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Comparative Efficacy and Safety of Sildenafil, Tadalafil, Vardenafil, Mirodenafil, Coenzyme Q, and Testosterone in the Treatment of Male Sexual Dysfunction: A Systematic Review and Meta-Analysis

Gaurav Uppal, Ashok Kudgi Shenoy, Sermin KİBAR ŞAYAN, Betsy Marina Babu, Asha Devi Dhandapani

BJPsych Open, 2025

Abstract

Aims: This study through systematic review approaches and meta-analysis aimed to determine safe drug options for treating male sexual dysfunction due to erectile dysfunction by comparing sildenafil, tadalafil, vardenafil, mirodenafil, coenzyme Q and testosterone. Methods: Systematic review methodology was used to retrieve data from complete database searches done in PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Randomized controlled trials research designs with adult male participants who presented with erectile dysfunction on sildenafil, tadalafil, vardenafil, mirodenafil, coenzyme Q and testosterone were included as part of the review. The Cochrane Risk of Bias version 2.0 was utilized by two independent reviewers for assessing bias risk and extracting data. Sensitivity analysis was used to reduce the risk of bias. Results: Phosphodiesterase inhibitors type 5 (PDE 5) are the most effective medications for erectile dysfunction (ED). Participants on sildenafil had effective erections between 77–84% at doses of 50–100 mg and tadalafil emerged as the “Weekend pill” because of its 36-hour maximum effect duration of action. The concentration-focused activity along with higher potency values of vardenafil make it superior to other PDE5 inhibitors. The newly developed therapeutic medication mirodenafil exhibits better PDE5 selectivity than existing drugs within its operational mechanism. Minor variations were noted as a cohort of participants…

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