How does vardenafil work for erectile dysfunction. What are the common side effects of vardenafil. Who should not take vardenafil. How to use vardenafil safely and effectively. What precautions should be taken when using vardenafil. When to seek medical help while taking vardenafil. How does vardenafil interact with other medications and substances.

Understanding Vardenafil and Its Uses

Vardenafil is a medication primarily used to treat male sexual function problems, specifically impotence or erectile dysfunction (ED). It belongs to a class of drugs known as phosphodiesterase type 5 (PDE5) inhibitors. But how exactly does vardenafil work?

Vardenafil functions by increasing blood flow to the penis in combination with sexual stimulation. This enhanced blood flow helps men achieve and maintain an erection. It’s important to note that vardenafil does not automatically cause an erection; sexual arousal is still necessary for the medication to be effective.

While vardenafil is effective in treating ED, it does not protect against sexually transmitted diseases (STDs) such as HIV, hepatitis B, gonorrhea, or syphilis. Users should still practice safe sex by using latex condoms and taking other necessary precautions.

Proper Usage and Administration of Vardenafil

To ensure the safe and effective use of vardenafil, it’s crucial to follow the prescribed guidelines. Here are some key points to remember:

• Take vardenafil as directed by your doctor, usually as needed about 1 hour before sexual activity.
• Do not take more than once daily, with doses spaced at least 24 hours apart.
• The medication can be taken with or without food.
• For the disintegrating tablet form, place it on your tongue and allow it to dissolve completely.
• Avoid consuming grapefruit or grapefruit juice while using vardenafil, as it can increase the risk of side effects.

It’s important to note that vardenafil disintegrating tablets are absorbed differently in the body compared to film-coated tablets. Do not switch between these forms without consulting your doctor.

Common Side Effects of Vardenafil

Like all medications, vardenafil can cause side effects, although not everyone experiences them. Understanding these potential effects can help users recognize and address any issues promptly. What are the most common side effects of vardenafil?

• Headache
• Flushing
• Dizziness
• Vision changes (increased sensitivity to light, blurred vision, difficulty distinguishing between blue and green)

These side effects are generally mild and often resolve on their own. However, if they persist or worsen, it’s important to consult a healthcare provider. To minimize the risk of dizziness and lightheadedness, users should rise slowly from sitting or lying positions.

Serious Side Effects and When to Seek Medical Help

While serious side effects are rare, they can occur and require immediate medical attention. Users should be aware of these potential complications:

• Sudden decreased vision or blindness in one or both eyes (NAION)
• Sudden decrease or loss of hearing, sometimes accompanied by ringing in the ears and dizziness
• Painful or prolonged erection lasting 4 or more hours
• Seizures
• Temporary memory loss

In the event of these serious side effects, users should stop taking vardenafil immediately and seek medical help. Additionally, those with heart problems should be cautious during sexual activity and stop if they experience severe dizziness, fainting, chest/jaw/left arm pain, or nausea.

Precautions and Contraindications for Vardenafil Use

Before starting vardenafil, it’s crucial to inform your healthcare provider about your medical history and any current medications. Certain conditions and medications may interact with vardenafil or increase the risk of side effects. Who should exercise caution or avoid using vardenafil?

• Individuals with heart problems or a history of heart attack
• Those who have had a stroke in the past 6 months
• People with kidney or liver disease
• Individuals with high or low blood pressure
• Those with certain eye conditions
• People taking nitrates or alpha-blockers

It’s also important to disclose any allergies to vardenafil or its inactive ingredients to your healthcare provider. This information helps ensure the safe and appropriate use of the medication.

Interactions with Other Medications and Substances

Vardenafil can interact with various medications and substances, potentially altering its effectiveness or increasing the risk of side effects. What are some important interactions to be aware of?

• Nitrates: Combining vardenafil with nitrates can cause a dangerous drop in blood pressure
• Alpha-blockers: These medications can interact with vardenafil, leading to a sudden drop in blood pressure
• Other ED medications: Taking vardenafil with other PDE5 inhibitors is not recommended
• Certain antibiotics and antifungal medications: These can affect the metabolism of vardenafil
• Alcohol: Excessive alcohol consumption can increase the risk of side effects

Always inform your healthcare provider about all medications, supplements, and herbal products you are taking to avoid potential interactions.

Lifestyle Considerations While Using Vardenafil

While vardenafil can be an effective treatment for ED, it’s important to consider overall lifestyle factors that can impact sexual health and medication effectiveness. What lifestyle modifications can complement vardenafil treatment?

• Maintaining a healthy diet and exercise routine
• Managing stress levels
• Quitting smoking
• Limiting alcohol consumption
• Getting adequate sleep

These lifestyle changes can not only improve overall health but may also enhance the effectiveness of vardenafil and reduce the risk of ED.

Long-term Use and Monitoring

For individuals using vardenafil long-term, regular check-ups with a healthcare provider are essential. These visits allow for monitoring of the medication’s effectiveness, assessment of any side effects, and adjustments to the treatment plan if necessary.

During these check-ups, healthcare providers may:

• Evaluate overall cardiovascular health
• Check blood pressure and cholesterol levels
• Assess for any changes in vision or hearing
• Discuss any concerns or side effects experienced

Regular monitoring ensures the continued safe and effective use of vardenafil over time.

Alternative Treatments for Erectile Dysfunction

While vardenafil is an effective treatment for many men with ED, it’s not the only option available. What are some alternative treatments for erectile dysfunction?

• Other PDE5 inhibitors (e.g., sildenafil, tadalafil)
• Vacuum erection devices
• Penile injections
• Penile implants
• Testosterone replacement therapy (for men with low testosterone levels)
• Psychological counseling

The choice of treatment depends on various factors, including the underlying cause of ED, overall health status, and personal preferences. Discussing these options with a healthcare provider can help determine the most suitable treatment approach.

Psychological Aspects of Erectile Dysfunction and Vardenafil Use

Erectile dysfunction can have significant psychological impacts, affecting self-esteem, relationships, and overall quality of life. While vardenafil addresses the physical aspects of ED, it’s important to consider the psychological factors as well. How can individuals address the psychological aspects of ED?

