Table 2. Dosing of Oral Pharmacologic Agents (Phosphodiesterase 5 Inhibitors) for the Treatment of Erectile Dysfunction11 |
Medication (Brand) and strengths |
Usual dose |
Dose adjustment |
Avanafil
(Stendra)
50, 100, and 200 mg tablets |
100 mg orally once daily (range 50 mg to 200 mg) approximately 15 minutes before sexual activity |
Concomitant use with potent CYP3A4 inhibitorsa: Do not use
Concomitant use with moderate CYP3A4 inhibitorsb: Do not exceed 50 mg once daily, approximately 30 minutes before sexual activity
Concomitant use with an α-receptor antagonist; patients should be stable on the α-receptor antagonist first, then start treatment at 50 mg once daily approximately 30 minutes before sexual activity
Severe hepatic impairment: No data available; avoid use
CrCl <30 mL/min: No data available; avoid use |
Sildenafil
(Viagra)
25, 50, and 100 mg tablets |
50 mg orally up to once daily (range 25 mg to 100 mg) 1 h prior to sexual activity (range 0.5 to 4 h) |
Geriatric males: 25 mg orally 1 h prior to sexual activity up to once daily
CrCl <30 mL/min: 25 mg orally up to once daily
Hepatic impairment (mild to moderate): 25 mg orally up to once daily
Concomitant use with potent CYP3A4 inhibitorsa: 25 mg orally up to once daily (maximum dosing frequency of every 48 h if used with ritonavir) |
Tadalafil
(Cialis)
2.5, 5, 10, and 25 mg tablets |
As needed use: 10 mg orally once daily (range 5 mg to 20 mg) 0.5 h up to 36 h prior to sexual activity
Once daily use:
2.5 mg orally once daily; may increase to 5 mg once daily |
CrCl 30 to 50 mL/min - as needed use: starting dose of 5 mg orally; maximum dose of 10 mg not more than once every 48 h; once daily use: no dosing adjustment necessary
CrCl <30 mL/min – as needed use: maximum dose of 5 mg not more than once every 72 h; once daily use: not recommended
Hepatic impairment (mild to moderate) – as needed use: not to exceed 10 mg daily; once daily use: not extensively studied in this patient population; use caution
Concomitant use with potent CYP3A4 inhibitorsa – as needed use: maximum dose of 10 mg, not to exceed every 72 h; once daily use: 2.5 mg orally daily |
Vardenafil
(Levitra and Staxyn)
Levitra: 2.5, 5, 10, and 25 mg tablets
Staxyn: 10 mg orally disintegrating tablets |
Oral tablet: 10 mg orally once daily (range 5 mg to 20 mg) 1 h prior to sexual activity
Orally disintegrating tablet: 10 mg orally once daily 1 h prior to sexual activity; maximum dose of 10 mg daily; if lower dose required, use regular tablet |
Geriatric males: initial dose of 5 mg orally once daily
Hepatic impairment (moderate): initial dose of 5 mg orally once daily, not to exceed 10 mg daily; do not use orally disintegrating tablet in patients with moderate or severe hepatic impairment given higher systemic exposure than regular tablet
Concomitant use with an α-receptor antagonist: patients should be stable on the α-receptor antagonist first, then vardenafil may be added; reduce initial dose to 5 mg (or 2.5 mg if certain CYP3A4 inhibitors also given)
Concomitant use with potent CYP3A4 inhibitorsa: 2.5 or 5 mg up to once daily depending on the agent (maximum dosing frequency of every 72 h if used with ritonavir) |
CrCl=creatinine clearance; CYP3A4=cytochrome P450 3A4.
