Treatment with a phosphodiesterase type 5 (PDE5) inhibitor like sildenafil may fail to improve a man's erectile function. The cause for this failure can often be found by a careful review of the patient's history and clinical findings.
Reasons for treatment failure with a PDE5 inhibitor
(1) too low a dose
(2) taking a medication that increases metabolism of the PDE5 inhibitor
(3) failure of the patient to take the drug as directed (poor adherence)
(4) not allowing enough time between taking the dose and attempting intercourse
(5) giving up too soon
(6) another condition contributing to the sexual dysfunction (hypogonadism, etc)
(7) troublesome side effects
Problem
Attempted Solution
too low a dose
increase the dose
drug causing increased clearance
increase the dose of the PDE5 inhibitor or stop the interfering drug
poor adherence
address the underlying causes
not allowing enough time
allow several hours for the drug to take effect
giving up too soon
provide encouragement to give the drug a reasonable clinical trial
another condition
identify other reasons and treat; consider continuing the PDE5 inhibitor therapy
troublesome side effects
try lowering the dose or switch to an alternative agent
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