Can I Take ED Meds Forever?
Erectile dysfunction most often has a slow progression, where patients initially have occasional trouble achieving or maintaining an erection, followed by subsequent difficulty finishing. Eventually, the condition becomes troublesome enough that without intervention, a satisfying, sex life is not possible. Of course, once the patient first realizes they have a problem, the psychological effects are often as problematic as the physical ones.
While the prospect of taking medication to achieve an erection can be dispiriting, patients need to know that they are not alone. Around 50% of all men over 60 have trouble attaining or maintaining their erection, and those that opt for medical therapy as a front-line attack on the condition can often regain a satisfying sex life immediately. Further, with generics like sildenafil and tadalafil on the market, the cost of this improvement in sexual function is minimal when compared to when these drugs were on-patent (Viagra and Cialis).
Patients often wonder how long these ED meds will be effective. This is not how long they can allow for an erection, but will the medication become less effective over time? In most cases where the erectile issue is primarily caused by age and associated blood flow reductions, the answer is undoubtedly yes. Dr. Engel analogizes the progression of ED to a roller coaster. Once you have reached the apex and begin to go down the other side, there is no stopping the coaster, and so too is the case with ED. This is because of the slow march of age and the fact that vascular deficiencies are inevitable in middle-aged and older life.
Are ED Meds Safe?
Of course, we can also interpret the question as whether these drugs are safe to use over the long term, and the answer here is typically yes. Some patients will experience side effects that ultimately force them to stop using one or the other. However, if patients react to sildenafil, they can often continue with tadalafil and vice versa. Occasionally, patients experience more severe side effects and should seek the care of an appropriate medical professional immediately.
Dosage for the Long-Term
Patients will start with the lowest effective dose of either drug and continue increasing dosage as needed until they reach the maximum amount of 20 mg for tadalafil/Cialis and 100 mg for sildenafil/Viagra. In our practice, we typically prescribe the highest dose for both medications, allowing patients to save a significant amount of money by cutting their pills in half or even a quarter, depending on the dosage they need.
Once patients have reached the maximum dosage and can no longer achieve a satisfactory erection, we must start considering the next steps in treatment. We usually propose injections as an excellent next step to begin where medication left off. Injections sound uncomfortable and unpalatable, but the skin of the flaccid penis is among the least sensitive areas of the body. Once properly trained, most patients can self-administer injections before sexual activity and enjoy a renewed sex life.
Another option is a vacuum erection device, but these are far less commonly used than in the past. Patient satisfaction is very low, and partner satisfaction is also low.
An option that must be mentioned due to the high level of marketing surrounding it is penile shock wave therapy. There is some hope that more recent generation machines may have some evidence that they actually do help ED, in reality even the studies that do exist show that the only patients with any hope of actual success with this are patients that are already highly responsive to ED pills. Patients choose this in the hope of a cure, but at a typical price tag of $6000 at ED clinics, and very scant data Dr. Engel usually encourages a patient to see if pills can be a solution for sure before suggesting this controversial approach to ED.
Of course, eventually, even injections no longer work, and in these cases, a penile prosthesis or implant may be a good option. Dr. Engel sees the prosthetic implant as a last resort when all other options have been tried and ultimately failed. However, penile prostheses are an elegant solution for patients with advanced erectile dysfunction, and Dr. Engel often suggests them for patients who experience ED due to prostatectomy when erectile function is permanently compromised.
To take advantage of our comprehensive ED management program, including low-cost, generic ED medications, please click here. If you have been taking medication as they are no longer working, we encourage you to schedule a consultation with Dr. Engel to learn more about the next steps for treating erectile dysfunction.