aPotent CYP3A4 inhibitors include drugs such as erythromycin, ritonavir, ketoconazole, itraconazole, saquinavir
bModerate CYP3A4 inhibitors include drugs such as erythromycin, amprenavir, aprepitant, diltiazem, fluconazole, fosamprenavir, verapamil |
Table 6. Antimuscarinic and Beta-3 Adrenergic Agonist Agents Used for the Treatment of Urinary Incontinence11 |
Medication (Brand) and strengths |
Usual dose |
Dose adjustment |
Oral antimuscarinics |
Darifenacin (Enablex)
7.5 and 15 mg extended-release tablets |
7.5 mg extended-release tablet once daily initially; may increase to 15 mg once daily after 2 weeks if needed |
Concomitant use with potent CYP3A4 inhibitorsa: do not exceed 7.5 mg daily
Not recommended for use in patients with severe hepatic impairment; for patients with moderate hepatic impairment, do not exceed 7.5 mg daily |
Fesoterodine (Toviaz)
4 and 8 mg extended-release tablets |
4 mg extended-release tablet once daily initially; may increase to 8 mg once daily if needed |
Concomitant use with potent CYP3A4 inhibitorsa: do not exceed 4 mg daily
Not recommended for use in patients with severe hepatic impairment
For patients with severe renal impairment, do not exceed 4 mg daily |
Oxybutynin (Ditropan XL; immediate-release is available only as generic)
Immediate-release: 5 mg tablets; 5 mg/5 mL solution and syrup
Ditropan XL: 5, 10, and 15 mg extended-release tablets |
Immediate-release: 5 mg 2 to 3 times daily; maximum of 5 mg 4 times daily (20 mg daily)
Extended-release: 5 to 10 mg once daily; dose may be increased by 5 mg weekly; maximum dose of 30 mg daily |
Immediate-release; geriatric patients: 2.5 mg 2 to 3 times daily initially, 5 mg 3 times daily may be tolerated
Lower dosages of immediate-release may be needed in hepatic impairment; extended-release formulations not recommended for use in hepatic impairment
Extended-release formulations not recommended in severe renal impairment
|
Solifenacin (Vesicare)
5 and 10 mg tablets |
5 mg once daily; may increase to maximum of 10 mg once daily |
Concomitant use with CYP3A4 inhibitors: do not exceed 5 mg daily
CrCl ≤30 mL/min: do not exceed 5 mg daily
Not recommended for use in patients with severe hepatic impairment; do not exceed 5 mg daily in patients with moderate hepatic impairment |
Tolterodine (Detrol and Detrol LA)
1 and 2 mg immediate-release tablets
2 and 4 mg extended-release capsules |
Immediate-release: 2 mg twice daily; may reduce to 1 mg twice daily based on response and tolerability
Extended-release: 4 mg once daily; may reduce to 2 mg once daily based on response and tolerability |
CrCl ≤30 mL/min or hepatic impairment: reduce dose to 1 mg twice daily for immediate-release; 2 mg once daily for extended-release
Concomitant use with CYP3A4 inhibitors: reduce dose to 1 mg twice daily for immediate-release; 2 mg once daily for extended-release |
Trospium (both immediate- and extended-release products available as generics only)
20 mg immediate-release tablets
60 mg extended-release capsules |
Immediate-release: 20 mg twice daily; may reduce to 20 mg once daily at bedtime based on tolerability; maximum 60 mg daily
Extended-release: 60 mg once daily in the morning |
CrCl <30 mL/min: reduce dose to 20 mg once daily at bedtime for immediate-release; extended-release dosage form not recommended
Use with caution in patients with hepatic impairment |
Non-oral antimuscarinics |
Topical oxybutynin (Gelnique)
3% and 10% topical gel |
Gelnique 10% topical gel: Apply 1 packet of 10% gel once daily (100 mg)
Generic oxybutynin 3% topical gel: Apply 3 pumps once daily (84 mg)
May be applied to abdomen, upper arms/shoulders, or thighs, rotate site so same site not utilized on consecutive days |
No dosing adjustment recommendations |
Transdermal oxybutynin (Oxytrol)b
3.9 mg/24 h transdermal patch |
Apply 1 patch to abdomen, hip, or buttock twice weekly (3.9 mg daily)
Every 3 to 4 days, rotate site to avoid irritation |
Beta-3 adrenergic agonist |
Mirabegron (Myrbetriq)
25 and 50 mg extended-release tablets |
25 mg once daily; dose may be increased up to 50 mg once daily; maximum dose 50 mg once daily |
Moderate hepatic impairment: do not exceed 25 mg once daily; not recommended in severe hepatic impairment
CrCl = 15 to 29 mL/min: do not exceed 25 mg once daily
CrCl < 15 mL/min: not recommended |
CrCl=creatinine clearance; CYP3A4=cytochrome P450 3A4.
aPotent CYP3A4 inhibitors include drugs such as erythromycin, ritonavir, ketoconazole, itraconazole, saquinavir
bAvailable over-the-counter and approved for women ≥18 years; available to men by prescription only |