The therapeutic dilemma: how to use short-acting PDE5 inhibitor drugs

In the last few years, the clinical context of the diagnosis and treatment of erectile dysfunction (ED) has changed radically. In fact, oral drug treatment with phosphodiesterase type-5 inhibitors (PDE5-i), licensed in the past years, appeared to offer advantages over other medical approaches in terms of ease of administration and cost. PDE5-i are now widely advocated as first-line therapy for ED. PDE5-i represent a class of orally active drugs for ED, which inhibit PDE5 enzyme and in turn enhance smooth muscle relaxation via prolongation of cyclic GMP action within the cavernous smooth muscle. Although the various types of PDE5-i differ with respect to selectivity and pharmacokinetic profiles, efficacy and safety of these agents are mostly comparable in broad populations of men with erectile ED, including those with diabetes, cardiovascular disease or those taking multiple antihypertensive agents. Aim of this article will be to review the different efficacy and safety profiles of oral short-acting compounds and to give indication for treatment of special populations of men with ED.