PDE5 inhibitors may also help restore erectile dysfunction in some (but fewer) men who have had the following conditions or treatments:
- Treatments for prostate cancer. In men who have had radiation, advanced techniques, such as 3D conformal therapy, along with PDE5 inhibitors offer the best chances for success. In men who have had surgery, PDE5 inhibitors are most effective in younger men who were potent before surgery and who had bilateral nerve-sparing procedures. It is unlikely to be effective for men over age 55 who had unilateral or non-nerve-sparing procedures. Starting first with alprostadil injections right after treatment, followed by a PDE5 inhibitor, may be the best approach and considerably improve success rates.
- Colon surgeries for cancer or inflammatory bowel disease.
- Spina bifida, a congenital defect of the spinal cord.
- Spinal cord injury. PDE5 inhibitors can be very effective in many of these men, especially those in which there is some erectile response and when the injuries are in the upper part of the spine.
Higher-Risk Candidates. PDE5 inhibitors are not suitable for everyone. Those taking nitrate drugs for angina or alpha-blockers (other than Flomax 0.4 mg once daily) for hypertension and BPH should not take PDE5 inhibitors. Men with the following conditions should not take PDE inhibitors without the recommendation of their doctors and even then should use them with caution:
- Severe heart disease, such as unstable angina, a history of heart attack, or arrhythmias. Sildenafil increases nerve activity associated with cardiovascular function, especially during physical and mental stress. Men with heart disease may benefit from an exercise test to determine whether resuming sexual activity increases their risk of a heart attack.
- Recent history of stroke
- Hypotension (very low blood pressure)
- Uncontrolled diabetes
- Uncontrolled hypertension (high blood pressure)
- Taking anticoagulant therapy
- Severe heart failure
- Retinitis pigmentosa. (With this genetic disease, people do not produce phosphodiesterase-5 and do not respond to PDE5 inhibitors.)
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