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Consider whether patients with underlying cardiovascular disease (e.g., severe left ventricular outflow obstruction, autonomic dysfunction, resting hypotension [BP Although not clear whether such effects are directly related to PDE type 5 inhibitors or to other factors (e.g., patient’s underlying medical condition, concomitant use of other ototoxic drugs), a strong temporal relationship has been observed. Thel-arginine-nitric oxide-cyclic GMP pathway mediates inhibitory nonadrenergic-noncholinergic neurotransmission in the corpus cavernosum of human and rabbit. (See Specific Drugs under Interactions.) Thorough medical history and physical examination recommended to diagnose ED, determine potential underlying causes, exclude potentially reversible or treatable causes, and identify appropriate treatment. 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