• Open communication with partners about ED and treatment
• Seeking counseling or therapy to address anxiety or depression related to ED
• Joining support groups for individuals with ED
• Practicing stress-reduction techniques
• Building self-confidence through other aspects of life

Addressing both the physical and psychological aspects of ED can lead to more comprehensive and effective treatment outcomes.

The Future of ED Treatment: Beyond Vardenafil

As medical research continues to advance, new treatments for erectile dysfunction are being explored. What are some potential future developments in ED treatment?

• Gene therapy to promote erectile function
• Stem cell treatments to regenerate erectile tissue
• Novel drug delivery systems for more targeted and efficient treatment
• Combination therapies that address multiple aspects of sexual function
• Personalized medicine approaches based on genetic profiles

While these potential treatments are still in various stages of research and development, they highlight the ongoing efforts to improve ED treatment options beyond current medications like vardenafil.

Vardenafil and Overall Men’s Health

The use of vardenafil for ED treatment can serve as a gateway to addressing broader men’s health issues. ED can sometimes be an early indicator of underlying health conditions such as cardiovascular disease or diabetes. How can vardenafil use contribute to overall men’s health?

• Encouraging regular health check-ups and screenings
• Promoting discussions about sexual health with healthcare providers
• Increasing awareness of the importance of cardiovascular health
• Motivating lifestyle changes for better overall health
• Improving quality of life and relationship satisfaction

By addressing ED with treatments like vardenafil, men may become more engaged in their overall health care, leading to earlier detection and management of other health issues.

Vardenafil in the Context of Aging and Sexual Health

As men age, the prevalence of erectile dysfunction tends to increase. Vardenafil can play a crucial role in maintaining sexual health and quality of life for older adults. What considerations are important for older adults using vardenafil?

• Potential interactions with medications commonly used by older adults
• Adjusting dosage based on kidney and liver function
• Addressing concurrent health conditions that may affect sexual function
• Considering the physical demands of sexual activity
• Discussing realistic expectations for sexual performance and satisfaction

Healthcare providers can help older adults navigate these considerations to ensure safe and effective use of vardenafil as part of a comprehensive approach to sexual health in aging.

The Role of Partners in Vardenafil Treatment

The treatment of erectile dysfunction with vardenafil often involves not just the individual with ED, but also their partner. How can partners support and be involved in the treatment process?

• Learning about ED and vardenafil to better understand the condition and treatment
• Participating in discussions with healthcare providers
• Providing emotional support and reassurance
• Adapting to changes in sexual routines and expectations
• Encouraging adherence to treatment plans and lifestyle changes

Partner involvement can significantly enhance the effectiveness of vardenafil treatment and improve overall relationship satisfaction.

Vardenafil and Sexual Health Education

The availability of treatments like vardenafil has opened up new opportunities for sexual health education and awareness. How can vardenafil contribute to broader sexual health education efforts?

• Promoting open discussions about sexual health and function
• Increasing awareness of the prevalence and treatability of ED
• Educating about the importance of safe sexual practices
• Addressing misconceptions about ED and its treatments
• Encouraging men to seek medical advice for sexual health concerns

By integrating information about vardenafil and other ED treatments into sexual health education, individuals can be better equipped to address sexual health issues throughout their lives.

Vardenafil Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

Vardenafil is used to treat male sexual function problems (impotence or erectile dysfunction-ED). In combination with sexual stimulation, vardenafil works by increasing blood flow to the penis to help a man get and keep an erection.This drug does not protect against sexually transmitted diseases (such as HIV, hepatitis B, gonorrhea, syphilis). Practice “safe sex” such as using latex condoms. Consult your doctor or pharmacist for more details.

How to use Vardenafil HCL Tablet,Disintegrating

Read the Patient Information Leaflet provided by your pharmacist before you start taking vardenafil and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication as directed by your doctor, usually as needed. Take vardenafil, with or without food, about 1 hour before sexual activity. Do not take more than once daily. Doses should be taken at least 24 hours apart.

Dry your hands before handling this medication. Remove the dose from the blister package right before use. Place the tablet on your tongue and allow it to dissolve completely. Do not crush or split the tablet. This medication should not be taken with liquid.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.

Vardenafil disintegrating tablets are absorbed differently in the body than vardenafil film-coated tablets. Do not switch from one to the other without consulting your doctor.

Tell your doctor if your condition does not improve.

Side Effects

Headache, flushing, or dizziness may occur. Vision changes such as increased sensitivity to light, blurred vision, or trouble telling blue and green colors apart may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Sexual activity may put extra strain on your heart, especially if you have heart problems. If you have heart problems and experience any of these serious side effects while having sex, stop and get medical help right away: severe dizziness, fainting, chest/jaw/left arm pain, nausea.

Rarely, sudden decreased vision, including permanent blindness, in one or both eyes (NAION) may occur. If this serious problem occurs, stop taking vardenafil and get medical help right away. You have a slightly greater chance of developing NAION if you have heart disease, diabetes, high cholesterol, certain other eye problems (“crowded disk”), high blood pressure, if you are over 50, or if you smoke.

Rarely, a sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness, may occur. Stop taking vardenafil and get medical help right away if these effects occur.

In the rare event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and get medical help right away, or permanent problems could occur.

Get medical help right away if you have any very serious side effects, including: seizures, temporary memory loss.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www. fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking vardenafil, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as heart attack or life-threatening irregular heartbeat in the past 6 months, chest pain/angina, heart failure), stroke in the past 6 months, kidney disease (dialysis), liver disease, high or low blood pressure, dehydration, penis conditions (such as angulation, fibrosis/scarring, Peyronie’s disease), history of painful/prolonged erection (priapism), conditions that may increase the risk of priapism (such as sickle cell anemia, leukemia, multiple myeloma), eye problems (such as retinitis pigmentosa, sudden decreased vision, NAION), bleeding disorders, active stomach ulcers.

