Comparative efficacy of on-demand Sildenafil, Tadalafil and daily Tadalafil for treatment of erectile dysfunction: A 12-week randomized controlled study

Q: How were participants with ED allocated to treatments in the study?

Seventy-five participants diagnosed with ED (ICD-11) were randomly assigned into three groups with 25 participants each.

Q: Which assessment tools were used to measure erectile function, premature ejaculation, and mental health?

Erectile function used IIEF and SEP2/3, premature ejaculation used PEDT, and depression/anxiety/stress were assessed with DASS-21.

Q: What was the main finding regarding daily tadalafil compared with on-demand sildenafil and tadalafil?

Daily tadalafil was superior for improving erectile function, significantly reduced depression and anxiety symptoms at 12 weeks, and showed advantage across domains.

Sep 29, 2026

Uploaded by MrHarris58

Comparison of first-line agents for erectile dysfunction (ED) in the Indian context is limited, particularly regarding effects on comorbid psychiatric symptoms and premature ejaculation. This 12-week randomized controlled study assigned 75 ICD-11 ED participants to on-demand sildenafil, on-demand tadalafil, or daily tadalafil. Erectile function was measured by IIEF and SEP2/3; PME by PEDT; depression, anxiety, and stress by DASS-21. Daily tadalafil improved erectile function, reduced mood symptoms, and outperformed sildenafil across domains.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background and Aim

Methods

Results

Conclusion

Introduction

Prevalence and contributing factors

Treatment options and rationale

Methods

Study design and setting

Sample size

ORIGINAL ARTICLE Comparative efficacy of on‑demand Sildenafil, Tadalafil and daily Tadalafil for treatment of erectile dysfunction: A 12‑week randomized controlled study Shevya Gagal, Ajeet K. Sidana, Abhinav Agrawal, Swarndeep Singh1 Department of Psychiatry, Government Medical College and Hospital, Chandigarh, 1Department of Psychiatry, VMMC and Safdarjung Hospital, Delhi, India ABSTRACT Background: Comparison of available first line agents for treating Erectile Dysfunction (ED) with each other regarding efficacy in Indian context remains scant. Sexual and mental health disorders frequently overlap and it is prudent to explore the potential of these medications to improve common comorbid psychiatric symptoms. Aim: To compare the efficacy of on‑demand Sildenafil, on‑demand Tadalafil and daily Tadalafil for ED, as well as their impact on premature ejaculation (PME) and mental health. Methods: Seventy‑five individuals diagnosed with ED (ICD‑11) were randomly assigned to one of the three treatment groups with 25 participants in each group: Group A (Sildenafil 50–100 mg SOS), Group B (Tadalafil 10–20 mg SOS), and Group C (Tadalafil 5 mg daily) . Severity of sexual functioning was evaluated using the International Index of Erectile Function (IIEF), Sexual Encounter Profile question 2 and 3 (SEP2/3), Premature Ejaculation Diagnostic Tool (PEDT) . Depression, Anxiety, and Stress Scale (DASS-21) assessed mental health status. Assessments were repeated at 2 weeks intervals till 12 weeks. Blood investigations were carried out at baseline and at the end of study period. Results: Daily Tadalafil was superior to on‑demand Sildenafil or Tadalafil in improving erectile function (P < 0.05), particularly in penetration (SEP 2/3) and was equally effective as on‑demand Tadalafil on IIEF, while outperforming Sildenafil. It also significantly reduced depression and anxiety symptoms at 12 weeks (P < 0.05) . On‑demand Tadalafil was most effective for managing associated PME, which was comorbid with ED in 66.7% of cases. Conclusion: Daily Tadalafil was more effective than on‑demand Tadalafil or Sildenafil for treating ED, especially inpatients with mood symptoms. PME was found tobe quite common with ED and responded best to on demand Tadalafil. Tadalafil was superior to Sildenafil in all domains. Key words: Depression, erectile dysfunction, impotence, premature ejaculation, Sildenafil, Tadalafil Gagal, et al.: Big shoes to fill: Comparing Sildenafil and Tadalfil INTRODUCTION Erectile Dysfunction (ED) prevails as a major sexual concern for men. [1] Worldwide prevalence varies from 37.5% to 52% . [1,2] In Indian context, it has been reported that one in five males suffers from at least one sexual disorder with reported prevalence for ED of about 15.7% . [3] ED stems from a complex interplay of psychological, social, and physiological factors. Studies show men with depression have a higher risk of ED, with reported frequencies ranging from 5% to 15% . [4] Men with ED were found to experience depression at a rate 1.8 times higher than those without ED.[5] Even when ED’s primary pathology is organic, psychological stressors can exacerbate it. [6] Various treatment options for ED are available and tailored based on underlying causes, patient profile, and preference. These include psychotherapy, oral pharmacotherapy (regular or on-demand), intraurethral and topical medications, penile injections, vacuum erection devices, penile prosthesis implantation, and revascularization surgeries.[2] Oralphosphodiesterase 5 (PDE5) inhibitors remain the first-line treatmentchoiceforalltypesofED (psychological,physiological, or mixed) due to their excellent safety profile and effectiveness.[7] In India, the most widely available and commonly used oral PDE5 inhibitors are Sildenafil and Tadalafil. Sildenafil is typically used as on-demand for ED treatment, whereas Tadalafil’s longer half-life of approximately 17.5 hours permits daily dosing

FAQs

How were participants with ED allocated to treatments in the study?

Seventy-five participants diagnosed with ED (ICD-11) were randomly assigned into three groups with 25 participants each.

Which assessment tools were used to measure erectile function, premature ejaculation, and mental health?

Erectile function used IIEF and SEP2/3, premature ejaculation used PEDT, and depression/anxiety/stress were assessed with DASS-21.

What was the main finding regarding daily tadalafil compared with on-demand sildenafil and tadalafil?

Daily tadalafil was superior for improving erectile function, significantly reduced depression and anxiety symptoms at 12 weeks, and showed advantage across domains.

Sep 29, 2026

Uploaded by MrHarris58