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When a man can’t get an erection to have sex or can’t keep an erection long enough to finish having sex, it’s called erectile dysfunction. Erectile dysfunction is the preferred term rather than the more commonly used term of impotence. Sexual dysfunction is often associated with disorders such as diabetes, hypertension, coronary artery disease, neurologic disorders, and depression. In some patients, sexual dysfunction may be the presenting symptom of such disorders. Additionally, ED is often an adverse effect of many medications.

Although there are a number of options available for non-surgical treatment of sexual dysfunction, it is clear that oral therapy has revolutionized the treatment approach to men with erectile dysfunction.

The FDA approved Viagra in 1998, and it became the first oral therapy for erectile dysfunction on the market. Vardenafil hydrochloride (Levitra) was approved in September, 2003, and Tadalafil (Cialis) was approved in November, 2003. Viagra, Levitra and Cialis work in much the same way. These PDE-5 inhibitors share many similarities, but they have differences as well.

Although sildenafil citrate (Viagra), vardenafil HCl (Levitra) and tadalafil (Cialis) sometimes are called sexual enhancers, they do not directly cause an erection of the penis, but alter the body’s response to sexual stimulation by enhancing the effect of the nitric oxide, a chemical that is normally released during stimulation. Nitric oxide causes relaxation of the muscles in the penis, which allows for better blood flow to the penile area.

PDE-5 inhibitors can be used to treat sexual dysfunction caused by high blood pressure, problems affecting nerve function, prostate surgery, side effects of medicines, emotional or psychological ED. Although they work in the similar way, they are not the same in all respects. Sildenafil and vardenafil have similar molecular structures, but tadalafil is structurally different.

  • The success rate of sildenafil amounts to an average of over 80%.
  • Several studies have shown a benefit of Viagra (sildenafil) for women with sexual arousal disorder, including an increased ability to lubricate, achieve orgasm, and experience sexual satisfaction.
  • Onset of action: 30-60 minutes.
  • Duration of action: up to 4 h.
  • Fatty food is known to delay the absorption of Viagra.
  • Contraindicated in persons taking organic nitrates; alpha-blockers (in the current labeling the interaction is considered a Precaution.)
  • Vision disturbances are more common after taking Viagra, than after other PDE-5 inhibitors. In July 2005, the FDA found that sildenafil could lead to vision impairment in rare cases and a number of studies have linked sildenafil use with nonarteritic anterior ischemic optic neuropathy.
  • The patent on Viagra expires in the early 2012.
  • Vardenafil is more potent and selective biochemically than other PDE-5 inhibitors.
  • Onset of action: 25 minutes (the quickest).
  • Duration of action is up to 5-6 hours, little longer than that reported for Viagra.
  • Not recommended in patients taking type 1A (such as quinidine, or procainamide) or type 3 antiarrhythmics (such as sotalol, or amiodarone).
  • The advantage that vardenafil has over sildenafil is that it does not alter color perception, a rare side effect which occurs with sildenafil (because vardenafil does not inhibit phosphodiesterase-6).
  • Vardenafil is contraindicated in patients taking organic nitrates, alpha-blockers (in the current labeling the interaction is considered a Precaution).
  • Fatty food delays the absorption of vardenafil. However, it is less sensitive than Viagra to food intake.
  • The patent on Levitra expires in 2018.
  • The most astounding feature of tadalafil is its length of action. It has long half life, which ensures 36-hour duration of effectiveness, allowing for more flexibility and spontaneity in sexual relations. This feature greatly distinguishes Cialis from its two predecessors Viagra and Levitra.
  • Onset of action: 16 to 30 minutes.
  • Tadalafil has the lowest prevalence of visual side effects. However, the myalgia seems to be more common with tadalafil, approaching 10%.
  • Tadalafil is contraindicated in patients taking organic nitrates, alpha-blockers.
  • Cialis is protected by a patent until 2016.

From a safety perspective, all three Viagra, Levitra and Cialis share similar drug interactions involving CY3A4 inhibitors and a contraindication in the use of nitrates. The side effects are similar for all three PDE-5 inhibitors and include headache, flushing, nasal congestion, and dyspepsia.

Which is better Viagra, Cialis or Levitra?

Cialis clearly works for 36 hours or more, making it an ideal choice for men who are very sexually active.

For men who develop angina and therefore might require an organic nitrate (such as nitroglycerine), the longer duration of action is a disadvantage. Also, some people are uncomfortable having the active ingredient in their system for an extended period of time.

Levitra works a little longer than Viagra, and gives a quite sufficient window of effectiveness for spontaneous sexual experience. Vardenafil is the most potent molecule of all PDE-5 inhibitors and works better in hard-to-treat cases of impotence [2].