This drug may make you dizzy or cause vision changes. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

This medication may contain aspartame. If you have phenylketonuria (PKU) or any other condition that requires you to limit/avoid aspartame (or phenylalanine) in your diet, ask your doctor or pharmacist about using this medication safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This medication is not usually used in women. It is unlikely to be used during pregnancy or breast-feeding. Consult your doctor if you have any questions about this medication.

Interactions

See also How to Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug are: riociguat, vericiguat.

Vardenafil can cause a serious drop in your blood pressure when used with nitrates, which can lead to dizziness, fainting, and rarely heart attack or stroke. Do not use vardenafil with any of the following: certain drugs used to treat chest pain/angina (nitrates such as nitroglycerin, isosorbide), recreational drugs called “poppers” containing amyl or butyl nitrite.

If you are also taking an alpha blocker medication (such as doxazosin, tamsulosin) to treat an enlarged prostate/BPH or high blood pressure, your blood pressure may get too low which can lead to dizziness or fainting. To manage this drug interaction, you should not start vardenafil treatment with the disintegrating tablet. Your doctor will start treatment with a lower dose of the regular vardenafil tablets first to minimize your risk of low blood pressure, and then may direct you to switch to vardenafil disintegrating tablets later.

Other medications can affect the removal of vardenafil from your body, which may affect how vardenafil works. Examples include azole antifungals (such as itraconazole, ketoconazole), cobicistat, macrolide antibiotics (such as clarithromycin, erythromycin), HIV protease inhibitors (such as indinavir), ritonavir, among others.

Do not take this medication with any other product that contains vardenafil or other similar medications used to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil).

Does Vardenafil HCL Tablet,Disintegrating interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: back/muscle pain, abnormal vision.

Do not share this medication with others.

Not applicable.

Store this medication in the original packaging at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

vardenafil 10 mg disintegrating tablet

Color: whiteShape: roundImprint: 477

This medicine is a white, round, tablet imprinted with “477”.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Vardenafil, or Levitra: Uses and risks

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Vardenafil, also known by the brand name Levitra, is a prescription medication that treats male erectile dysfunction.

Erectile dysfunction is when a man is unable to get or sustain an erection. It usually happens because the arteries that carry the blood to the penis are too narrow.

Vardenafil increases blood flow to the penis.

Its action is similar to that of sildenafil, or Viagra, but Viagra lasts between 2 and 4 hours, while Levitra lasts 4 hours.

Share on PinterestVardenafil can help a man get and maintain an erection.

During a penile erection, the penis fills with blood.

The blood vessels that supply the penis with blood expand, or dilate, and the vessels that take blood away from the penis contract. The two large chambers in the penis, known as the corpus cavernosa, fill with blood.

As the blood accumulates in the penis, an erection results.

Vardenafil belongs to a class of drugs called phosphodiesterase type-5 (PDE5) inhibitors. A PDE5 inhibitor stops PDE5 from constricting the arteries.

By relaxing the arteries, vardenafil enhances blood flow when a man is sexually aroused.

The active ingredient works on the chain of reactions within the penis during arousal.

When a male is sexually aroused, nitric oxide is released into his penis, and this triggers a chain of reactions.

This causes an enzyme, guanylate cyclase, to produce cyclic guanosine monophosphate (cGMP).

cGMP regulates the contraction and dilation, or expansion, of blood vessels that carry blood to and from the penis. The chemical reaction causes the vessels that supply the penis to dilate, while those removing blood from the penis contract.

Phosphodiesterase-5 (PDE5), another enzyme breaks down or destroys cGMP.

When cGMP is destroyed, the blood vessels return to their normal size, effectively ending the erection. Vardenafil stops PDE5 from destroying cGMP. In this way, it allows cGMP to work for longer. As a result, it helps prolong an erection.

Vardenafil is available in tablets of 2.5 milligrams (mg), 5 mg, 10 mg, and 20 mg. The first dose is normally 10 mg.

Share on PinterestNo more than one tablet should be taken in 24 hours.

A 10-mg dose of vardenafil is approximately equivalent to 50 mg of sildenafil, or Viagra. This is because the chemical composition of vardenafil is different from that of sildenafil.

Vardenafil is taken 25 to 60 minutes before sex. The effect lasts for up to 5 hours. A maximum of one tablet can be used every 24 hours.

Orodispersible tablets must be left to dissolve on the tongue before swallowing. They should not be taken with any kind of drink.

The drug will not work unless the man is sexually aroused, so foreplay will normally be necessary.

Vardenafil can be taken with or without food, but drinking alcohol is not advised, as it reduces the chance of getting an erection. Alcohol can also increase the risk of adverse effects.

As with all medications, adverse effects and interactions can occur when using vardenafil.

One in 10 men will experience headache.

Other common side effects include:

• stuffy or runny nose
• stomach upset
• dizziness
• flushing

In most cases, these disappear within a few hours.

Other potentially serious symptoms include:

• ringing in the ears, or sudden hearing loss
• irregular heartbeat
• swelling in the ankles, hands, or feet
• difficulty breathing
• chest pain

The patient should stop using vardenafil if these occur.

Rarely, an allergic reaction may occur. This can lead to hives, difficulty breathing, and swelling of the face, tongue, and throat. It can lead to shock, and it can be fatal. If these symptoms appear, it should be treated as a medical emergency.

Priapism

Very rare side effects may include priapism, when an erection lasts longer than 4 hours. This can damage the penis. If an erection lasts too long, the individual should seek medical attention.

Visual disturbances

Visual disturbances can happen when blood pressure drops in the eye. The individual may see a blue tinge to objects, and they may have difficulty distinguishing between the colors green and blue.

Very rarely, there may be a sudden deterioration in vision in one or both eyes. This can indicate a heart condition, an existing eye problem, high cholesterol, diabetes, or hypertension.

If any sudden loss of vision occurs, the individual should stop taking the medication and seek medical help immediately.

Vision problems are most likely in patients with other conditions, such as heart or coronary artery disease, diabetes, and high cholesterol. Vision problems are more likely to happen if the person smokes, or if they are aged over 50 years.

Interactions

Using vardenafil with some other drugs can lead to serious adverse effects.

Possible reactions include:

• a potentially dangerous drop in blood pressure, or hypotension
• dizziness
• fainting

There is also a risk of stroke and heart attack.

