Managing patients effectively

A broad spectrum of treatments for ED now caters for the needs of almost all men who have the condition.

Most men with ED prefer a tablet due to ease of administration, versus injections or vacuum devices. It is now common practice for first line treatment of ED to be with a PDE5 inhibitor (PDE5i).

There are currently three different PDE5is: Levitra® (vardenafil), Viagra® (sildenafil) and Cialis® (tadalafil). Each has a slightly different offering. While overall efficacy data are similar, there are variations in success with the first tablet, speed of onset, duration of action and interactions with food and alcohol.

By discussing with the patient what they are looking for in a treatment and the sex life they wish to resume, a choice can be made about which PDE5i to try first.

It is also important to remember that if one treatment has failed for a patient, it is possible that another type of PDE5i may work. To understand more about how PDE5is work, click here.

Once the decision has been made to treat with a PDE5i, it is important that the patient's expectations are managed appropriately. The media hype that has surrounded this class of treatment can make them sound like a cure. Patients need education about the need for desire and sexual stimulation and whether their treatment is affected by food, alcohol or other factors.

Key to managing expectations is that, if a patient perceives that the treatment has 'failed', they may not return. If the situation is handled appropriately, the patient will have a clearer understanding of what to expect and will hopefully feel more comfortable in returning to address any problems experienced with the treatment.

Once a treatment plan has been agreed, a timeframe for a follow-up meeting should be decided. The follow-up meeting will allow the patient and healthcare professional to discuss treatment satisfaction and assess whether any alternative treatment options need to be trialed.

It’s important to clarify that not all men with ED are suitable for treatment with a PDE5i. The relevant SmPCs should be consulted prior to prescribing. Click here for further treatment options and click here for more information on referrals.

There are a number of myths around PDE5is and heart safety and it is worth remembering that treatment for ED does not necessarily increase the risk of a heart problem, providing the patient is properly medically assessed.

In fact, ED in an otherwise asymptomatic man may be a marker for underlying coronary artery disease. Therefore, all men with unexplained ED should have a thorough evaluation and any risk factors for coronary heart disease that are identified should be addressed ¹⁹.