Impotence Trial Pack

ED Trial Pack contains a selection of phosphodiesterase type 5 (PDE5) inhibitor tablets — typically sildenafil, tadalafil, and vardenafil — allowing men with erectile dysfunction to compare the three treatments and identify which suits them best before committing to a larger prescription.

All three medications work by the same core mechanism: they block PDE5, an enzyme that breaks down cyclic GMP in the corpus cavernosum.

By preserving cyclic GMP, smooth muscle relaxation is maintained, blood flow to the penis increases, and an erection can develop and be sustained in response to sexual stimulation.

Why a Trial Pack?

Although the pharmacological target is the same, each PDE5 inhibitor differs in onset time, duration of action, food interactions, and side-effect profile.

Sildenafil and vardenafil act for four to six hours, while tadalafil lasts up to 36 hours.

Some men prefer a shorter-acting agent for planned encounters; others value the flexibility of a longer window.

The trial pack helps patients and prescribers make an informed choice based on real-world response rather than guesswork.

Sildenafil

Take one tablet approximately one hour before sexual activity. Swallow with water. Avoid heavy or fatty meals beforehand, as these delay absorption. Effect lasts around four to six hours.

Tadalafil

Take one tablet at least 30 minutes before anticipated activity. It is not affected by food. The effect can last up to 36 hours, so timing is more flexible.

Vardenafil

Take one tablet 25 to 60 minutes before sexual activity. A light meal is acceptable, but high-fat food may delay onset. Effect lasts four to six hours.

General Advice

Sexual stimulation is required — the tablets do not produce an automatic erection. Do not take more than one PDE5 inhibitor in a single day.

Typical Trial Pack Contents

• Sildenafil 50 mg x 4 tablets
• Tadalafil 10 mg x 4 tablets
• Vardenafil 10 mg x 4 tablets

Dose Adjustments

If a starting dose is ineffective, the prescriber may increase to sildenafil 100 mg, tadalafil 20 mg, or vardenafil 20 mg. Do not adjust doses without medical advice.

Elderly and Renal/Hepatic Impairment

Lower starting doses may apply. Sildenafil 25 mg and vardenafil 5 mg are typical starting points in these groups.

Common (up to 1 in 10 patients, all three agents)

• Headache
• Facial flushing
• Nasal congestion
• Dyspepsia

Uncommon (up to 1 in 100 patients)

• Dizziness
• Visual disturbance (blurred vision, blue-tinged vision — more common with sildenafil)
• Back pain and myalgia (more common with tadalafil)
• Palpitations

Rare (up to 1 in 1,000 patients)

• Priapism (erection lasting more than four hours) — seek urgent medical help
• Sudden hearing loss
• Non-arteritic anterior ischaemic optic neuropathy (NAION) — sudden vision loss in one eye

Very Rare (fewer than 1 in 10,000 patients)

• Seizures
• Severe hypotension

Headache and flushing typically diminish with repeated use.

Nitrate Interaction

PDE5 inhibitors must never be combined with nitrates (glyceryl trinitrate, isosorbide mononitrate, amyl nitrite). The combination can cause a severe, life-threatening drop in blood pressure.

This includes recreational "poppers.

Cardiovascular Risk

Sexual activity itself places demands on the heart.

Men with unstable angina, recent myocardial infarction (within 90 days), severe heart failure, or uncontrolled hypertension should not use these medications until stabilised.

Alpha-Blockers

Concomitant use with alpha-blockers (e.g., tamsulosin, doxazosin) may cause postural hypotension. Start PDE5 therapy at the lowest dose if an alpha-blocker is already prescribed.

Priapism

An erection lasting longer than four hours requires emergency medical treatment to prevent permanent damage.

Do not use any PDE5 inhibitor if you:

• Take nitrate medications in any form
• Have had a recent stroke or myocardial infarction (within 6 months)
• Have severe hepatic impairment
• Have hypotension (systolic blood pressure below 90 mmHg)
• Have hereditary retinal disorders such as retinitis pigmentosa
• Have a known allergy to sildenafil, tadalafil, or vardenafil
• Use riociguat (a guanylate cyclase stimulator)