# Erectile dysfunction - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Cardiovascular 2024 · EAU Guidelines on Sexual and Reproductive Health 2023 · eMC SmPC, Vardenafil Mylan 10 mg film-coated tablets (Viatris), sections 4.1, 4.2 and 4.3 - Verified date: 2026-08 ## Verified against - EAU Guidelines on Sexual and Reproductive Health 2023 - eMC SmPC, Vardenafil Mylan 10 mg film-coated tablets (Viatris), sections 4.1, 4.2 and 4.3 - Erectile Dysfunction - disease-level clinical article (erectile-dysfunction-clinical.txt) - Egyptian National Drug Formulary - Endocrine System 2024 (testosterone monograph, hypogonadism in men) - Erectile dysfunction - disease-level clinical article (erectile-dysfunction-full.txt) ## Treatment metadata - Sildenafil — 50 mg — oral.solid - Tadalafil — 5 mg — oral.solid - Vardenafil — 10 mg — oral.solid - Referral & safety-netting (no drug therapy) - Testosterone — injection ## Complete treatment card ```text ERECTILE DYSFUNCTION Sources: Egyptian National Drug Formulary - Cardiovascular 2024 · EAU Guidelines on Sexual and Reproductive Health 2023 · eMC SmPC, Vardenafil Mylan 10 mg film-coated tablets (Viatris), sections 4.1, 4.2 and 4.3 Review status: REVIEWED against EAU Guidelines on Sexual and Reproductive Health 2023, eMC SmPC, Vardenafil Mylan 10 mg film-coated tablets (Viatris), sections 4.1, 4.2 and 4.3, Erectile Dysfunction - disease-level clinical article (erectile-dysfunction-clinical.txt), Egyptian National Drug Formulary - Endocrine System 2024 (testosterone monograph, hypogonadism in men), Erectile dysfunction - disease-level clinical article (erectile-dysfunction-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Patients rate their erectile rigidity on a 0 to 100% scale, where 50% is just enough for penetration - An abrupt, unexplained start to the erection trouble points toward a psychological cause - Erections that work fine with masturbation or another partner but not the usual partner suggest a situational, psychological cause - Preserved morning erections with day-to-day variability in rigidity suggest a psychological cause - Patients often report vascular risk factors like hypertension and diabetes, plus smoking, alcohol, or recreational drug use [hypertension] SIGNS - what you find (4) - Peripheral pulses are checked and blood pressure measured as part of the cardiovascular exam - Palpable penile plaques or fibrosis suggest Peyronie disease, and an unretractable foreskin indicates phimosis - Stroking the inner thigh should normally cause the same-side testicle to retract, confirming an intact reflex - Small or shrunken testes on exam raise suspicion for hypogonadism TESTS (5) - Baseline labs typically include CBC, a metabolic panel, lipid profile, TSH, HbA1c, and a morning testosterone level - An optional office test measures vibration-sensation thresholds on the penile shaft and glans to screen for neuropathy - Normal nocturnal erection tracings favor a psychogenic cause, while abnormal tracings point to an organic cause - On penile Doppler ultrasound, a peak systolic velocity below 25 cm/s suggests arterial insufficiency, while above 35 cm/s is normal - A resistive index below 0.75 on penile ultrasound indicates a venous leak IF NOT THIS - what else fits (3) - Hypogonadism, loss of libido, and depression are among the main differentials for erectile dysfunction - Erectile dysfunction can be the earliest sign of undiagnosed diabetes or cardiovascular disease - A detailed sexual history usually distinguishes true erectile dysfunction from premature ejaculation and