Viagra vs. levitra vs. cialis vs. Sildenafil

The differences and similarities of the most popular erectile dysfunction medications.

Mild to moderate erectile dysfunction affects around 50% of men aged 40+ years, making it one of the most common disorders in older men worldwide. An erection is a carefully orchestrated physical response to sexual stimulation. Sensory nerve signals in the brain compel the smooth muscles in the penis to relax which increases blood flow to the male sex organ. As a result, the penis expands and becomes erect. Erections start and stop with the help of nitric oxide and phosphodiesterase-5 (PDE-5). While nitric oxide promotes relaxation of the penis muscles, PDE-5 blocks an erection after intercourse.

In men with erectile dysfunction, these processes are disrupted. Luckily, effective medications are available. PDE-5 inhibitors are effective in up to 63% of men. There are three main types of PDE-5 inhibitors – sildenafil (Viagra, Revatio), tadalafil (cialis) and vardenafil (levitra). All of these drugs act by inhibiting PDE-5, the enzyme responsible for shutting down an erection. When PDE-5 is blocked, the smooth muscles of the penis relax, allowing for a firmer and longer-lasting erection.

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The difference between sildenafil and Viagra

Technically, sildenafil is the active ingredient in Viagra. In other words, there is no difference. But sildenafil is also a compound of a drug called Revatio which treats pulmonary hypertension (high pressure in the lungs).

Revatio can technically be prescribed for the treatment of erectile dysfunction, but it exists only as a 20 mg dose. Doctors may prescribe Revatio instead of Viagra, but it is at their discretion to do so. Patients can take multiple doses of Revatio at once to reach a higher dose of sildenafil. Having smaller doses to work with can provide more flexibility in treating mild to moderate or occasional erectile dysfunction.

Viagra is available in three doses: 25 mg, 50 mg, and 100 mg and is a branded prescription drug. However, Pfizer’s patent of the drug expired in 2019, which means that cheaper, generic versions are available.

What’s the difference between cialis, levitra and Viagra?

Erectile dysfunction prescription medications usually differ in the time it takes for them to work, the duration of action, and their side effects and contraindications.

Although all three medications share a similar mode of action, that is, they inhibit PDE-5, they vary when it comes to effectiveness.

Viagra and cialis are effective within one hour after ingestion, while levitra takes a little longer (2-4 hours). But the action of levitra lasts considerably longer at up to 36 hours compared to 3-6 hours for Viagra and cialis.

Viagra and cialis are best taken on an empty stomach because food may delay absorption. levitra can be taken alongside food and is a better option for men who may not know when intercourse will occur. levitra has also been approved as a daily medication to treat both ED and symptoms of an enlarged prostate.

levitra is available in doses ranging from 2.5 to 20 mg. The starting daily dose of levitra is 2.5 to 5 mg. Daily dosing eliminates the timiing and planning needed with cialis or Viagra, allowing for more spontaneity.

Side effects can vary from pill to pill. Headaches, runny nose, upset stomach, flushing, and back pain are common for all three erectile dysfunction medications. Nausea, dizziness and visual disturbances are more common when taking Viagra. Indigestion is a more common side effect with cialis and levitra.

It’s important to discuss side effects with a doctor before committing to a prescription drug. Patients may also wish to try a few different medications or vary their doses depending on their symptoms. Finding the best erectile dysfunction drug for you can be a case of trial and error.

Drug interactions

All three prescription drugs can interact with certain blood pressure medications and nitrates. Beta and alpha-blockers, and some anti-fungal and anti-bacterial drugs are also known to interact with erectile dysfunction medications. Read the package insert and discuss your medical conditions with a doctor.

Which erectile dysfunction medication is the best?

The answer to that question will vary from patient to patient and is highly dependent on the severity of erectile dysfunction, the desired effect, and whether a patient suffers from other medical conditions.

One research study found that patients taking sildenafil (Viagra) or vardenafil (levitra) were similarly satisfied with their resulting erections. But a meta-analysis of 16 separate drug trials noted that although both drugs improved erectile dysfunction symptoms in men, sexual confidence was higher in those taking levitra. Both men and women preferred levitra over sildenafil for the treatment of erectile dysfunction.

A comparison of the biochemical and physiological effects of Viagra and cialis found cialis to be preferable for efficacy and a better choice for men when Viagra does not produce the desired effect.

Ultimately, the choice between Viagra, cialis and levitra should be dependent on a patient's medical history and the potential side effects.

What about avanafil?

Avanafil is a newer PDE-5 inhibitor. It was approved by the US Food and Drug Administration in 2012 and is available in a dose of 50 mg, 100 mg or 200 mg.

Avanafil has been shown to act more rapidly compared to sildenafil and tadalafil. Marketed under the name Stendra by Mitsubishi Tanabe, avanafil acts within 30 minutes after ingestion and lasts up to six hours. It is less affected by food intake. Some studies have shown successful intercourse after only 15 minutes of taking the drug, making it an excellent option for men seeking a quick-acting PDE-5 inhibitor. Stendra is not currently available in generic form, and is therefore quite expensive compared to Viagra, cialis and levitra in their generic forms.

References

Yafi, F. A., Jenkins, L., Albersen, M., Corona, G., Isidori, A. M., Goldfarb, S., … Hellstrom, W. J. (2016). Erectile dysfunction. Nature reviews. Disease primers, 2, 16003. https://doi.org/10.1038/nrdp.2016.3
"PAH Treatment | REVATIO® (sildenafil) | Safety Info". in , , 2019, [accessed 5 October 2019].
"levitra Uses, Dosage & Side Effects - Drugs.com". in , , 2019, [accessed 5 October 2019].
"VIAGRA® (sildenafil citrate) Drug Interactions | Pfizer Medical Information - US". in , , 2019, [accessed 5 October 2019].
Gong, B., Ma, M., Xie, W., Yang, X., Huang, Y., Sun, T., … Huang, J. (2017). Direct comparison of vardenafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International urology and nephrology, 49(10), 1731–1740. https://doi.org/10.1007/s11255-017-1644-5
Burke, R. M., & Evans, J. D. (2012). Avanafil for treatment of erectile dysfunction: review of its potential. Vascular health and risk management, 8, 517–523. https://doi.org/10.2147/VHRM.S26712
Traish, A, & N Kim, "Is tadalafil “Noninferior” or Superior to Sildenafil in the Management of Erectile Dysfunction? Revisiting the Biochemical, Physiological, and Clinical Evidence.". in The Journal of Sexual Medicine, 5, 2008, 1762-1769.
Kedia, G. T., Uckert, S., Assadi-Pour, F., Kuczyk, M. A., & Albrecht, K. (2013). Avanafil for the treatment of erectile dysfunction: initial data and clinical key properties. Therapeutic advances in urology, 5(1), 35–41. https://doi.org/10.1177/1756287212466282

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Viagra vs. levitra vs. cialis vs. Sildenafil

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References

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22.08.2023 14:20:00

2023-08-22 14:20:00