For many years, the treatment of choice for erectile dysfunction was Viagra. Introduced in the early 1990s, the drug eventually became so popular that it sold in excess of 100 million tablets worldwide in 2010.
However, since then, various newer drugs have surpassed Viagra in popularity. In fact, due to growing research into alternative therapies for erectile dysfunction, it’s not uncommon for men to explore complementary and alternative options before turning to prescription medication.
Why Choose an Over-the-Counter Alternative?
As outlined by the Mayo Clinic, men with erectile dysfunction are more likely to tolerate the side effects of prescription medications, explaining that 40% to 60% of men are able to achieve satisfactory erections with the aid of oral medication. This is in comparison to the success rate of 6% for those men who try to self-medicate with prescriptions.
While many prescription drugs come with significant side effects and the potential for addiction, men who choose over-the-counter alternatives often report alleviating the symptoms of ED without the dangerous consequences that come with certain drug therapies. One of the OTC medications that gained popularity among men searching for an effective ED treatment is Cialis.
According to research, while Cialis has been proven to increase the pleasure of sex for both men and women, it’s primarily designed for use in cases of erectile dysfunction. It’s also been noted that Cialis has a more favorable side effect profile than Viagra, with fewer men reporting issues with nausea, headache, or diarrhea. It’s also been shown to improve sexual desire and performance for men with diabetes, heart disease, and high cholesterol levels. And, in a survey of over 10,000 men aged 18-59, it was reported that 59% of respondents were comfortable taking Cialis prior to having sex, compared to 44% for men who took Viagra before sexual activity. (1)
More Advancements In ED Treatment
Despite the prevalence of ED, the disease remains largely overlooked and undertreated. Only recently have researchers begun to focus on finding an ED treatment that’s both safe and effective. This has led to new developments in the field, including the creation of the International Society for Sexual Medicine (ISSM), which was established in 2001 to promote the study of sexual medicine and provide a network for professionals and researchers working in the field.
In 2014, the society published comprehensive guidelines for the diagnosis and treatment of ED. (2) These guidelines state that sexual function should be assessed in all men with ED and that all patients should be offered treatment trials, beginning with pharmacotherapy and, if desired, combined with psychosexual therapy. (2)
While the guidelines address many aspects of ED including its epidemiology, pathophysiology, and clinical trials, they don’t provide information about the relative effectiveness of the various treatment options available. As such, it’s up to the individual clinicians to decide which treatment is most effective for their patients based on the guidelines presented.
Current Status Of Viagra And Cialis
Based on data from IMS Health, in 2015, 28.9 million prescriptions were written for Viagra, and it was the eighth most prescribed drug in the United States. (3) In the same year, Cialis was the 11th most prescribed drug, with 7.7 million prescriptions written.
These figures make it clear that while Viagra was once the golden child among ED treatments, it’s now been usurped by newer, more effective drugs. Nevertheless, Viagra is still used to treat erectile dysfunction, especially in cases where other drug therapies haven’t worked for the patient and it’s important to maintain continuous coverage. In some cases, particularly in the UK, where Viagra is a protected name, generic forms of the drug are readily available without a prescription.
Unfortunately, while Viagra was once the gold standard in the treatment of erectile dysfunction, its status has deteriorated in the wake of newer drugs. This is likely because Viagra was originally designed for use in cases of mild erectile dysfunction, and since its introduction into the market 20 years ago, it’s been prescribed for increasingly severe cases. (4)
With the introduction of generic Viagra in 2004, it became possible for pharmaceutical companies to manufacture cheaper versions of the drug, which undercut the prices of earlier formulations. This is why it was once so accessible for patients, with wholesale prices declining by as much as 85% between 1999 and 2009. (5)
The Future Of ED Treatment
While it’s clear that Viagra and Cialis are currently the gold standard in the treatment of erectile dysfunction, it’s also important to remember that new research is ongoing and that newer, more effective drugs are being developed. Not only is this important from a clinical standpoint, but it also means that men with ED will continue to have treatment options available in the future.
In September of 2019, the FDA approved a new medication, brexpiprazole, to treat erectile dysfunction. (6)
The medication is a combination of two drugs, one of which is bispiprazole (inhibits serotonin reuptake) and the other is aprazole (a partial 5-HT~1A~ agonist). The combination of these two drugs was shown in clinical trials to be more effective in increasing the pleasure of sex than either of the individual components. (6)
While this is obviously good news for men with ED, it’s also important to note that the medication is not yet available for purchase in most countries, including the United States. (7)
It will be interesting to see how clinicians respond to this new medication, particularly since it’s not clear how well it will work compared to older drug therapies. However, it’s evident that clinical trials are ongoing and that as more is learned about this new therapy, it will further evolve and improve the lives of men with ED.