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The four PDE5i currently approved in both Europe and the United States, and used with variable dosages and formulations, display different pharmacokinetic profiles enabling tailored treatment of ED based on patients requirements; nevertheless, despite all PDE5i provided well-established efficacy results in placebo-controlled RCTs, direct comparison studies among the various PDE5i are scarce, and a clear consensus concerning the most efficient PDE5i is lacking, also due to heterogeneity of methods used to address penile erectile function . In placebo group, 4.26% of patients experienced adverse events, including pyrosis, intense thirst and cholestasis, none of which was manifested as clinically relevant.