What are PDE5 inhibitors?
PDE5 inhibitors are a class of medications commonly used to treat erectile dysfunction (ED) by increasing blood flow to the penis. These medications work by blocking the enzyme phosphodiesterase type 5 (PDE5), which can restrict blood flow.
Uses of PDE5 Inhibitors
PDE5 inhibitors are primarily used to treat erectile dysfunction (ED) and pulmonary arterial hypertension (PAH).
Erectile Dysfunction (ED): PDE5 inhibitors are most commonly prescribed to help men with ED, a condition where achieving or maintaining an erection is difficult. These medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), improve blood flow to the penis, enabling you to get an erection when sexually stimulated.
Pulmonary Arterial Hypertension (PAH): PDE5 inhibitors are also used to treat PAH, a condition where high blood pressure affects the arteries in the lungs, making it harder for the heart to pump blood. Medications like tadalafil (Adcirca) can help lower pulmonary blood pressure by relaxing the blood vessels in the lungs, improving exercise capacity and reducing symptoms of PAH.
How Does PDE5 Inhibitor Work?
PDE5 inhibitors work by blocking the enzyme phosphodiesterase type 5 (PDE5), which helps to relax the blood vessels and increase blood flow to the penis or lungs.
In the case of erectile dysfunction (ED), PDE5 inhibitors help by stopping PDE5 from breaking down cGMP, a substance that causes the blood vessels in your penis to relax and widen, allowing more blood to flow into the area during sexual arousal. This helps you achieve and maintain an erection.
For pulmonary arterial hypertension (PAH), PDE5 inhibitors work by relaxing the blood vessels in the lungs, reducing high blood pressure in the pulmonary arteries. This improves blood flow and allows your heart to pump blood more easily, improving exercise capacity and reducing symptoms like shortness of breath.
Top PDE5 Inhibitor Tablets in Pakistan (2025)
The leading PDE5 inhibitor tablets available in Pakistan for treating erectile dysfunction (ED) are including Viagra (Sildenafil Citrate), Cialis (Tadalafil), Levitra (Vardenafil), Sildigra (Generic Sildenafil) and Everlong Dapoxetine.
Viagra (Sildenafil Citrate)
Viagra, containing sildenafil citrate, is one of the most recognized ED medications globally. In Pakistan, it remains a top choice for treating ED.
Cialis (Tadalafil)
Cialis, with the active ingredient tadalafil, is another widely used ED treatment in Pakistan. Tadalafil has a longer duration of action compared to sildenafil, lasting up to 36 hours, earning it the nickname “the weekend pill.”
Levitra (Vardenafil)
Levitra, containing vardenafil, is another PDE5 inhibitor used to treat ED. Vardenafil works similarly to sildenafil but may have a slightly faster onset of action and a longer duration.
Sildigra (Generic Sildenafil)
Sildigra is a generic version of sildenafil available in Pakistan. It offers the same efficacy as the brand-name Viagra but at a more affordable price point.
Everlong (Dapoxetine)
Everlong tablets contain dapoxetine, a selective serotonin reuptake inhibitor (SSRI) specifically developed for the treatment of premature ejaculation (PE).
Who Should Avoid PDE5 Inhibitors?
PDE5 inhibitors should be avoided by individual including Heart Conditions, Severe Low Blood Pressure, Liver or Kidney Problems, Use of Nitrate Medications , Eye Conditions and allergic reactions.
Heart Conditions
If you have a history of heart disease, especially recent heart attack or stroke, PDE5 inhibitors can pose risks by affecting your blood pressure and heart function. These medications can cause a drop in blood pressure, which may lead to complications like dizziness, fainting, or even more severe cardiovascular events. Always consult your healthcare provider if you have heart conditions before using these medications.
Severe Low Blood Pressure (Hypotension)
PDE5 inhibitors, including sildenafil and tadalafil, are not recommended if you have low blood pressure. These medications can further lower your blood pressure, potentially causing symptoms like dizziness, fainting, and a rapid heart rate, which can be dangerous for individuals with already low blood pressure.
Liver or Kidney Problems
If you suffer from severe liver or kidney disease, PDE5 inhibitors may not be metabolized properly, leading to an increased concentration of the drug in your system and raising the risk of side effects. In such cases, your healthcare provider might adjust the dosage or recommend alternative treatments.