Viagra clearly works for women with sexual arousal disorder [1].

Implicit advantage of Viagra: Many men have been ordering high-dose pills and splitting them, because Pfizer’s Viagra blue pills are pretty large (14mm) and easy to split.

Levitra, a small hard orange 8mm pill, is much more difficult to cut. Cialis 12mm pills are also inconvenient to split because of their asymmetrical almond shape.

Keep in mind that you don’t have to make a definitive choice and stay on one ED medication all the time. You can choose all three and alternate between them depending on your requirements. For example, Viagra or Levitra on weekdays and Cialis on weekend or holiday.

  • 1. Schoen C, Bachmann G. Sildenafil citrate for female sexual arousal disorder: a future possibility? Nat Rev Urol. 2009 Apr;6(4):216-22.
  • 2. Wang HY, Huang YF. Vardenafil for refractory erectile dysfunction: the latest advances. Zhonghua Nan Ke Xue. 2009 Nov;15(11):1035-8.

Last Updated: December 14, 2013

MALE IMPOTENCE

E.D. COMPARISON

MEDICATIONS

TIME SCALE

SIDE EFFECTS

Serious side effects may include:

  • sudden vision loss;
  • ringing in your ears, or sudden hearing loss;
  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
  • irregular heartbeat;
  • swelling in your hands, ankles, or feet;
  • shortness of breath;
  • vision changes;
  • feeling light-headed, fainting;
  • penis erection that is painful or lasts 4 hours or longer; or
  • seizure (convulsions).

Less serious side effects may include:

  • warmth or redness in your face, neck, or chest;
  • runny or stuffy nose;
  • headache, dizziness;
  • upset stomach; or
  • back pain.

IMPORTANT

Time Between Next ED Medication: You will have to wait a minimum of 24 hours before you can take another dose or different erectile dysfunction medication. Food and Drink to Avoid: Grapefruit and grapefruit juice may interact with these ED Medications and lead to unwanted side effects. Avoid the use of grapefruit products while taking these medicines. Drinking alcohol can increase certain side effects of these medications.

FOOD AND DRINK

Viagra can be taken with or without food. If you take VIAGRA AFTER A HIGH FAT MEAL (such as a cheeseburger and french fries), it may take a little longer to start working. Do not drink alcohol before taking Viagra. Alcohol will negate the effectiveness of your dose.

You can take CIALIS with or without food. Do not drink too much alcohol when taking CIALIS (ex. 5 glasses of wine or 5 shots of whiskey). Drinking too much alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.

Levitra and Staxyn can be taken with or without food. Do not drink large amounts of alcohol when taking Levitra or Staxyn. Drinking too much alcohol can reduce your ability to get an erection and this may prevent you from getting the maximum benefit from these tablets.

You can take Stendra with or without food. Do not drink too much alcohol when taking STENDRA (ex. more than 3 glasses of wine, or 3 shots of whiskey). Drinking too much alcohol when taking STENDRA can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.

MEDICAL INFORMATION

Medications to Avoid while taking ED medications:

  • cimetidine;
  • bosentan;
  • imatinib;
  • nefazodone;
  • St. John’s wort;
  • an antibiotic—clarithromycin, erythromycin, telithromycin;
  • antifungal medication—fluconazole, itraconazole, ketoconazole, miconazole, posaconazole, voriconazole;
  • heart or blood pressure medication—amlodipine, amiodarone, nicardipine, quinidine;
  • hepatitis C medications—boceprevir, telaprevir;
  • HIV/AIDS medication—atazanavir, delavirdine, efavirenz, fosamprenavir, indinavir, nelfinavir, nevirapine, ritonavir, saquinavir;
  • seizure medication—carbamazepine, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone; or
  • tuberculosis medication—isoniazid, rifabutin, rifampin, rifapentine.

Health Conditions:

  • heart disease or heart rhythm problems,
    coronary artery disease;
  • a recent heart attack (within the past 90 days);
  • a recent history (in the past 6 months) of a stroke,
    or congestive heart failure;
  • angina (chest pain), high or low blood pressure;
  • liver or kidney disease (or if you are on dialysis);
  • a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
  • a bleeding disorder such as hemophilia;
  • a stomach ulcer;
  • retinitis pigmentosa (an inherited condition of the eye);
  • a physical deformity of the penis (such as Peyronie’s disease); or
  • if you have been told you should not have sexual intercourse for health reasons.