A man should not use vardenafil if he is taking nitrate drugs, such as riociguat (Adempas), or other nitrate drugs for chest pain or heart problems.

It should not be used with the recreational drugs, amyl nitrate and butyl nitrate, also known as poppers.

Other drugs that may interact include, but are not limited to:

• antibiotic and antifungal medications
• other medications for erectile dysfunction
• drugs for prostate problems, blood pressure, or heart rhythm disorders
• medications for HIV or AIDS

Grapefruit juice contains a chemical that makes adverse effects more likely, so it should not be consumed while using vardenafil.

Patients should tell their doctor about all their medical conditions and any other medications or supplements they use before taking vardenafil.

This is especially important if they have:

• a deformity in the shape of the penis, such as Peyronie’s disease
• a heart condition, such as arrhythmia, heart failure, or angina
• a family history of a rare heart condition known as long QT syndrome
• hearing problems
• hemophilia or some kind of bleeding problem
• hypotension (low blood pressure) or hypertension (high blood pressure)
• liver or kidney problems
• multiple myeloma, leukemia, sickle cell anemia, or some other kind of blood cell problem
• non-arteritic anterior ischemic optic neuropathy (NAION)
• damage to the retina of the eye
• stomach ulcers
• retinitis pigmentosis, a rare genetic eye disease

They should also tell the doctor if they have ever experienced priapism, a seizure, or if they have recently had a stroke or a heart attack.

Levitra is available to purchase online, but users should consider the above points and check with their health provider first.

If any adverse effects occur, users are encouraged to report them to the FDA.

Active substance VARDENAFIL (VARDENAFILUM) | Compendium – drug reference book

• Pharmacological properties
• Indications VARDENAFIL
• Application of VARDENAFIL
• Contraindications
• Side effects
• Special instructions
• Interactions
• Diagnosis
• Recommended alternatives
• Trade names

Medicines containing the active substance VARDENAFIL

Levitra

film-coated tablets 20 mg blister, № 1, 4

Bayer

Pharmacy prices

Levitra ^® ODT

dispersible tablets 10 mg blister, № 4

Bayer

Prices in pharmacies

a drug for the treatment of patients with erectile dysfunction, a selective PDE-5 inhibitor. Erection of the penis is a hemodynamic process, which is based on the relaxation of the smooth muscles of the cavernous bodies. During sexual stimulation, nitric oxide (NO) is released in the cavernous bodies, which activates the enzyme guanylate cyclase, which leads to an increase in the content of cGMP in the cavernous bodies. As a result, the smooth muscles of the cavernous bodies are relaxed, which contributes to an increase in blood flow to the penis. Vardenafil blocks PDE-5, under the influence of which the breakdown of cGMP occurs, as a result, the effect of endogenous NO in the cavernous bodies during sexual stimulation increases, which determines the ability of vardenafil to enhance the natural response to sexual stimulation. The clinical effect of vardenafil occurs approximately 15 minutes after administration and lasts 8–12 hours.

After oral administration, vardenafil is rapidly absorbed from the gastrointestinal tract. Absolute bioavailability is about 15%. C _max in blood plasma after oral administration at a dose of 20 mg is achieved after 30 minutes – 2 hours (average after 30 minutes). Simultaneous intake with fatty foods leads to a decrease in plasma C _max by 18-50%. The mean volume of distribution of vardenafil at steady state is 208 liters. Metabolized in the liver. Approximately 95% of vardenafil and its major metabolite bind to plasma proteins. The total clearance of vardenafil is 56 l / h, terminal T _½ of vardenafil and its main metabolite is 4-5 hours. It is excreted mainly with feces (91-95%), the rest (2-6%) is excreted in the urine.

erectile dysfunction.

at the beginning of treatment, the recommended dose is 10 mg, administered orally approximately 25-60 minutes before sexual contact, but can be up to 4-5 hours. The maximum recommended frequency of administration is 1 time / day. Vardenafil can be taken with or without food. Adequate level of sexual stimulation is essential for the treatment to be effective. Depending on the effectiveness and tolerability of treatment, the dose can be increased to 20 mg or reduced to 5 mg / day. The maximum recommended dose is 20 mg once daily. In the elderly, a change in dosing regimen is not required. In patients with moderate hepatic impairment, there is a decrease in the clearance of vardenafil, so the initial dose should be 5 mg / day. In the future, depending on the effectiveness and tolerability, the dose of vardenafil can be increased to 10 mg and then to 20 mg. In patients with mild hepatic impairment, no change in dosing regimen is required. In patients with minor, moderate and severe impaired renal function, changes in the dosing regimen are not required.

Dispersible tablets are not bioequivalent to coated tablets. The maximum recommended dose for dispersible tablets is 10 mg/day.

A dispersible tablet is placed in the oral cavity on the tongue, held until completely dissolved, then swallowed. The dispersible tablet should be taken immediately after removing it from the blister, without drinking liquid.

hypersensitivity to vardenafil, concomitant use of organic nitrates or other NO donors, α-adrenergic blockers, severe liver failure, end-stage kidney disease requiring hemodialysis, arterial hypotension (systolic blood pressure at rest below 90 mmHg Art. ), recent stroke or myocardial infarction (within the last 6 months), unstable angina pectoris, hereditary degenerative diseases of the retina (including retinitis pigmentosa), age up to 16 years.

headache, dizziness, increased muscle tone, facial flushing, increased or decreased blood pressure, dyspepsia, nausea, nasal congestion, photosensitivity, priapism.

should be used with caution in anatomical deformities of the penis (curvature, cavernous fibrosis or Peyronie’s disease), diseases predisposing to the development of priapism (sickle cell anemia, multiple myeloma or leukemia), bleeding tendency, peptic ulcer of the stomach and duodenum. Not intended for use in women and children.

