissue of the penis, leading to ED. An occasional episode of erectile dysfunction (ED) is not uncommon, but men who are consistently unable to achieve or maintain an erection should see their doctor because ED may be a sign of a serious health problem, such as atherosclerosis or a nerve disorder.

• Vacuum pump types: Include manual pumps, battery-operated pumps, and FDA-cleared devices.
• Constriction ring materials: Made from silicone, leather, or metal; must be timed.
• Pump sizing: Important to choose the correct cylinder size for effective use.
• Implant surgery: Procedure typically takes 1-2 hours under general or spinal anesthesia.
• Implant recovery: Involves several weeks of healing and learning to use the device.
• Implant risks: Include infection, mechanical failure, and erosion, though rare.
• Implant satisfaction: Has very high patient and partner satisfaction rates.
• Malleable implants: Rods that keep the penis permanently firm but bendable.
• Inflatable implants: Allow for a flaccid state and an erect state via a pump.
• Three-piece inflatable implants: Include cylinders, a pump, and a fluid reservoir.

The following information can help men know when to see a doctor and what to expect during the evaluation. In men with ED, certain symptoms and characteristics are cause for concern. Absence of erections during the night or upon awakening in the morning Absence of erections during the night or upon awakening in the morning Numbness in the area between and around the buttocks and genital area (called the saddle area or perineum) Numbness in the area between and around the buttocks and genital area (called the saddle area or perineum) Painful cramping in the muscles of the legs that occurs during physical activity but is relieved promptly by rest (claudication) Painful cramping in the muscles of the legs that occurs during physical activity but is relieved promptly by rest (claudication) Although ED may diminish a man's quality of life, it is not itself a dangerous condition. However, ED may be a symptom of a serious medical disorder. Because numbness in the groin or leg can be a sign of spinal cord damage, men who suddenly develop such numbness should see a doctor right away. Men who have other warning signs should call their doctor and ask how soon they need to be seen and examined.

Premature Ejaculation (PE)

Absence of erections during the night or upon awakening in the morning Absence of erections during the night or upon awakening in the morning Numbness in the area between and around the buttocks and genital area (called the saddle area or perineum) Numbness in the area between and around the buttocks and genital area (called the saddle area or perineum) Painful cramping in the muscles of the legs that occurs during physical activity but is relieved promptly by rest (claudication) Painful cramping in the muscles of the legs that occurs during physical activity but is relieved promptly by rest (claudication) Although ED may diminish a man's quality of life, it is not itself a dangerous condition. However, ED may be a symptom of a serious medical disorder. Because numbness in the groin or leg can be a sign of spinal cord damage, men who suddenly develop such numbness should see a doctor right away. Men who have other warning signs should call their doctor and ask how soon they need to be seen and examined. Doctors first ask questions about the man's symptoms and medical history.

When to see a doctor

What they find during the history and physical examination often suggests a cause for ED and additional tests that may need to be done (see table ). Drug (prescription, recreational, and illicit) and alcohol use Drug (prescription, recreational, and illicit) and alcohol use History of surgery (for example, for prostate enlargement, prostate or rectal cancer, or blood vessel disorders) History of surgery (for example, for prostate enlargement, prostate or rectal cancer, or blood vessel disorders) History of injury (for example, a broken pelvic bone or a back injury) History of injury (for example, a broken pelvic bone or a back injury) Symptoms of disorders of the blood vessels (for example, pain in the calves when walking or coolness, numbness, or blue color of the feet) Symptoms of disorders of the blood vessels (for example, pain in the calves when walking or coolness, numbness, or blue color of the feet) Symptoms of nerve disorders (for example, numbness, tingling, weakness, incontinence, or falling) Symptoms of nerve disorders (for example, numbness, tingling, weakness, incontinence, or falling) Symptoms of hormonal disorders (for example, loss of sex drive, increased size of breasts, decreased size of testes, loss of body hair, tremor, changes in weight or appetite, or difficulty tolerating heat or cold) Symptoms of hormonal disorders (for example, loss of sex drive, increased size of breasts, decreased size of testes, loss of body hair, tremor, changes in weight or appetite, or difficulty tolerating heat or cold) Sexual dysfunction (for example, vaginal dryness or depression) in the man's partner Sexual dysfunction (for example, vaginal dryness or depression) in the man's partner Even though men may be embarrassed to talk to their doctors about some of these subjects, the information is important in determining the cause of ED. The physical examination focuses on the genitals and prostate, but doctors also look for signs of hormonal, nerve, and blood vessel disorders and examine the rectum. The cause is sometimes clear from the history. For example, ED may occur soon after prostate surgery or beginning a new medication. Doctors first ask questions about the man's symptoms and medical history. What they find during the history and physical examination often suggests a cause for ED and additional tests that may need to be done (see table ). Drug (prescription, recreational, and illicit) and alcohol use Drug (prescription, recreational, and illicit) and alcohol use History of surgery (for example, for prostate enlargement, prostate or rectal cancer, or blood vessel disorders) History of surgery (for example, for prostate enlargement, prostate or rectal cancer, or blood vessel disorders) History of injury (for example, a broken pelvic bone or a back injury) History of injury (for example, a broken pelvic bone or a back injury) Symptoms of disorders of the blood vessels (for example, pain in the calves when walking or coolness, numbness, or blue color of the feet) Symptoms of disorders of the blood vessels (for example, pain in the calves when walking or coolness, numbness, or blue color of the feet) Symptoms of nerve disorders (for example, numbness, tingling, weakness, incontinence, or falling) Symptoms of nerve disorders (for example, numbness, tingling, weakness, incontinence, or falling) Symptoms of hormonal disorders (for example, loss of sex drive, increased size of breasts, decreased size of testes, loss of body hair, tremor, changes in weight or appetite, or difficulty tolerating heat or cold) Symptoms of hormonal disorders (for example, loss of sex drive, increased size of breasts, decreased size of testes, loss of body hair, tremor, changes in weight or appetite, or difficulty tolerating heat or cold) Sexual dysfunction (for example, vaginal dryness or depression) in the man's partner Sexual dysfunction (for example, vaginal dryness or depression) in the man's partner Even though men may be embarrassed to talk to their doctors about some of these subjects, the information is important in determining the cause of ED. The physical examination focuses on the genitals and prostate, but doctors also look for signs of hormonal, nerve, and blood vessel disorders and examine the rectum.