MOST POPULAR E.D. CHOICE

OTHER INFORMATION

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Viagra Coupon & Discounts

Viagra, or sildenafil in its generic form, is a PDE5 inhibitor drug primarily used to treat erectile dysfunction whether it’s a result of a health condition or a side effect from taking other medications. Viagra works by relaxing smooth muscle tissue and allowing for vasodilation, or the widening of the blood vessels. Widening blood vessels allow blood to flow freely into the penis. Because sildenafil relaxes smooth muscle tissue and allows for vasodilation, it is also used to treat PAH, or pulmonary arterial hypertension. Viagra will not boost libido and create an erection on its own. The penis must be sexually stimulated before an erection will form.

How do I take Viagra?

After obtaining a prescription from your doctor, you may purchase Viagra at your local pharmacy. Try our Viagra coupons to get a substantial discount on the sale price. Viagra comes in the form of a blue tablet to be taken orally. Take this medication ideally one hour before engaging in sexual activity, but it usually lasts for up to four hours. Viagra should not be taken more than once per day. Your doctor may adjust your dosage over time.

Before taking Viagra, tell your doctor if:

  • You are taking or have recently taken nitrates or medications for chest pain such as isosorbide dinitrate and nitroglycerin (Nitro-BID, Nitro-Dur, Nitroquick, Nitrostat, others).
  • You are taking prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take especially alpha blockers, antifungals, blood thinners, barbiturates, beta blockers, HIV protease inhibitors, other medications used for erectile dysfunction, high blood pressure medication, and medications for seizures.
  • You are taking herbal supplements, especially St. John's wort.
  • You smoke.
  • You have ever had an erection that lasted for several hours.
  • You have recently lost a large amount of body fluids and might be dehydrated.
  • You have or have ever had pulmonary veno-occlusive disease, a stomach ulcer, heart, kidney, or liver disease, a heart attack, irregular heartbeat, stroke, chest pain, high or low blood pressure, high cholesterol, a bleeding disorder, blood circulation problems, blood cell problems, multiple myeloma, leukemia, diabetes, retinitis pigmentosa, or if you have ever had sudden severe vision loss.
  • You have conditions affecting the shape of the penis (e.g. angulation, cavernosal fibrosis).
  • You have ever been advised by a health care professional to avoid sexual activity for medical reasons or if you have ever experienced chest pain during sexual activity

Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking Viagra. It may interact with the drug.

It is especially dangerous to take street drugs containing nitrates such as amyl nitrate and butyl nitrate (poppers) while taking Viagra.

What are the possible side effects of taking Viagra?

Side effects from taking Viagra include: flushing, headache, runny nose, indigestion and muscle aches. These are common side effects experienced due to the widening of blood vessels. These should go away after 48 hours. If side effects persist, call your doctor.

Rare side effects include: Changes in vision or hearing, chest pain, painful erection, erection that lasts longer than four hours, hearing loss, dizziness, fainting, stroke and heart attack. If you experience a serious side effect, or pain, dizziness or nausea during sexual activity, contact your doctor immediately.

What if I forget to take a dose of Viagra?

If taking Viagra or sildenafil for erectile dysfunction, take the dose as soon as you remember. Never take a double dose and do not exceed one dose in 24 hours. If taking sildenafil to treat pulmonary hypertension, take the missed dose as soon as your remember it. Skip a dose if it’s almost time for your next dose and continue on your regular schedule.

How do I store Viagra?

Store Viagra in a cool, dry place between the temperatures of 59 and 86 degrees Fahrenheit. Keep the medication in a tightly closed container out of reach of children. Throw away any expired Viagra. Ask your pharmacist about the proper disposal of your medication.

What happens if I overdose on Viagra?

Overdose on Viagra is not likely to occur unless someone is purposely trying to overdose. Symptoms of Viagra overdose would involve a worsening of side effects including blurred vision, fast or irregular heartbeat, headache, fainting and painful erection. If you or someone you know has overdosed on Viagra, contact the Poison Control Center at 1-800-222-1222 or call 911.

Alcohol may increase the side effects of Viagra. Do not exceed one dose in 24 hours if taking Viagra to treat erectile dysfunction.

A cheap version of Viagra is sildenafil. Other brand names include Revatio which is used to treat pulmonary hypertension. Check our site for Viagra coupons and coupons for related products. Get Viagra with a discount up to 75% off the sale price in your local pharmacy.

Related Pages and Posts

Erectile dysfunction (ED) is so prevalent that it is one of the most searched medical conditions on the Internet.

Erectile dysfunction (ED) is a common malady that affects a number of adult men in the United States.

The market for medications that treat erectile dysfunction is highly competitive, with both Viagra and Cialis touting its superiori.

It’s not uncommon for men to sometimes have difficulty maintaining an erection. However, when it becomes a more regular.

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