Drug therapy for erectile dysfunction

Viagra and Co. still play the most important role in the drug therapy for erectile dysfunction. Their biggest advantage: The tablets with active ingredients from the group of PDE5 inhibitors are easy to use. Other widely spread forms of medical treatment are intracavernous auto-injection therapy (ICI) and the so-called transurethral applications (MUSE).

PDE5 inhibitors: Tablets against erectile dysfunction

Almost all men know Viagra. The small blue pill has the reputation of eliminating all potency problems from the planet. What is much less well known: Sildenafil (the active ingredient in Viagra) and the other active ingredients from the group of PDE5-inhibitors by far do not help all men. Nevertheless, PDE5 inhibitors are ranked among the most effective therapeutic options against erectile dysfunction.

Effectiveness of PDE5 inhibitors is at 50 percent

Recent studies demonstrate that only in 40 to 50 percent of the cases of impotence Viagra and Co. have a positive effect on the erection. On the one hand, this is due to the individual causes of erectile dysfunction. Far more importantly: Generally, only half of men respond to medical treatment with PDE5 inhibitors. In particular for men with calcifications of the vessels leading to the penis these medications often do not have a sufficient effect or none at all. For these patients, stent implantation is a very interesting addition to the range of treatments. For detailed information see: PDE5 inhibitors - The group of active ingredient of Viagra, Cialis and Co. For these patients, stent implantation or shock wave therapy are sometimes a very suitable alternative.

In Switzerland approved PDE inhibitors

Despite all restrictions: PDE5 inhibitors are an essential part of the drug therapy for erectile dysfunction. And Viagra is no longer the only “potency-enhancing pill”. Currently (summer 2018) a total of four PDE5 inhibitors are approved in Switzerland and the EU.  These are the active ingredients Avanafil, Sildenafil, Tadalafil and Vardenafl. Besides, there is Lodenafil, Mirodenafil, Udenafil as well as Zaprinast. These active ingredients are not approved for treatment of erectile dysfunction in Switzerland and the EU.

Time of onset and half-life of PDE5 inhibitors

Even if they are based on the same mechanism of action: There are clear differences in the effect of PDE inhibitors. With some the effect occurs particularly quickly (time of onset), for others it takes particularly long time until the concentration of the active ingredient in the blood is broken down to less than half. This half-life influences the duration of effectiveness.

PDE5 active ingredientTime of onsetDuration of effectivenessDosageTrade names
Avanafil30 to 45 min6 to 17 h50 to 200 mgSpedra
Sildenafil30 to 60 min4 to 5 h25 to 100 mgViagra, Revatio, Generika
Tadalafil120 minto 17.5 h5 to 20 mgCialis
Vardenafil60 min4 to 5 h5 to 20 mgLevitra, Vivanza


Intracavernous auto-injection therapy

Even if the treatment with PDE5 inhibitors is not possible or not effective, the possibilities for drug therapy for erectile dysfunction are not yet exhausted. The first options in these cases are intracavernous auto-injection therapy (ICI) and the so-called transurethral application (MUSE) of urethral rods. However, both procedures presuppose that blood reaches the arteries leading to the penis and that the cavernous bodies are intact. What both procedures have in common is that a drug is inserted into the penis - and hence an erection lasting about one hour is induced.

Injection into the penis: intracavernous auto-injection therapy (ICI)

In intracavernous auto-injection therapy men inject a ready-to-use drug with the active ingredient Alprostadil. This is the synthetic form of the body's natural messenger substance Prostaglandin E1. Alprostadil is injected directly into the cavernous body. Thus the term intracavernous auto-injection therapy. After the injection, the smooth muscle cells in the walls of the cavernous bodies relax. This facilitates the afferent blood flow and hence the erection.

Urethral rods: Transurethral application (MUSE)

An alternative to intracavernous auto-injection therapy is the transurethral application (MUSE). In this treatment approach a rod coated with Alprostadil is inserted into the urethra. Mode of action and effect are identical with the intracavernous auto-injection therapy method. Read more about the process of erection here: How do erections occur?


Potency-enhancing drugs obtainable without a prescription against erectile dysfunction

On the Internet you will find a multitude of potency-enhancing drugs obtainable without a prescription that promise true wonders. For the overwhelming majority of these offers it can be generally stated that: At best, the majority of the potency-enhancing drugs obtainable without a prescription are ineffective. In the worst case, they endanger your health. There is one possible exception: the amino acid L-arginine.

L-arginine against erectile dysfunction

L-arginine is an amino acid, in which nitrogen is abundantly bound (NO). NO (nitric oxide), on the other hand, plays a substantial role in ensuring that the smooth muscles in the blood vessels can relax. Numerous studies demonstrate that L-arginine lowers blood pressure and improves blood flow. In this respect, a positive effect on erectile dysfunction is indeed conceivable and plausible.

However: Otherwise healthy men with erectile dysfunction only very rarely have a deficiency of L-arginine. Whereas, an undersupply of L-arginine is much more common in men with hypertension and in diabetics. Because in hypertension or diabetes the body produces less L-arginine. According to most experts, this deficiency though can be compensated by a diet containing L-arginine. L-arginine is particularly highly contained in nuts, pulses, soy products and meat.

In Switzerland and the EU, products containing L-arginine are not approved as medication. Rather, they are labeled and distributed as dietary supplements because the authorities are not 100% convinced of the study situation. Nevertheless, men repeatedly report positive experiences with L-arginine in erectile dysfunction. An Israeli study from 1999 shows that L-arginine could alleviate erectile dysfunction. For the study, 29 men with erectile dysfunction received 5 mg L-arginine per day for several weeks. 9 of these men reported that the treatment had a positive effect. However, 2 of the 17 men of the control group who received an ineffective tablet said the same.


Expert tip: Taking erectile dysfunction seriously as a warning sign

“You should not engage in experiments in the drug therapy of erectile dysfunction. PDE5 inhibitors from the black market are a serious threat to your health - and your purse. The panacea promised in advertising do not exist. More importantly: Erectile dysfunctions are an early warning sign of your body that you should not ignore. For almost all men with serious diseases of the cardiovascular system such as heart attack or stroke it turned out that they often have had recurrent erectile problems for months or even years before the event”.

Prof. Dr. med. Nicolas Diehm, specialist in Angiology and Internal Medicine

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