• Sildenafil dosage: Typically 25mg, 50mg, or 100mg taken about one hour before sex.
• Tadalafil dosage: 10mg or 20mg on-demand, or 2.5mg/5mg daily.
• Vardenafil dosage: Typically 5mg, 10mg, or 20mg taken about 60 minutes before sex.
• Avanafil dosage: Typically 50mg, 100mg, or 200mg taken about 15-30 minutes before sex.
• Alprostadil injection dosage: Typically starts at 2.5 mcg, titrated upward.
• Alprostadil suppository dosage: Typically 125 mcg, 250 mcg, 500 mcg, or 1000 mcg.
• Testosterone gel dosage: Typically 1-2 pumps or packets applied daily.
• Testosterone injection frequency: Typically every 1-2 weeks for cypionate/enanthate.
• Yohimbine dosage: Typically 5.4mg three times a day, but not standardized.
• Compounded TriMix dosage: Highly variable and customized by a compounding pharmacist.

The cause is sometimes clear from the history. For example, ED may occur soon after prostate surgery or beginning a new medication. One important clue is whether erections are present at night or on awakening. When erections are present, a physical cause is less likely than a psychological cause because physical causes typically inhibit erections at all times. Other factors that suggest a psychological cause are sudden development in a young healthy man, occurrence of symptoms only in certain situations, and resolution fildena purple pill of ED without any treatment. Claudication or coolness or a blue color in the toes or feet may indicate a problem with the blood vessels such as peripheral vascular disease or vascular disease caused by diabetes. Common Causes and Features of Erectile Dysfunction Some Commonly Used Medications That Can Cause Erectile Dysfunction Laboratory tests include the measurement of the level of testosterone in the blood. If the testosterone level is low, doctors measure additional hormones.

What special dietary instructions should I follow?

(See also Overview of Sexual Function and Dysfunction in Men.) Every man occasionally has a problem achieving an erection, and such occurrences are considered normal. Erectile dysfunction (ED) occurs when a man Repeatedly achieves erection briefly but not long enough for intercourse Repeatedly achieves erection briefly but not long enough for intercourse ED is called primary if the man has never been able to attain or sustain an erection. ED is called secondary if it is acquired later in life by a man who was previously able to attain erections. Secondary ED is much more common than primary ED. In the United States, ED is very common and increases in prevalence with age, with the majority of men over the age of 50 being affected.

The best place to get medications for ED

However, ED can be successfully treated at any age. To achieve an erection, the penis needs an adequate amount of blood flowing in, a slowing of blood flowing out, proper function of nerves leading to and from the penis, adequate amounts of the male sex hormone testosterone, and sufficient sex drive (libido). A disorder of any of these systems may lead to erectile dysfunction (ED). Most cases of ED are caused by abnormalities of the blood vessels or nerves of the penis. Other possible causes include hormonal disorders, structural disorders of the penis, use of certain medications, and psychological problems (see table ). Depending on the results of the history and physical examination, blood tests may also be done to check for previously unrecognized diabetes, thyroid disorders, and lipid disorders. Usually, these tests provide doctors with enough information to plan treatment. Occasionally, doctors inject a medication into the penis that stimulates erection and then use ultrasonography to assess blood flow in the arteries and veins of the penis. Rarely, doctors may recommend the use of a home monitor that detects and records erections during sleep.

Drug Name	Available Forms	Typical Dose	Special Notes
Sildenafil	Tablets, oral suspension	50 mg, 100 mg	Taken on an empty stomach
Tadalafil	Tablets	10 mg, 20 mg	Can be taken with or without food
Levitra	Tablets	10 mg, 20 mg	Take 25-60 mins before activity
Stendra	Tablets	50 mg, 100 mg	Fast onset, flexible dosing

Sometimes other drugs, mechanical devices, or surgery Sometimes other drugs, mechanical devices, or surgery Any underlying disorder is treated, and doctors often stop medications that may be causing erectile dysfunction (ED) or switch the man to a different medication.

Rank	Drug Name	Estimated Sales (USD Millions)	Market Share (%)
1	Sildenafil	950	45
2	Tadalafil	700	33
3	Vardenafil	150	7
4	Avanafil	100	5

However, men should talk with their doctor before they stop taking any drug. Excess weight is a risk factor for many disorders that may cause ED, so weight loss may improve erectile function.

Alternative medicine

Sometimes other drugs, mechanical devices, or surgery Sometimes other drugs, mechanical devices, or surgery Any underlying disorder is treated, and doctors often stop medications that may be causing erectile dysfunction (ED) or switch the man to a different medication. However, men should talk with their doctor before they stop taking any drug. Excess weight is a risk factor for many disorders that may cause ED, so weight loss may improve erectile function. Smoking is a risk factor for atherosclerosis, so stopping smoking may also improve erectile function. Stopping or decreasing alcohol use, if excessive, can also help. Smoking is a risk factor for atherosclerosis, so stopping smoking may also improve erectile function. Stopping or decreasing alcohol use, if excessive, can also help.