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Medications for Erectile Dysfunction

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By Editorial Team

3 min read

Reviewed by: HU Medical Review Board | Last reviewed: July 2024 | Last updated: July 2024

Erectile dysfunction (ED) is when you are not able to get or keep an erection. Prostate cancer typically does not directly cause ED. But many prostate cancer treatments can cause ED.1,2

These treatments include:1,2

Some treatments can damage nerves that help cause erections. These nerves surround the prostate. Your risk for ED depends on age, health, and other factors.1

For some people, ED gets better or goes away over time. But other people may want treatment. Several drugs are available to treat ED. Talk to your doctor about the risks and benefits of each option.1,3

How do ED drugs work?

Several drugs are available to treat ED. They work in similar ways but are given in different forms. They may generally be referred to as “vasodilators.” This means they relax muscle cells and allow blood vessels to expand.3

During normal sexual arousal, the body releases chemicals that increase blood flow to the penis. This leads to an erection. Prostate cancer treatment may disrupt this process. Vasodilators can fix this by increasing blood flow to the penis.3

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Examples

The 2 main types of ED drugs are:3

  • Oral phosphodiesterase-5 (PDE5) inhibitors
  • Injectable or transurethral prostaglandin E1 (PGE1)

Oral PDE5 inhibitors

Oral PDE5 inhibitors are often the first-line treatment for ED. They work by blocking the breakdown of a chemical called cGMP. During sexual arousal, cGMP relaxes muscles around the blood vessels leading to the penis. This increases blood flow to the area.3-5

Examples of oral PDE5 inhibitors include:3,4,6

  • Viagra® (sildenafil citrate)
  • Levitra® (vardenafil hydrochloride)
  • Stendra® (avanafil)
  • Cialis® (tadalafil)

These drugs start working within an hour. Starting PDE5 inhibitors early can improve erectile function quicker. About 3 in 4 men who have had nerve-sparing prostatectomy report successful erections using these drugs.2,3

Prostaglandin E1

Prostaglandin E1 (PGE1) works similarly to PDE5 inhibitors. Prostaglandins are naturally occurring fats in the body. They stimulate muscle cells around the penis to produce a molecule that relaxes muscles and increases blood flow.3,4,7

The most common PGE1 drug used to treat ED is alprostadil. It comes in several forms, including:3,4,6

  • MUSE® (alprostadil pellets placed into the urethra)
  • Caverject® and Edex® (alprostadil injected into the penis)

Each form works at a slightly different rate. But they all typically start working within 15 minutes and last for about an hour.3,4

What are the possible side effects?

Side effects can vary depending on the specific ED drug you are taking. Common side effects of PDE5 inhibitors include:3-5

  • Nasal congestion
  • Headache
  • Flushing
  • Backache
  • Dizziness
  • Altered vision
  • Low blood pressure

Serious side effects of PDE5 inhibitors are rare but possible. Seek emergency help if you experience:5

  • Fainting
  • Priapism (erection lasting longer than 4 hours)
  • Sudden vision loss
  • Sudden hearing loss
  • Heart problems
  • Signs of an allergic reaction

The most common side effects of alprostadil include:3,7

  • Low or high blood pressure
  • Fainting
  • Priapism
  • Headache
  • Dizziness
  • Rash
  • Swelling

These are not all the possible side effects of ED drugs. Talk to your doctor about what to expect when taking ED drugs. You also should call your doctor if you have any changes that concern you when taking ED drugs.

Other things to know

Take ED medicines as your doctor prescribes. Your doctor will work with you to find the right dose. They may also monitor you regularly for side effects. Ask them whether to take the drugs on an empty stomach or after eating.3

Certain drugs will not be effective for everyone. Some people need at least 8 doses to see a reliable response. Using medicine for ED regularly may lead to a better response.3

Your doctor may suggest combining ED drugs with other treatment strategies. This overall treatment program is called penile rehabilitation. It combines medicine with other treatments, such as:3,4,6

  • Lifestyle changes to improve general health
  • Mechanical devices, such as a vacuum erection device
  • Psychosexual therapy
  • Penile implants

If you take nitrate drugs, you cannot use PDE5 inhibitors. Men who have a higher risk of priapism generally should not take alprostadil.5,7

Before beginning treatment for ED, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.