Chronic PDE-5 inhibition in patients with erectile dysfunction – a treatment approach using tadalafil once-daily

INTRODUCTION: Tadalafil distinguishes itself from other available phosphodiesterase type 5 (PDE-5) inhibitors by its half-life of ∼ 17.5 h, which results in erectile responsiveness for up to 36 h after a single dose. Most clinical experience has been reported with on-demand use of PDE-5 inhibitors, but several studies have been able to demonstrate that tadalafil, given once-daily in low doses, is both highly effective and well tolerated. AREAS COVERED: This paper reviews the current evidence for efficacy and safety of tadalafil, as well as the rationale for offering low-dose tadalafil once-daily to patients with erectile dysfunction as an alternative to on-demand treatment. EXPERT OPINION: Tadalafil once-daily provides efficacy comparable to on-demand dosing regimens with PDE-5 inhibitors, is well tolerated and allows patients and their partners to disconnect the administration of medication from sexual activity, thereby enabling them to return to the sex-life they had before the onset of erectile dysfunction.