The therapeutic dilemma: How to use tadalafil

Carosa, Eleonora; Lombardo, Francesco; Martini, Paolo; Brandetti, F.; Jannini, Emmanuele A.

doi:10.1111/j.1365-2605.2005.00590.x

Cited by 5 publications

(3 citation statements)

References 41 publications

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“…It has been suggested, although not demonstrated, that there might be a tendency for younger men to choose tadalafil because it gives them a broader window of opportunity, while older men tend to prefer vardenafil or sildenafil [30]. To solve the dilemma of therapeutic choice, it has been proposed to give each patient a short‐ [31] and long‐acting agent [32], and for individuals to decide on their preference [33]. In any case, most patient‐preference studies of these drugs conducted to date have serious design flaws that hinder interpretation of the data, and thus limit the utility of the results [34–36].…”

Section: Discussionmentioning

confidence: 99%

The ENDOTRIAL Study: A Spontaneous, Open-Label, Randomized, Multicenter, Crossover Study on the Efficacy of Sildenafil, Tadalafil, and Vardenafil in the Treatment of Erectile Dysfunction

Jannini

Isidori

Gravina

et al. 2009

The Journal of Sexual Medicine

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Introduction The three effective, commercially available drugs for the treatment of erectile dysfunction—sildenafil, vardenafil, and tadalafil—inhibit the same substrate, the erectolytic enzyme phosphodiesterase type 5 (PDE5). Although there are pharmacological differences between these three compounds, few comparative studies have been conducted to date. Aim The aim of this study was to determine the efficacy of sildenafil, tadalafil, and vardenafil in a randomly assigned 8-week fixed regimen. Methods This was a spontaneous, open-label, randomized, multicenter, crossover study where the patients were randomized to receive sildenafil 50 mg, sildenafil 100 mg, tadalafil 20 mg, or vardenafil 20 mg. Main Outcome Measures The primary outcome included the posttreatment analysis of erectile function domains of the abridged International Index of Erectile Function (IIEF5+1). The secondary objectives included the analysis of peak-systolic velocities (PSVs), end-diastolic velocities (EDVs), and resistive index (RI), and the estimate of the percentage of men with normal penile hemodynamic parameters after each treatment. Results In all groups of patients taking sildenafil 50 mg, sildenafil 100 mg, tadalafil 20 mg, and vardenafil 20 mg at a frequency reflecting the common treatment regimens in real life, there was a statistically significant baseline-to-end point improvement in subjective perception of erectile function measured by IIEF5+1. When the four groups were compared, the treatments were not different in modifying IIEF5+1 and penile flow parameters. However, the within-group analysis showed that PSV improved in the sildenafil 50 mg group and that PSV together with RI significantly ameliorated in patients receiving 100 mg of sildenafil. Regression analysis confirmed an independent effect of sildenafil on hemodynamic efficacy parameters. Conclusions An overall equivalence was demonstrated in the subjective perception of treatment benefits for all the PDE5i tested. However, sildenafil, in a dose-dependent manner, was the unique PDE5i able to ameliorate some of the penile flow parameters within the 8-week treatment period. These findings should be interpreted conservatively because of the observational nature of the study.

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Section: Discussionmentioning

confidence: 99%

The ENDOTRIAL Study: A Spontaneous, Open-Label, Randomized, Multicenter, Crossover Study on the Efficacy of Sildenafil, Tadalafil, and Vardenafil in the Treatment of Erectile Dysfunction

Jannini

Isidori

Gravina

et al. 2009

The Journal of Sexual Medicine

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“…In conclusion, all three PDE5Is currently available are excellent, effective, and very well‐tolerated drugs, with a safety profile better than that of aspirin [47]. The few, existing differences are consequence of the pharmacokinetics and pharmacodynamics of the three molecules: tadalafil seems superior in number of full sexual intercourse per pill (due to the longer half life) [13,48], preference [49–51], and switching [49,52]; vardenafil have been particularly studied in the parameter of the duration of erection [53] and discreet use [10,54], and sildenafil seems the best in vascular efficacy when penile hardness is examined, particularly with the dose of 100 mg [44]. Only clinical experience, careful evaluation of the couple setting, and evidence‐based data will permit to individuate the subset of patients in which one drug, or one dose, or dose regimen, is to be considered of first choice.…”

Section: Couple's Taxonomy Of Treatments For Erectile Dysfunction [Frmentioning

confidence: 99%

How to Evaluate the Efficacy of the Phosphodiesterase Type 5 Inhibitors

Jannini

Derogatis

Chung

et al. 2012

The Journal of Sexual Medicine

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“…However, limited data suggest that the combination of tadalafil daily dosing with a short-acting PDE5i can improve outcomes, without a significant increase in side effects [259,260]. Table 5 may help in the choice of PDE5i [156,[261][262][263][264][265][266][267][268][269][270]. Interestingly, a recent perspective open-label study evaluated the efficacy and the safety of combination the co-administration of a PDE5i and topical alprostadil (300 μg/100 mg) in patients with ED non-responders to oral therapy alone (avanafil, sildenafil, vardenafil, and tadalafil used at the maximal available doses, 200, 100, 20 and 20 mg, respectively) [271].…”

Section: Pde5i Evidencementioning

confidence: 99%

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

Corona

Cucinotta

Lorenzo

et al. 2023

J Endocrinol Invest

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Purpose Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized. Methods The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed. Conclusions These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health. Supplementary Information The online version contains supplementary material available at 10.1007/s40618-023-02015-5.

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The therapeutic dilemma: How to use tadalafil

Cited by 5 publications

References 41 publications

The ENDOTRIAL Study: A Spontaneous, Open-Label, Randomized, Multicenter, Crossover Study on the Efficacy of Sildenafil, Tadalafil, and Vardenafil in the Treatment of Erectile Dysfunction

The ENDOTRIAL Study: A Spontaneous, Open-Label, Randomized, Multicenter, Crossover Study on the Efficacy of Sildenafil, Tadalafil, and Vardenafil in the Treatment of Erectile Dysfunction

How to Evaluate the Efficacy of the Phosphodiesterase Type 5 Inhibitors

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

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