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[6] First-line pharmacological treatments include phosphodiesterase type 5 (PDE5) inhibitors, which are licensed, well-studied medications: Sildenafil (Viagra): Typically effective within 30-60 minutes, lasting 4-6 hours [7] Tadalafil (Cialis): Longer duration of action (up to 36 hours), also available as daily low-dose formulation [8] Vardenafil (Levitra): Similar efficacy to sildenafil with slightly different pharmacokinetics Avanafil (Spedra): Take approximately 30 minutes before sexual activity
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Tzang 2025 (18 RCTs): overweight/obesity regains +5.63 kg while type 2 diabetes regains +2.03 kg but rebounds harder on blood-sugar control (HbA1c +0.65 vs +0.25%)
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