Vardenafil in the multidisciplinary management of erectile dysfunction: a narrative review on multidimensional outcomes and clinical integration

Erectile dysfunction (ED) is a multifactorial condition that often indicates underlying systemic disorders. Among phosphodiesterase type 5 inhibitors (PDE5is), vardenafil has pharmacological properties that may provide advantages in certain clinical situations. This narrative review aims to synthesize current evidence on the pharmacological mechanisms, clinical efficacy, and future research directions of vardenafil in the multidisciplinary treatment of ED. A comprehensive literature search was conducted in PubMed, Web of Science, and Embase for studies published between January 2019 and March 2025, focusing on vardenafil’s pharmacology, clinical efficacy, and its integration with other therapeutic modalities (endocrine, psychological, lifestyle, cardiovascular). Relevant randomized controlled trials, cohort studies, and key mechanistic studies were reviewed. Due to the heterogeneity of the available evidence, a narrative synthesis was performed to summarize findings across different intervention domains. Evidence indicates that vardenafil demonstrates favorable short‑term efficacy across various etiologies of ED. Quantitative data from included studies (summarized in Table 1) support its efficacy as monotherapy and suggest synergistic benefits when combined with testosterone replacement therapy, psychological interventions, lifestyle modifications, and cardiovascular risk management. However, heterogeneity in sample sizes, follow‑up durations, and outcome measures limits the robustness of the current evidence. Vardenafil represents a valuable treatment option within multidisciplinary management strategies for ED, particularly when its pharmacokinetic profile aligns with patient needs and preferences. High‑quality, long‑term randomized trials are necessary to determine optimal combination protocols, treatment duration, and long‑term safety, with particular emphasis on precision dosing and biomarker‑guided interventions.