Cytochrome P450 inhibitors (cimetidine, ketoconazole, itraconazole, indinavir, ritonavir) may reduce the clearance of vardenafil (when used simultaneously with these drugs, the dose of vardenafil 5 mg / day should not be exceeded). When used simultaneously with the CYP 3A4 inhibitor erythromycin, it is not recommended to exceed the dose of vardenafil 10 mg / day. Simultaneous use with α-adrenergic blockers can lead to a decrease in blood pressure, so vardenafil should be taken no earlier than 6 hours after taking these drugs. There were no significant pharmacokinetic interactions with the combined use of vardenafil with glibenclamide, nifedipine, warfarin and digoxin. With simultaneous use with warfarin, there was no change in prothrombin time and the level of blood coagulation factors. With simultaneous use with acetylsalicylic acid, antacids, ACE inhibitors, β-adrenergic blockers, diuretics, hypoglycemic drugs (sulfonylurea derivatives and metformin), ranitidine, the pharmacokinetics of vardenafil did not change. Since PDE inhibitors affect the NO/cGMP system, PDE-5 inhibitors may enhance the hypotensive effect of nitrates.

Vardenafil alone does not inhibit platelet aggregation induced by various platelet agonists. When using vardenafil at concentrations higher than therapeutic, there was a slight dose-dependent increase in the antiaggregation effect of sodium nitroprusside, which releases NO.

Combination therapy for erectile dysfunction uMEDp

The results of a comparative study of the effectiveness of mono- and combination therapy with Impaza and phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil) are presented. The use of Impaza, the only drug that increases the level of endogenous NO, made it possible to restore endothelial function, as well as to increase the effectiveness of oral monotherapy for erectile dysfunction with phosphodiesterase type 5 inhibitors due to their combination with Impaza.

Table 1. Main pharmacokinetic parameters of vardenafil, sildenafil, tadalafil

Table 2. Side effects observed in more than 2% of patients, %

Fig. 1. Scheme of double effect in the treatment of ED

Table 3. Distribution of ED patients by therapy groups, abs. (%)

Table 4. The effectiveness of pharmacotherapy depending on various factors, abs. (%)

Fig. 2. Side effects of ED pharmacotherapy

Fig. 3. Comparative analysis of the effectiveness of Impaza depending on the duration of treatment

Fig. 4. Study Design

Fig. 5. Results of treatment with vardenafil

Drug treatment of erectile dysfunction

Erection is a neurovascular phenomenon associated with hormonal control, including arterial dilatation, relaxation of trabecular smooth muscles, and activation of the corporo-vein-occlusive mechanism [1, 2]. The results of scientific and clinical studies have identified new directions in the treatment of erectile dysfunction (ED). Achievements in pharmacotherapy and the failure of reconstructive vascular surgery in the long term have significantly changed approaches to the treatment of ED [3].

The most common mechanisms of ED include endothelial dysfunction, which is characterized by inadequate production of nitric oxide (NO) by the vascular endothelium in response to adequate stimuli (hemodynamic effects, cholinergic stimulation, etc. ). In this regard, it is the endothelial function that serves as one of the targets of the most effective modern drugs for the treatment of ED – inhibitors of the phosphodiesterase type 5 enzyme (PDE-5). Another target is central dopaminergic mechanisms (for apomorphine).

The advent of PDE-5 inhibitors, which are currently considered the most effective treatment for ED, has revolutionized the treatment of this disease. Suppression of PDE-5 activity leads to a slowdown in the breakdown and an increase in the level of cyclic guanosine monophosphate (cGMP) in the cavernous tissue, and thereby contributes to the induction and maintenance of an erection. PDE-5 inhibitors do not have a direct relaxing effect on the smooth muscle cells of the cavernous bodies of the penis, but act by enhancing the physiological erectile response to NO after sexual arousal.

Sildenafil

The prediction of the World Health Organization experts that “when indicated, oral drugs will become the first-line treatment for most patients with ED due to their potential efficacy and non-invasiveness” came true when the first PDE-5 inhibitor sildenafil (sildenafil citrate) appeared on the market. The availability and effectiveness of sildenafil led to better results in the treatment of ED compared to other methods (intracavernous injections of vasoactive drugs, vacuum devices, implants, and other surgical interventions). This made it possible for general practitioners to help patients with ED.

However, many men, especially those with severe ED, diabetes, arterial hypertension, who underwent radical prostatectomy were not completely satisfied with the existing treatment and continued to experience the negative impact of ED on sexual relations, and hence on the quality of life in general [4-7]. Some pharmacokinetic properties of sildenafil (half-life, inability to combine with food and alcohol intake) make it necessary to plan sexual intercourse, reduce romance, lead to loss of spontaneity of sexual activity, limit a man in time and frequency of sexual attempts. In addition, there is an inexplicable lack of effect in 20% of cases. For these reasons, some patients were not satisfied with sildenafil treatment, and some even stopped using it [8, 9]. Moreover, only 33% of patients who took sildenafil were completely satisfied, and only 50% of those who took sildenafil intended to continue treatment [10]. All of the above dictated the need to search for new highly effective, safe and affordable drugs, which led to the creation of drugs such as tadalafil, vardenafil hydrochloride, Impaza.

Tadalafil

The next PDE-5 inhibitor after sildenafil was tadalafil. Compared to sildenafil, tadalafil has a longer half-life (17.5 hours), and its pharmacokinetics does not depend on food and alcohol intake [11]. The duration of the dose of tadalafil (36 hours) allows you not to plan sexual intercourse in advance, to maintain the spontaneity and romance of sexual relations. Consequently, the psychological component and dependence on the pill are nullified or significantly reduced: “I took it – I had sexual intercourse, if not, nothing will work out.” This helps the patient to overcome the increased psycho-emotional background (instability), which is present in ED of any origin. It is possible that tadalafil can provide the desired result in the absence of the effect of sildenafil and vice versa.

However, in some patients taking tadalafil, side effects in the form of headache, heartburn or back pain are observed for as long as the drug works, that is, 36 hours or more (up to three days), which significantly limits the use of the drug. In addition, studies show that only 13% of the surveyed patients with ED are interested in increasing the duration of action of drugs, they are more concerned about the reliability (40%) and safety (40%) of the therapy they receive [7].