Use of Nitrate Medications
Taking PDE5 inhibitors alongside nitrate medications (used to treat chest pain or angina) can cause a dangerous drop in blood pressure. This combination should be strictly avoided as it can lead to life-threatening conditions.
Eye Conditions (Retinitis Pigmentosa)
If you have retinitis pigmentosa, a rare genetic eye condition, you should avoid PDE5 inhibitors. These medications may worsen vision problems associated with the condition.
Allergic Reactions
If you are allergic to any component of PDE5 inhibitors, such as sildenafil, tadalafil, or dapoxetine, taking these medications could cause an allergic reaction. Symptoms may include hives, swelling, difficulty breathing, or severe skin reactions.
Common Side Effects Of PDE5 Inhibitors
The common side effects of PDE5 inhibitors are including Headaches, Flushing, Dizziness or Lightheadedness, Indigestion or Upset Stomach, Vision Changes, Priapism (Prolonged Erections), Hearing Loss, hest Pain or Heart Problems, Allergic Reactions, Nasal Congestion.
Headaches
One of the most common side effects of PDE5 inhibitors is headaches. These medications increase blood flow, which can cause mild to moderate headaches in some people. This typically goes away on its own but may require over-the-counter pain relief if it becomes bothersome.
Flushing
You may experience redness or a warm sensation in your face or upper body, known as flushing. This happens due to the blood vessels widening as a result of the increased blood flow caused by PDE5 inhibitors.
Dizziness or Lightheadedness
Some people feel dizzy or lightheaded after taking PDE5 inhibitors, especially if they stand up quickly. This is usually due to the drop in blood pressure these medications can cause.
Indigestion or Upset Stomach
PDE5 inhibitors can cause digestive issues, such as indigestion, upset stomach, or nausea. Taking these medications with food may reduce the likelihood of experiencing these side effects.
Vision Changes
In rare cases, PDE5 inhibitors can affect your vision. Some people report seeing a bluish tint or having difficulty distinguishing between blue and green. If you experience sudden vision loss or other severe changes in vision, contact your doctor immediately.
Priapism (Prolonged Erections)
Priapism is a rare but serious side effect of PDE5 inhibitors. It is a painful, prolonged erection lasting more than 4 hours. If not treated promptly, priapism can cause permanent damage to the penis. Seek emergency medical attention if you experience this condition.
Hearing Loss
Some users have reported sudden hearing loss or ringing in the ears (tinnitus) after taking PDE5 inhibitors. If you experience these symptoms, stop using the medication and consult your healthcare provider.
Chest Pain or Heart Problems
If you have underlying heart conditions, PDE5 inhibitors can strain your cardiovascular system. Chest pain, shortness of breath, or irregular heartbeat can occur, especially if combined with other medications that affect the heart, like nitrates.
Allergic Reactions
As with any medication, PDE5 inhibitors can cause allergic reactions in some people. Symptoms may include rash, swelling of the lips or throat, or difficulty breathing. Seek immediate medical attention if you experience any signs of an allergic reaction.
Nasal Congestion
PDE5 inhibitors can also cause nasal congestion, which might make it harder to breathe through your nose. This effect is usually temporary and resolves after the medication leaves your system.
Natural Alternatives to PDE5 Inhibitors
Natural alternatives to PDE5 inhibitors for erectile dysfunction include various herbs, foods, and supplements that have some PDE5 inhibiting effects or improve overall sexual health and blood flow. Key natural options are
Horny Goat Weed (Epimedium): Contains icariin, a compound with PDE5 inhibitory activity used traditionally to improve sexual function.
Thai (Black) Ginger: Contains compounds that may improve sexual stimuli and physical performance.
Pomegranate Juice: Shown to have benefits for mild to moderate ED.
Yohimbe: Bark containing yohimbine, used as an aphrodisiac but with possible side effects.
Ashwagandha: Claimed to boost testosterone and overall vitality.
L-arginine: An amino acid that promotes blood vessel dilation for better blood flow.
Are PDE5 Inhibitor Safe in Young Men?
Yes, PDE5 inhibitors are generally considered safe for young men with erectile dysfunction when used under medical supervision. Clinical studies show many young men use these medications effectively to manage ED, with some achieving medication-free erectile function recovery after treatment.