Types, how they work, what they cost

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Erectile dysfunction can be caused by psychological or physiological factors. PDE5 inhibitors are only effective in treating erectile dysfunction caused by physiological factors.

Psychotherapy or counseling are treatment options for the psychological cause of erectile dysfunction, such as stress or anxiety.

The four main types of PDE5 inhibitors available include:

Let’s take a look at each.

Sildenafil was the first extensively researched PDE5 inhibitor and was approved by the FDA in 1998 as Viagra to treat erectile dysfunction in men. Sildenafil usually works within an hour. As with other PDE5 inhibitors, you will not get an erection until you are sexually aroused.

How long does it last

The effects of Viagra usually last about 4 hours, but can last up to 12 hours. It is usually taken in doses between 25 and 100 milligrams (mg) per day.

Common side effects

Common side effects include:

Cost

The exact price of sildenafil varies depending on where you buy it. Brand name Viagra often sells for over $ 50. However, sildenafil has been sold under its generic name since 2017. Generic brands are often at a fraction of the price.

Tadalafil has been on the market since 2003 to treat erectile dysfunction. It usually takes effect within 20 minutes and should be taken at least half an hour before sex.

Tadalafil is also approved by the FDA to treat benign prostatic hyperplasia (BPH).

How long does it last

Tadalafil has the longest action of all available PDE5 inhibitors from 24 to 36 hours. A typical daily dose ranges from about 2.5 to 20 mg.

Common side effects

Common side effects include:

Cost

The cost of Cialis varies from pharmacy to pharmacy and depends on the strength of the drug. The larger 20 mg tablets cost over $ 70. Like sildenafil, Cialis is also sold under its generic name (tadalafil) for a fraction of the price.

Vardenafil has been approved since 2003 for the treatment of erectile dysfunction. It has the shortest onset of action of all PDE5 inhibitors and takes effect within 10 minutes.

How long does it last

Vardenafil usually lasts 5 to 7 hours, but can last up to 12 hours. A typical dose of vardenafil is 5 to 20 mg per day.

Common side effects

Side effects include:

  • headache
  • rinsing
  • indigestion
  • nasal congestion
  • cold symptoms
  • eyesight problems

Cost

Staxyn tends to be cheaper than Levitra, and you can expect to pay over $ 40 per pill. Generic brands are also available.

Avanafil is the newest PDE5 inhibitor on the market and has been available since 2012. It usually takes 30 to 45 minutes to work.

How long does it last

Avanafil has a longer duration of effect than vardenafil and sildenafil but shorter than tadalafil with a half-life of approximately 5 hours. Avanafil is usually taken at a dose of 50 to 200 mg per day.

Common side effects

Common side effects include:

  • headache
  • rinsing
  • indigestion
  • nasal congestion
  • cold symptoms

Cost

Stendra typically sells for over $ 70 per 100 mg tablet, but prices vary from drugstore to drugstore. There are currently no generic brands of avanafil available in the United States.

PDE5 inhibitors have a vasodilating effect on the penis, which means they help the blood vessels relax and increase blood flow.

The science behind an erection

The process of getting an erection is complex. When you become sexually aroused, your parasympathetic nervous system activates. This neuronal activity results in the release of a molecule called nitric oxide (NO) which increases the production of another molecule called cyclic GMP.

Cyclic GMP relaxes the smooth muscles inside the blood vessels of your penis and increases blood flow by 20 to 40 times.

An enzyme called PDE5 breaks down cyclic GMP molecules and reverses the erection process. However, PDE5 inhibitors are structurally similar to cyclic GMP and bind to PDE5 to block this degradation. This action enhances the action of NO and helps promote blood circulation.

PDE5 inhibitors are naturally present in some herbs. These herbs are often sold in supplement form and marketed to treat erectile dysfunction or improve male vitality.

The FDA cautions against dietary supplements for the treatment of erectile dysfunction as many of these products contain undisclosed ingredients which can be harmful. The safety and effectiveness of these supplements have also not been sufficiently studied.

Epimedium (horny goat weed)

Epimedium, commonly known as horny goat weed, is a flowering plant native to East Asia.

The name horny goat weed comes from a legend of a Chinese goat herder who observed increased sexual activity in his herd after eating the leaves of this plant.

The active ingredient in horny goat weed is called icariin. It has been suggested that icariin may inhibit PDE5, increase the production of NO in the penis, and have a number of possible benefits for erectile dysfunction. However, there are no long-term toxicity studies and there are no clinical trials in humans.

Kaempferia parviflora (black ginger)

Kaempferia parviflora, also known as black ginger or Thai ginger, is a plant native to Thailand. Laboratory and animal studies have shown that it may have moderate inhibitory effects on PDE5.

A small study with 13 participants found that it can improve certain parameters of erectile dysfunction in men between the ages of 50 and 70, but more research is needed to fully understand its potential benefits.

Tribulus terrestris

Tribulus terrestris is a leafy plant that grows in Europe, Asia and Africa. Research has shown that the plant’s natural alkaloids may have inhibitory effects on PDE5.

A 2017 clinical trial found that Tribulus terrestris was able to significantly improve erectile function in men aged 18 to 65 with moderate erectile dysfunction, and was generally well tolerated.

Malculra pomifera (osage orange)

Isoflavones Malculra pomifera plant may have PDE5 inhibitory effects. Research has shown that derivatives of these isoflavones could be a potential avenue for the future development of PDE5 inhibitors.

PDE5 inhibitors are a group of drugs commonly used to treat erectile dysfunction. These drugs are effective for erectile dysfunction caused by physiological factors, such as poor circulation. However, they are not effective in treating erectile dysfunction caused by psychological factors, such as stress or anxiety.

Some herbs like horny goat weed also contain PDE5 inhibitors, but research has yet to assess the effectiveness or safety of herbal supplements for the treatment of erectile dysfunction.

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