Recent peer-reviewed studies evaluating phosphodiesterase type 5 inhibitors (PDE5i) suggest variability in clinical potency and duration of action among approved agents for erectile dysfunction treatment. Could we discuss the available evidence comparing the maximal dosages, pharmacokinetic profiles, and observed therapeutic outcomes of agents such as sildenafil, tadalafil, vardenafil, and avanafil? In particular, I am interested in understanding which medication may be considered the most potent under controlled conditions, taking into account both efficacy measures and safety profiles in patient populations with varying comorbid conditions. Additionally, what are the implications of these findings for clinical practice, and are there circumstances under which combination therapy or adjunctive treatments have been shown to enhance erectile response beyond the use of a single agent?
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