other sexual disorders Source StatPearls "Erectile Dysfunction" - disease-level clinical article Status traced to the source above Rx: Main treatment | Proven hypogonadism - after PDE-5 failure, or with low libido MAIN TREATMENT - choose one 1. SILDENAFIL [1st line] Adult 50 mg orally approximately 1 hour before sexual activity (max 100 mg/dose, max once daily) - as required Peds Condition restricted to adult males Choice Alternatives, all PDE5 inhibitors. Sildenafil is the cheapest to start (from 7 EGP) and the most familiar. Source EAU Guidelines on Sexual and Reproductive Health 2023 Why Improves erectile response to sexual stimulation by enhancing the nitric oxide-cGMP signalling pathway in penile smooth muscle, blocking the enzyme that would otherwise break that signal down; requires sexual stimulation to work, and is strictly contraindicated with nitrates because they act on the same pathway, risking severe hypotension. Caution STRICTLY CONTRAINDICATED with nitrates or nitric oxide donors (severe fatal hypotension). Sexual stimulation is required for therapeutic effect. Seek immediate medical attention if erection lasts >4 hours (priapism risk). Egypt ECTAGOR 50 MG 4 F.C. TABS. UNIPHARMA CO.... 7.00 EGP (1.75/unit) V-GONE 50 MG 10 F.C. TAB. AMRIYA 24.00 EGP (2.40/unit) VIGORAN 50MG 4 F.C.TAB. AMOUN 10.00 EGP (2.50/unit) EZEQUEL 50 MG 4 F.C.TAB. COPAD PHARMA 18.00 EGP (4.50/unit) SILVIGO 50MG 5 F.C. TABS. MEMPHIS 24.00 EGP (4.80/unit) VIGORAMA 50 MG 4 F.C.TABS. MUP 19.20 EGP (4.80/unit) VIAGRA 50 MG 4 F.C.TABS. VIATRIS 112.00 EGP (28.00/unit) SILDEN 50 MG 4 ORODISPERSIBLE TABS. EIPICO 19.00 EGP SILDINOVA 10 MG PD. FOR SUSP. 120 ML INTERNATIONAL DRUG AGENCY (IDI) 78.75 EGP -> ? strength differs, ? different route - not oral solid ANSELAFIL 10MG/ML PWD. FOR ORAL SUSP. 120 ML EVA PHARMA 98.00 EGP -> ? strength differs, ? different route - not oral solid 2. TADALAFIL [1st line] Adult 5 mg once daily at approximately the same time each day (or 10-20 mg on demand 30 min before activity) - long-term / as required Peds Condition restricted to adult males Source EAU Guidelines on Sexual and Reproductive Health 2023 Why Works the same way as sildenafil but lasts longer, allowing more spontaneous sexual activity without needing to time dosing tightly around intercourse; also used to treat symptoms of coexisting benign prostatic hyperplasia. Caution STRICTLY CONTRAINDICATED with nitrates or nitric oxide donors. Once-daily 5 mg dosing allows spontaneous activity and treats co-existing BPH. Tadalafil has a long duration of action (up to 36 hours). Egypt CIALONG 5 MG 30 F.C.TABS. BORG 150.00 EGP (5.00/unit) DIAMONRECTA 5 MG 30 F.C.TABS. EVA PHARMA 187.50 EGP (6.25/unit) ERECTOBACK 5 MG 30 F.C.TABS. OCTOBER PHARMA 187.50 EGP (6.25/unit) COPADTADA 5 MG 30 TABS. COPAD EGYPT >... 195.00 EGP (6.50/unit) TADATRONA 5 MG 21 F.C. TABS. AVERROES PHARMA 136.50 EGP (6.50/unit) STARKOPREX 5 MG 30 TABS. MULTI-APEX 252.00 EGP (8.40/unit) TADAGOLD 5 MG 5 F.C.TABS. RAMEDA 46.25 EGP (9.25/unit) TADALANDRO 5 MG 30 F.C. TABS. MARCYRL PHARM... 