Mayo Men's Health Moment: Erectile Dysfunction (ED) Treatment: Pills

how are you Toby Kohler back again with

male men's health moment today we're

going to talk about erectile dysfunction

treatments pills otherwise known as pde5

inhibitors or phosphodiesterase

inhibitors so what kind of pills can you

take to help with problems with

erections well it's an interesting back

story the first pill to be developed for

problems with erections was sildenafil

this was developed in the 1980s for

chest pain of all things to treat angina

and it was developed in England and the

pill actually didn't work that well with

for chest pain but when they asked for

the patients who were in the trials and

sent the pills back lo and behold they

didn't get sent back so den FL was born

otherwise known as viagra because

patients realised that it was helping

that there are actions so in general

this whole class of medications that

includes many pills which we'll see in

the next slide are called pde5

inhibitors or phosphodiesterase

inhibitors phosphodiesterase is a

chemical that is found throughout the

body which helps regulate blood flow and

as many many functions and because it's

all over the body you can have side

effects throughout the body when you

take these type of pills keep in mind

that no other pills

other than the fostered registered ACE

inhibitor class has really strong

evidence that it helps your penis so do

not waste your money on various Laidback

commercial ads you'll see four problems

with erections stick with this class the

pde5 inhibitors they work very very well

it takes a number of trials of these

medicines to get them to work properly

why is that well in previous videos

we've talked we've talked about

performance anxiety and when you are

nervous about getting an erection you

produce adrenaline an adrenaline is the

most powerful agent to make erections go

away in fact if you end up going to the

emergency room for something called

priapism where the erection won't go


the first thing a urologist will

typically do or the emergency medicine

doctor is they will directly inject

adrenaline into your penis that almost

always makes the erection go away so no

matter what type of approach you use

other than a surgery if you are nervous

about getting erection

things won't work well despite pills or

shots etc so what happens is guys

haven't had sex for a long time they

take these pills they expect them to

work well and then they take them to get

excited and they don't work because

they're nervous so I tell all my

patients if you are going to try this

class of medications try them on your

own at home first do not take them out

you know for intercourse or take it for

the first time for partnered sex because

you may be disappointed when we educate

patients properly on taking these pills

we have what's called a lot of salvage

success that is they say the pills don't

work but then when we re-educate

patients how to use them properly they

do end up working so what are some of

the other things you need to know about

these pills to work properly other than

you need to try them more than once I

would say you need to try the pills at

least three is six times to really rule

out whether or not they're gonna be

effective for you or they're not you

know they're gonna fail the other thing

is that of all the men that try pills

only about two-thirds of them will they

work one during the time the pills don't

work why is that well the penis is too

sick for the pills actually help and

then of the men in which the pills are

effective they typically last on the

range of three to five years over that

time period you don't get immune to the

pills but again the same thing happens

you get your penis get sicker and so

then the pills aren't strong enough to

work effectively the other thing you

need to know about these pills is that

your testosterone needs to be in a

reasonable range for them to work so it

doesn't need to be extremely high but it

should be greater than 300 which is kind

of the gold standard level and so if

you've tried pills and they don't work

and then you replace testosterone if it

happens to be low sometimes we'll have

Salvage success in those circumstances

too so these pills do need a normal

testosterone level to work effectively

another common question I get is well

which pill is the best which one should

I use it depends so there's no single PD

5 inhibitor that

works quote uncle the best you should

pick the pill that you like the best

based on cost side-effects convenience

and a lot of patience try to push the

envelope say well you know the hundred

milligram max dose doesn't work

can I take 200 milligrams typically that

does not work and it just ends up giving

you way more side effects when pills are

developed by drug companies they

basically find the sweet spot between

efficacy or how well they work and

side-effect profile so if you push the

envelope typically you don't get much

more efficacy but you get much more


what are the side effects with PD v

Himmler's well headache facial flushing

upset stomach runny nose back pain and

visual changes so depending on which

drug you try some drugs cause more of

these than the others we'll talk about

that in a second in general you never

take these pills in combination with

nitroglycerin why is that well remember

that this drug was originally designed

at least sildenafil was originally

designed to treat angina or chest pain

how do you treat chest pain we dilate

the blood vessels in the heart

nitroglycerin does the exact same thing

so if you're taking both a dilator of

the heart with that ro glycerin and a

dilate over the heart with these pde5

inhibitors that creates a really big