Vardenafil

Vardenafil is a highly effective and most powerful representative of PDE-5 inhibitors [12-14]. According to the results of in vitro studies , vardenafil has the most selective effect (10 times stronger than sildenafil and 13 times stronger than tadalafil) on PDE-5, the main target of ED treatment [14]. The effect on PDE-6, an isoenzyme contained in the retina of the eye, blocking which causes color perception disorders, is less pronounced in vardenafil than in sildenafil. In addition, vardenafil is less effective than sildenafil and tadalafil on testicular PDE-11 [13]. Thus, vardenafil is highly selective for PDE-5 and therefore safer. The drug does not inhibit spermatogenesis and does not cause a violation of color perception.

Vardenafil is absorbed faster than all PDE-5 inhibitors after oral administration, the maximum level of drug concentration in the blood plasma in some men is reached as early as 15 minutes after administration. In 90% of cases, the maximum concentration (C _max ) is reached 30 minutes after oral administration and maintained for up to 120 minutes (Table 1) [13]. The results of studies have shown that even with daily use, the drug does not accumulate in the body [14]. This is a fundamental difference between vardenafil and tadalafil, whose significant half-life is the cause of undesirable effects when taken daily. In addition, the intake of food and alcohol does not affect the effectiveness of vardenafil [15].

Vardenafil is available in three dosages: 5, 10 and 20 mg, which allows individual dose selection.

Side effects when taking vardenafil are short-term and insignificant. When using vardenafil, like other PDE-5 inhibitors, headache and hot flashes are observed (Table 2). Unlike other PDE-5 inhibitors, back pain and visual impairment while taking vardenafil are less common [16-18]. In the first phase of the clinical trial of vardenafil, two cases of priapism were recorded (while taking a dose of 40 mg) [17], however, no cases of priapism were noted in further studies.

In one clinical study, 3.7% of patients treated with vardenafil and 1.4% of patients treated with placebo discontinued treatment due to side effects [15]. In another study, the most common reasons for premature discontinuation of the drug were headache (0.7%), hot flashes (0.4%), rhinitis (0.3%).

One of the main problems in the treatment of ED is the ineffectiveness of PDE-5 inhibitors in certain groups of patients. As shown by the multicenter double-blind study PROVEN (463 patients with moderate and severe ED), the use of vardenafil compared with placebo led to a statistically and clinically significant improvement in erectile function in patients who had previously unsuccessfully taken sildenafil (including at a dose of 100 mg). The indicator of erectile function (according to the International Index of Erectile Function – IIEF) increased by eight points when taking vardenafil and only by one point in the placebo group. In addition, 62% of patients treated with vardenafil noted an improvement in erection (in the placebo group, 15%).

Impaza

PDE-5 inhibitors improve erection by slowing down the breakdown of cGMP. Another mechanism for increasing the amount of cGMP is the activation of NO synthase. The first and so far the only drug with such a mechanism of action is the domestic drug Impaza (Materia Medica Holding, Russia). The active substance of Impaza is antibodies in a release-active form to endothelial NO synthase (NO synthetase) (RA AT eNOS).

The theoretical prerequisite for the creation of Impaza was the discovery of the modifying properties of RA AT [19]. The mechanisms of action of Impaza as a representative of a new class of drugs based on RA AT, on the one hand, and a fundamentally new means of restoring erectile function, on the other, can be judged with sufficient confidence on the basis of experimental studies.

According to preclinical studies, oral course administration to male rats under conditions of physiological (seasonal) and age-related inhibition of reproductive function, the drug Impaza significantly stimulated sexual activity and increased the copulative function of animals. At the same time, a change in some indicators indicated the effect of the drug on the central mechanisms of erection [20, 21].

Against the background of the introduction of Impaza, the content of the intracellular level of cGMP in the tissue of the cavernous bodies significantly increased (similar data were obtained for sildenafil) [22]. However, unlike sildenafil, the content of NO derivatives increased in the tissues of the corpora cavernosa both with a single and course administration of Impaza. The increase in the content of NO in the tissue of the cavernous bodies of animals treated with Impaza is due to a twofold increase in the activity of NO synthase (sources of NO in the cavernous bodies are neuronal and endothelial NO synthase).

Thus, the main peripheral mechanism of action of Impaza has been experimentally confirmed: an increase (restoration) of the activity of endothelial NO-synthase, a key enzyme that determines the maintenance of an erection. That is, when the drug is administered, the ability of the endothelium to produce NO is increased (restored), which means that Impaza helps to restore endothelial function. In addition, the results of preclinical and clinical studies suggest the ability of Impaza not only to improve, but also to restore erectile function.

Schematically, the mechanism of action of the drug Impaza is shown in Fig. 1 and consists in increasing the activity of endothelial NO-synthase and increasing the production of NO in the cavernous tissue. This effect may be mediated by a system of natural antibodies involved in the immunoneuroendocrine regulation of homeostasis. Natural antibodies can act as factors that “shield” endothelial NO-synthase from the influence of its endogenous inhibitors (low-density lipoproteins, glycosylation products, tumor necrosis factor, asymmetric dimethylarginine, etc.).

Among the advantages of Impaza are sufficient efficiency, permission to use against the background of taking nitrates, the almost complete absence of side effects and systemic negative effects, and relatively low cost. Course application with a consistent increase in efficiency in some patients indicates the therapeutic effect of Impaza [23]. In addition, the different mechanisms of action of Impaza and PDE-5 inhibitors led to the possibility of prescribing these drugs in combination to increase the effectiveness of treatment and simultaneously reduce the dose of PDE-5 inhibitors.

Purpose of study

Evaluation of the effectiveness of oral mono- and combination therapy with PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) and Impaza in patients with ED of various origins.

Material and methods

The study included 218 men aged 21–73 years (average 58.1 ± 13.2 years) who applied for ED. Age distribution: up to 35 years old – 58 patients, 35–55 years old – 69patients, older than 55 years – 91 patients.

In 174 patients, possible etiological factors of ED were identified: essential arterial hypertension (n = 81), diabetes mellitus (n = 27), coronary heart disease (n = 15), osteochondrosis of the lumbosacral spine (n = 23), chronic pelvic pain (n = 21), a consequence of radical operations on the pelvic organs (n ​​= 7). In eight patients, it was not possible to establish the etiology of organic disorders. Psychogenic ED was revealed in 36 patients.

