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This response is mediated by the release of nitric oxide NO from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic guanosine monophosphate more commonly known as cyclic GMP or cGMP in smooth muscle cells. Tadalafil and sildenafil and vardenafil inhibits PDE 5.

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  • However, because sexual stimulation is required to initiate the local penile release of nitric oxide, tadalafil's inhibition of PDE 5 will have no effect without direct sexual stimulation of the penis. Duration of action Although sildenafil, vardenafil, and tadalafil all work by inhibiting PDE 5, tadalafil's pharmacologic distinction is its longer half-life 17.

    Furthermore, the longer half-life is the basis for tadalafil's daily therapeutic use in treating pulmonary arterial hypertension.

    Comparison with actions of other PDE 5 inhibitors Tadalafil, sildenafil, and vardenafil all act by inhibiting the PDE 5 enzyme, but these drugs also inhibit PDE enzymes 6, and 11 in varying degrees.

    Sildenafil and vardenafil inhibit PDE 6, an enzyme found in the eye, more than tadalafil.

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