Understanding Erectile Dysfunction

Erectile dysfunction (ED) is the inability to consistently obtain and sustain an erection strong enough to engage in satisfying sexual activity (Salonia et al., 2021). Erectile dysfunction affects 15% of men annually (Johannes et al., 2000), and it is estimated to affect 350 million men worldwide by 2025 (Abolfotouh and Al Helali, 2001).

There has always been a social stigma and embarrassment attached to discussing or getting treatment for ED. People either think it is an embarrassment or a blow to their masculinity. Denial and misperception are also implicating factors for ED. As a result, numerous men opt to endure their ED issues privately rather than reaching out to healthcare experts for assistance. This hesitance to address and consider ED treatments can adversely impact both their physical and emotional health.

We have detailed information on erectile dysfunction in our already published article titled “Unveiling the Truth: Erectile Dysfunction: Causes, Symptoms, Diagnosis, and Treatment”.

What is Tadalafil?

Tadalafil is a type of phosphodiesterase-5 (PDE5) inhibitor used as a first-line treatment for ED (Khera and Goldstein 2011). Tadalafil received approval from the US FDA in 2003 and earned its nickname as the “weekend pill” due to its remarkable 36-hour effectiveness, which provided patients with increased spontaneity. In 2008, the FDA granted approval for the daily use of tadalafil (2.5 mg and 5 mg). Furthermore, in October 2011, tadalafil, sold under the name Cialis (5 mg), was also authorized for the treatment of benign prostatic hyperplasia (BPH), whether or not erectile dysfunction was present (Huang and Lie 2013.

How does tadalafil help in treating erectile dysfunction?

Let us understand the mechanism of action of tadalafil in a simple way (Frajese et al., 2003).

• Upon sexual arousal in a man, the body initiates the release of nitric oxide within the penile erectile tissue. This nitric oxide, in turn, triggers the activation of an enzyme known as guanylate cyclase.
• Guanylate cyclase acts as the catalyst for the production of cyclic guanosine monophosphate (cGMP) from guanosine triphosphate (GTP).
• The cGMP is responsible for relaxing the smooth muscle cells in the penile arteries, leading to their dilation by increasing blood flow to the penis.
• PDE5, on the other hand, breaks down cGMP, hence limiting the duration of erection.
• Tadalafil works by blocking the action of the enzyme PDE-5.
• The action of tadalafil maintains the elevated level of cGMP in the penile region, facilitating sustained blood flow and thereby leading to rigid and enduring erection.

Tadalafil advantages

An effective medication for ED should offer reliable efficacy and a predictable onset of action, be easily tolerated and simple to administer, and have minimal associated side effects. The US FDA has granted approval to four PDE-5 inhibitors, namely sildenafil, tadalafil, vardenafil, and avanafil, all of which exhibit similar levels of efficacy and share comparable profiles when it comes to side effects (Patel and Bennett 2016).

Tadalafil, however, has some advantages over other PDE-5 inhibitors. It begins to take effect within 20 minutes and should be ingested 30 minutes before engaging in sexual activity. Tadalafil exhibits a half-life of 17.5 hours in healthy, younger men, and it extends to 21.6 hours in elderly men. The extended half life of tadalafil offers a therapeutic window lasting 36 hours (Porst et al., 2003). Tadalafil has also shown a notable improvement in ED for individuals with psychogenic erectile dysfunction (Li et al., 2017). One of the other advantages of tadalafil is that it is not affected by high-fat meals (Forgue et al., 2006) or alcohol consumption (Francis and Corbin, 2003). A meta-analysis comparing tadalafil with sildenafil has shown that patients and their partners preferred tadalafil over sildenafil (Gong et al., 2017).

Tadalafil has also shown to enhances endothelial function in individuals at heightened cardiovascular risk. A randomized controlled study involving 32 patients with increased cardiovascular risk to received either tadalafil 20 mg or placebo every alternate day for 4 weeks. The study showed that enhanced endothelial function in individuals with elevated cardiovascular risk, irrespective of the severity of their ED. The positive effects of this therapy persist for a minimum of two weeks after its discontinuation (Rosano et al., 2005).

Tadalafil has also been found efficacious in treating ED in men with diabetes. As study comprising 637 diabetic men with ED were randomized and treated with tadalafil 10 mg, 20 mg, or placebo for 12 weeks. The study showed that even with more pronounced initial ED in men with diabetes, tadalafil proved to be effective and well-tolerated (Fonseca et al,. 2004).

Side effects of Tadalafil

Tadalafil has been shown to cause a small decrease in blood pressure; however, it is not considered meaningful. Tadalafil should not be used in patients who are undergoing nitrate therapy due to the risk of experiencing substantial drops in blood pressure (Kloner et al., 2003). The most common side effects associated with tadalafil were headache and dyspepsia, with back pain, nasal congestion, myalgia, and flushing following closely in terms of frequency (Frajese GV et al., 2006). Most of these side effects are usually of mild to moderate intensity and tend to subside as your body becomes accustomed to the medication.

Conclusion

Tadalafil has become a valuable pharmaceutical choice for individuals grappling with erectile dysfunction. A prominent benefit of tadalafil is its extended duration of action, providing a therapeutic window of up to 36 hours. While its side effects are typically mild to moderate and often alleviated with continued use, it is crucial for patients to remain attentive and seek advice from their healthcare providers if they experience persistent or severe symptoms. Considering both the advantages and potential side effects, it is evident that tadalafil presents a valuable option for those in need. It is essential to stress that the decision to use tadalafil or any medication should be made after consulting with a qualified healthcare professional who can offer personalized guidance and monitoring. If you have any questions about this medicine, talk to our expert at Science & Humans.