African Urology Journal

Sildenafil in Erectile Dysfunction: A Proven First-Line Choice ¹

Oral phosphodiesterase type 5 inhibitors (PDE5-Is) remain the first-line pharmacological treatment for erectile dysfunction (ED), owing to their established efficacy and tolerability profile. ¹

Sildenafil, the first selective PDE5-I introduced in 1998, has well-established clinical efficacy. ¹ Approximately 80 % of men receiving sildenafil (25-100 mg) report improved erections, compared with 25 % on placebo, irrespective of age, disease severities, and aetiologies. ¹ A large multicentre study reports that 99,1 % of patients achieved erectile hardness above EHS grade III following treatment. ² Treatment response may improve with repeated use, particularly in men with more severe ED, supporting the value of early intervention. ³

With an onset of action typically within 30 minutes, and lasting 4-6 hours, sildenafil is suited to on-demand use. ⁴ Survey data show that the average interval between deciding to have intercourse and activity is about one hour, aligning with peak sildenafil plasma concentrations and its on-demand use. ³ Patient data indicates a preference for treatment effects that resolve within a few hours, while durations beyond 12 hours are generally considered undesirable. ¹

With more than 25 years of use, sildenafil has been established to be an effective treatment option for ED across comorbidities including hypertension, diabetes mellitus, stable coronary artery disease, and depression. ¹ Its half-life of approximately 3 to 5 hours and administered as-needed in a maximum dosing frequency of once per day are associated with a low risk of clinically significant medication interactions. ^{5, 6, 7} The most common adverse effects are mild and transient, including headache and flushing. ¹

With established efficacy, tolerability, and a pharmacokinetic profile aligned to real-world use, sildenafil remains a first-line option for the management of ED. ^{1, 3, 4}

References:
1. Jannini EA, Droupy S. Needs and Expectations of Patients with Erectile Dysfunction: An Update on Pharmacological Innovations in Phosphodiesterase Type 5 Inhibition with Focus on Sildenafil. Sex Med. 2019;7(1):1-10
2. Tang WH, Zhuang XJ, Ma LL, Hong K, Zhao LM, Liu DF, et al. Effect of sildenafil on erectile dysfunction and improvement in the quality of sexual life in China: a multi-center study. Int J Clin Exp Med. 2015;8(7):11539-11543
3. Barada JH. Optimizing outcomes of oral therapy for patients with erectile dysfunction. Rev Urol. 2003;5 Suppl 7(Suppl 7):S28-S34
4. Gong B, Ma M, Xie W, Yang X, Huang Y, Sun T, Luo Y, Huang J. Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. Int Urol Nephrol. 2017;49(10):1731-1740 5. Giuliano F, Jackson G, Montorsi F, Martin-Morales A, Raillard P. Safety of sildenafil citrate: review of 67 double-blind placebo-controlled trials and the postmarketing safety database. Int J Clin Pract. 2010;64(2):240-255
6. Taylor J, Baldo OB, Storey A, Cartledge J, Eardley I. Differences in side-effect duration and related bother levels between phosphodiesterase type 5 inhibitors. BJU Int. 2009;103(10):1392-1395
7. VIAGRA® 25 mg / 50 mg / 100 mg film-coated tablets professional information approved by the medicines regulatory authority. 17 April 2024
S4 VIAGRA® 25 mg, 50 mg and 100 mg film-coated tablets (Reg. nos.: 32/7.1.5/0621, 0622, 0623). Each film-coated tablet contains sildenafil citrate equivalent to 25 mg, 50 mg and 100 mg sildenafil respectively. For full prescribing information, refer to the professional information approved by the Medicines Regulatory Authority.
LICENCE HOLDER: Viatris Healthcare (Pty) Ltd. Reg. No.: 1949/035112/07 4 Brewery Street, Isando, Kempton Park, Gauteng, 1601, South Africa. Tel.: +27 (11) 451 1300 www.viatris.co.za SA-VIAG-2026-00027 Exp: 03/2028