All patients underwent an examination that included analysis of the medical history and anamnesis of sexual activity, questionnaire (IIEF), physical examination, Viagra test, intracavernous pharmacological test with prostaglandin E ₁ , pharmacodopplerography of the penile vessels with audio-visual sexual stimulation before and after artificial erection simulation, penile electromyography, blood test for hormones and standard laboratory tests (complete blood count, urinalysis, blood glucose, creatinine, lipid profile).

According to the severity of ED, the patients were distributed as follows: mild (18–25 points) – 74 (33.9%), moderate (11–17 points) – 91 (41.7%), severe (10 or less points) – 53 (24.4%) patients.

According to the results of a comprehensive andrological examination, 36 (16.5%) patients suffered from psychogenic ED, the arteriogenic component prevailed in 87 (39.9%), veno-occlusive – in 54 (24.8%), neurogenic – in 41 (18.8%) ) of the patient.

Patients were divided into three groups, comparable in number and age of patients, presumed etiology, pathogenesis and severity of ED (Table 3). The first group (n = 81) took sildenafil at an individually adjusted dose starting from 100 mg with a further possibility of dose reduction depending on the effect, tolerability and severity of adverse reactions two to three times a week for six months. The second group (n = 64) took tadalafil at a dose of 20 mg two to three times a week for six months. The third group (n = 73) took Impaza one tablet under the tongue until complete resorption every other day for six months.

The effectiveness of treatment in all groups was assessed by an increase in the indicator “erectile function” of the IIEF questionnaire by 3 or more points or by reaching 26 points.

Results

The overall effectiveness of sildenafil therapy was 77.8%, tadalafil – 81.3%, Impaza – 56.2%. The influence of various factors (age of patients, pathogenesis and severity of ED) on the effectiveness of treatment was analyzed (Table 4). In men younger than 35 years, all drugs showed comparable efficacy. In men older than 55 years, the effectiveness of tadalafil was significantly higher than that of other drugs. Perhaps patients at this age are more in need of a prelude to sexual intercourse and attach more importance to the attributes of sex (romantic setting, dinner, etc.).

The effectiveness of PDE-5 inhibitors was generally similar and did not depend on the pathogenesis of ED. However, tadalafil proved to be more effective in veno-occlusive ED, which may be due to the pharmacological features of the drug and its long-term presence in the blood plasma. Impaza was more effective in psychogenic and compensated and subcompensated arteriogenic ED.

With an increase in the severity of ED, the effectiveness of all drugs naturally decreased.

In the treatment of sildenafil, the main side effects occurred after taking a dose of 100 mg on an empty stomach: headache (n = 11, 13.6%), redness of the face and neck (n = 7, 8.6%), dyspepsia (n = 5, 6, 2%), color perception disorders (n = 3, 3.7%) (Fig. 2). These phenomena persisted for a period of several tens of minutes to four hours. While taking tadalafil, such side effects were recorded as headache (n = 8, 12.5%), dyspepsia (n = 6, 9.4%), redness of the face and neck (n = 4, 6.3%), back pain (n = 2, 3.1%). The duration of side effects ranged from several hours to several days, and in some cases, side effects persisted throughout the entire period of the drug, that is, for 36 hours or more (up to a maximum of three days). No side effects were recorded in patients taking Impaza. No negative effect of Impaza on the course of concomitant diseases was observed, and therefore there was no need to change therapy.

In the group of patients taking Impaza, the effectiveness of treatment slowly increased: from 33.2% after the first month to 56.2% after six months of treatment, while 19 (26%) patients noted noticeable changes in the third or fourth month (Fig. 3 ). At first, patients reported improvement and restoration of spontaneous erections, swelling and enlargement of the penis, that is, its being in a state of constant partial tumescence, and after three to four months of taking Impaza, the normalization of adequate erections. This testified to the cumulative effect of the drug. Thus, for the onset of a stable therapeutic effect, Impaza must be taken for a long time, at least three to four months.

Taking into account the different mechanism of action of PDE-5 inhibitors (sildenafil, tadalafil) and Impaza, it was decided to prescribe them in combination to patients in whom monotherapy was ineffective or severe side effects were observed (Fig. 4).

18 patients with no effect from taking sildenafil began to additionally take Impaza, one tablet every other day. This combination made it possible to obtain a positive result in eight patients. Ten patients without effect were prescribed tadalafil, which was effective in two. The remaining eight patients were transferred to intracavernous injections. However, after vardenafil appeared on the Russian market in November 2003, they were prescribed this PDE-5 inhibitor.

The combination of Impaza and sildenafil in 12 patients who experienced severe headache while taking sildenafil 100 mg allowed in eight patients to reduce the dose of sildenafil to 50 mg, which was previously insufficiently effective, while the effectiveness remained at the same level, and there were no adverse events. Four patients who failed to reduce the dose of sildenafil subsequently successfully took tadalafil without noting any adverse events.

12 patients without effect on tadalafil monotherapy also started taking Impaza one tablet every other day. The combination was effective in six. In one of the remaining six patients, a good effect was obtained after taking sildenafil at a dose of 100 mg, the remaining five were transferred to therapy with intracavernous injections, and later included in the vardenafil therapy group.

The patients of the first group who took Impaza without effect (n = 32) were prescribed sildenafil (n = 16) and tadalafil (n = 16). Positive results were obtained while taking sildenafil in 11 (68.7%) patients, tadalafil in 12 (75%) patients. Nine patients without effect were transferred to intracavernous injections. Subsequently, these patients were also included in the vardenafil treatment group.

After vardenafil entered the market, 22 patients transferred to intracavernous injections of vasoactive drugs began to receive this drug. The vardenafil therapy group also included 32 primary patients with ED. The total number of patients was 54 (Fig. 5). They first took vardenafil 20 mg 20–40 minutes before intercourse. Then the dose was individually adjusted depending on the effect and tolerability: either reduced to 10.5 mg, or left the same – 20 mg. The course of treatment with vardenafil was three months. The effectiveness of treatment was assessed monthly using the IIEF questionnaire.