dilation of the heart causing an unsafe

drop in blood pressure just like you

hear the commercials say all the time

typically if you've taken pde5

inhibitors you want to tell the person

that's coming to get you in the

ambulance if you develop chest pain that

you've taken these types of drugs and

they will change how they manage things

in general it's pretty safe if you start

to experience chest pain with any type

of activity the best thing to do is take

full dose aspirin and put it under your

tongue and let that absorb and call the

ambulance that's the best thing you can

do to help save your life and finally if

you experience very rare problems with

these drugs visual changes that persist

or hearing problems you want to notify

your physician right away everyone's

home we get some really goofy side

effects and so then you won't want to

take these class of drugs anymore for

the most part though these are very well

tolerated very safe

and a great therapy for problems of the

directions alright so which one should

you personally choose I've listed a few

things based on my experience and some

of the literature you can see the

references I use in the bottom corner of

the screen

so sildenafil is viagra this is the most

probably the most familiar brand that's

available guess what that's now

available in a generic form the generic

form comes in two 20 milligram dose so

in order to take the full set of data

file dose you'll need to take five of

these pills together right five times 20

is a hundred this one is the most common

to cause visual changes or blue dots in

the vision typically this gets better

relatively quickly and then you don't

have to worry about it but if visual

changes persist over several days you're

gonna want to contact your physician

what about two Dallow fill this is

otherwise known as cialis also generic

currently and whenever you have a

generic medication my recommendation is

to go to these online websites that are

available that can help lead you to the

cheapest version of the drug in

whichever pharmacy you go to in that

town and so then you can save some money

so look up those websites but again

today la filler cialis is generic it

comes in two standard doses five and

twenty milligrams as the max dose the 20

milligram dose should be taken two hours

before intended intercourse or longer

whereas all the other three drugs that

you see listed here is available for an

interval in Habana fill should be taken

about an hour before sex on an empty

stomach that's very important if you ate

a big bacon double cheeseburger and you

try to take any one of these three drugs

it will delay the absorption it will

still work but it will delay it for two

hours so the best thing to do with these

pills in general if you don't have to

remember anything is taking out take

them on an empty stomach

an hour before unless you're taking

Cialis or two dallof he'll you just take

it at least two hours before and it

doesn't matter what you've eaten back to

death today laughs he'll respectively

so today Olive Hill has the longest half

like it means that once you take this

pill it will last and be in your system

for one to three days that is both good

and bad it is good because that's people

be spontaneous

and have sex whenever they wish they

don't have to time it perfectly it is

bad in that if you get side effects from

this type of medication those side

effects can last longer right the other

thing that's unique about too dalla fill

in its daily dose that's the five

milligram tablet you take every day

that's been shown to help with the

urinary symptoms

what type of urinary symptoms you're

gonna make a frequency urgency having to

get up in the middle of night those type

of irritative symptoms I found this drug

to be very effective and so if you have

both problems with the urination and

problems with erections tadalafil makes

a lot of sense at least the daily

version today LaFell has unique side

effects and that it can cause back and

muscle aches so if you take these pills

and all of a sudden start develop back

pain or muscle aches you are susceptible

about this to this and happen maybe in

about 5% of patients and you probably

don't wanna switch to a different drug

if the pain is too debilitating this one

tends to cause less facial flushing than

the rest of these drugs vard NFL is not

generic but maybe works a little bit

faster in some of the studies and so

that's an option that you can choose and

finally avanná Phil also of one of the

newer agents probably causes less

stomach upset and it has probably

decreased side-effect duration so if

you're very sensitive do these drugs

this may be a good choice because you

won't get a headache for as long rep set

stomach for example in general the side

effects the ones that don't ever get

better with time

our facial flushing and upset stomach

that's because these drugs dilate both

the blood vessels in the face and the

sphincter between your esophagus and

stomach respectively and that tends not

to improve with you know continued usage

all the other side effects like headache

you know the other you know and and

other side effects runny nose they tend

to get better the more you take them if

headache is a problem for you some

people choose to take tylenol with the

medication to help address this issue

okay so that is a summary of which pills

to choose from again it's a personal

decision as to which is best for you I

hope you find this information useful

thanks again for watching as always if

you have any questions about today's

talk please call the number on the


or if you like discuss an appointment

same deal until next time toby kohler

signing off maiya men's health moment

Rochester Minnesota