300.00 EGP (10.00/unit) 3. VARDENAFIL [1st line] Adult 10 mg taken approximately 25-60 minutes before sexual activity. Adjust within the range 5-20 mg according to response and tolerability; maximum 20 mg and not more than once in 24 hours. Start at 5 mg in a man already stabilised on an alpha-blocker - As required, not more than once in any 24 hours Peds Not indicated below 18 years of age; there is no relevant paediatric use. Source eMC SmPC, Vardenafil Mylan 10 mg film-coated tablets (Viatris), sections 4.1, 4.2 and 4.3 Why 40 live products. The condition holds two PDE5 inhibitors and has two free slots; vardenafil's faster onset than tadalafil and shorter duration suit a different patient preference, and it is heavily marketed in Egypt. Caution ABSOLUTELY CONTRAINDICATED with nitrates or nitric oxide donors in any form - including the glyceryl trinitrate and isosorbide mononitrate in the Stable Angina condition, and nicorandil. Check the patient's full drug list before prescribing. Contraindicated in men for whom sexual activity is inadvisable - unstable angina, severe heart failure, recent stroke or myocardial infarction. Start at 5 mg in a man on an alpha-blocker, which includes the tamsulosin or doxazosin used for benign prostatic hyperplasia - the combination causes symptomatic hypotension. Contraindicated with potent CYP3A4 inhibitors: ketoconazole, itraconazole, ritonavir, indinavir. Reduce the dose with moderate inhibitors such as erythromycin. An erection lasting more than 4 hours needs emergency urological care. Sudden hearing loss or visual loss means stopping immediately and seeking assessment. Erectile dysfunction is often the first sign of cardiovascular disease - check blood pressure, glucose, lipids and smoking status rather than only writing the prescription. Egypt ROMANTIGRA 10MG 4 F.C. TABS GLOBAL NAPI P... 18.00 EGP (4.50/unit) FARORECTA 10 MG 12 F.C.TABS. PHAROPHARMA 60.00 EGP (5.00/unit) FARORECTA 10 MG 4 F.C.TABS. PHAROPHARMA 20.00 EGP (5.00/unit) VARDATRIN 10 MG 4 F.C. TABS. WADI ELNEEL B... 29.00 EGP (7.25/unit) POWERECTA 10MG 4 ORODISPERSIBLE TABS. EVA PHARMA 30.00 EGP ERECANOVA 10 MG 4 DISINTEG. TABS. ATCO PHARMA > ATM PHARMACEUTICAL INDUS... 40.00 EGP WESTRECTA 10 MG 4 ORO-DISPERSIBLE TABS. WESTERN PHARMACEUTICALS INDUSTRI... 47.00 EGP POWERECTA 10MG 6 ORODISPERSIBLE TABS. EVA PHARMA 69.00 EGP 4. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Erectile Dysfunction - disease-level clinical article (erectile-dysfunction- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Cardiovascular risk screening is needed for all ED patients, with formal cardiology referral for those found to be high-risk (ED is often an early marker of silent cardiovascular disease). PROVEN HYPOGONADISM - AFTER PDE-5 FAILURE, OR WITH LOW LIBIDO - give alongside 5. TESTOSTERONE [add-on - not a substitute] Adult Testosterone enanthate IM: initial 250 mg every 2 to 3 weeks, then adjusted within the usual range every 3 to 12 months on symptoms and testosterone levels Peds The ENDF states adult dosing for this indication; no paediatric figure is given with it. Source Egyptian National Drug Formulary - Endocrine System 2024 (testosterone monograph, hypogonadism in men) Why The disease article calls testosterone reasonable in proven hypogonadism when PDE-5 inhibitors have failed or libido is also low; the card carried the three PDE-5 inhibitors and nothing else. The ENDF doses testosterone for exactly that indication, by intramuscular injection. Caution The ENDF restricts this to hypogonadism due to androgen deficiency in men, and states it is not for men with hypogonadal conditions that are not associated with structural or genetic etiologies (e.g. age-related hypogonadism) - so confirm the diagnosis first. Androgen-dependent carcinoma Marked cardiac, hepatic, or renal disease; liver tumors; thrombophilia Pregnancy; breastfeeding; not indicated for use in women Egypt TESTONON 250MG/ML I.M 1 OILY AMP. EL NILE. 20.00 EGP GONATESTON 250MG/ML I.M AMP. MARCYRL PHARM... 26.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)