Vardenafil was effective in 44 (81.5%) patients, including 28 (87.5%) primary patients and 16 (72.7%) patients who had already been treated with sildenafil, tadalafil, Impaza and their combinations without effect. . In 19 (59.4%) primary patients, the effective dose of vardenafil was 10 mg, 16 (72.7%) patients initially included in the study successfully took vardenafil at a dose of 20 mg.

Four primary patients did not respond to vardenafil therapy. None of the PDE-5 inhibitors helped six patients. After three unsuccessful attempts to have sexual intercourse while taking vardenafil, these ten patients were transferred to the vardenafil + Impaza combination. Impaza was taken one tablet every other day under the tongue until completely resorbed. The effectiveness of treatment was assessed using the ICEF questionnaire on a monthly basis. A positive effect was obtained by the end of the third month in seven patients. This made it possible to increase the effectiveness of vardenafil monotherapy from 81.5 to 94.4%.

Treatment with vardenafil was generally well tolerated, efficacy and side effects did not depend on food or alcohol intake. Side effects were observed mainly after a dose of 20 mg against the background of the peak concentration of the drug in the blood (50–90 minutes): headache (n = 7, 12.9%), flushing to the face or neck (n = 6, 11.1% ), nasal congestion (n = 6, 11.1%), dyspepsia (n = 2, 3.7%). The phenomena were of mild severity, persisted for a period of several tens of minutes to an hour and a half, did not require additional medication or drug withdrawal, and did not cause discontinuation of treatment.

Talk

Modern pharmacotherapy for ED requires adherence to certain principles. First of all, sexual rehabilitation of patients should be provided as soon as possible. It is desirable that the patient should be able to have sexual intercourse already at the beginning of treatment. This will improve the psycho-emotional state and increase the effectiveness of the therapy. It must be understood that every unsuccessful sexual intercourse aggravates the course of ED.

Another important point is the need for a comprehensive andrological examination. Some authors suggest prescribing therapy without examination, which, in our opinion, is incorrect. First, many patients want to know the cause of their disease. Secondly, the doctor will determine the tactics of treatment, taking into account risk factors, etiology, pathogenesis and severity of ED. Sometimes only the elimination of risk factors, the correction of concomitant therapy can give certain results and radically change the course of therapy. For example, a patient taking nitrates is contraindicated in taking PDE-5 inhibitors, replacing nitroglycerin with another effective drug will make it possible to take PDE-5 inhibitors. Thirdly, by comparing the results of the examination, the doctor will be able to observe the patient in dynamics, objectively assess the effectiveness of the therapy and make adjustments as necessary (switch from more invasive to less invasive, from more expensive to less expensive therapy). Fourthly, the examination will help the doctor to understand difficult situations. For example, it is known in literature and practice that the effectiveness of sildenafil decreases with prolonged use. This may be due to both the effect of tachyphylaxis and the progression of the underlying disease, including ED. If the doctor does not know the initial indicators of penile blood flow, determined by dopplerography of the vessels of the penis, and cavernous electrical activity, recorded by electromyography of the cavernous bodies, then it will be difficult for him to understand such situations.

When choosing therapy for ED, it is also necessary to take into account the sexual habits of a man (the ability to plan sexual intercourse, combine sex life with eating, including fatty food, and drinking alcohol).

It should be noted that, despite the same mechanism of action, PDE-5 inhibitors may demonstrate different efficacy in each specific case. The use of PDE-5 inhibitors in combination with Impaza (taking into account the different mechanism of action) can increase the effectiveness and reduce the side effects of pharmacotherapy.

Taking into account all the above principles of therapy, we were able to increase the effectiveness of pharmacotherapy from 56.2 to 94.4%, as well as determine the indications and contraindications for each drug.

Young patients with psychogenic, isolated neurogenic (osteochondrosis), compensated and subcompensated mild or moderate arteriogenic ED, concomitant coronary heart disease or taking nitrates, can be prescribed initial treatment with Impaza, given the sufficient effectiveness of the drug in these cases. With the ineffectiveness of Impaza, as well as severe or moderate ED with veno-occlusive ED, PDE-5 inhibitors are indicated.

For patients who do not feel the need to combine sexual activity with food or alcohol, sildenafil can be recommended, the effect of which is weakened by fatty foods or alcohol. If there is such a need, it is necessary to find out how important it is for patients to have repeated intercourse during the day or morning intercourse. With a positive answer, tadalafil will be the drug of choice. If, in addition to the ability to take food and alcohol, the rapid onset of the drug’s action is important to patients, and the effect lasting several hours is sufficient for sexual intercourse, including repeated ones, then vardenafil is indicated for them in an individually selected dose.

If one of the PDE-5 inhibitors does not help, you need to prescribe another one, and not abandon this type of pharmacotherapy. According to our observations, even in the case of ineffectiveness of 100 mg of sildenafil and 20 mg of tadalafil, vardenafil was effective, and not only at a dose of 20 mg, but also 10 mg and even 5 mg. After the selection of therapy, the doctor must monitor the patient and conduct dynamic monitoring of the treatment.

We suggest prescribing Impaza from the first days of treatment together with PDE-5 inhibitors. The addition of Impaza makes it possible to reduce the severity of side effects of monotherapy by reducing the dose of PDE-5 inhibitors while maintaining the effectiveness at the same level. In addition, such therapy allows you to increase the intervals between taking PDE-5 inhibitors without affecting the ability to conduct a successful sexual intercourse.

With long-term treatment with Impaza and PDE-5 inhibitors, adequate and spontaneous erections are restored, which is confirmed not only by subjective, but also by objective data. Thus, there is an increase in cavernous blood flow (data of ultrasonic dopplerography of the penis with audiovisual sexual stimulation) and cavernous electrical activity (data of electromyography of the penis) [24–26]. It becomes possible to reduce the minimum effective dose of the PDE-5 inhibitor and gradually abandon it with the transfer of the patient to Impaza monotherapy, and subsequently even its cancellation.