Abstract
Unless contraindicated, phosphodiesterase type 5 inhibitors (PDE5Is) are the first-line pharmacological treatment for erectile dysfunction. Treatment of some men who do not initially respond to a PDE5I can be salvaged through in-depth patient counselling and physician follow-up measures. Patients should receive a full trial with at least two PDE5Is before PDE5I failure is declared. Second-line therapy usually involves more invasive measures, such as intraurethral alprostadil, intracavernosal injections of erectogenic drugs or surgical implantation of a penile prosthesis. According to patient preference, additional non-invasive PDE5I-based options such as using a higher than recommended dose of a PDE5I, using a daily instead of an on-demand PDE5I regimen, combining two different PDE5Is or combining a PDE5I with another medication or treatment modality can be considered. Data to support the use of these off-label options, however are limited.
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