The best treatment for ED is the one that is best for you. Viagra (sildenafil) and Cialis (tadalafil) are the most commonly prescribed, and are equally safe and effective. In most cases, lifestyle and cost will help you decide between them.
What are Viagra and Cialis?
Viagra(sildenafil), Cialis (tadalafil) and Levitra (vardenafil) belong to a class of drugs known as PDE5-inhibitors. To understand how they work, we’ll need a quick 101 on erections: For a man to get an erection, a chemical called nitric oxide (NO) sends a message to the tissues of the penis (in technical terms, the corpus cavernosum), which relax and fill with blood. Another messenger, PDE5 (phosphodiesterase-5), then ends the erection.
PDE5-inhibitor drugs slow the erection “off switch,” helping the erection last long enough for satisfying sex. (These medications do not help with turning erections “on”––that’s down to you).
How are Viagra and Cialis taken?
Viagra shouldn’t be taken with food. Ideally, you should wait 1 – 2 hours after eating before taking it. It can start to take effect in as quickly as 11 minutes, but usually, you’ll have to wait 1 hour before it reaches maximum effect. Then it keeps working for 3 – 5 hours. If you really can’t wait, then try to stick to a light, low-fat meal. Fatty meals and alcohol actually stop Viagra from working.
Cialis, on the other hand, is a pill that is not affected by food. It can be taken at any time: either when you need it or regularly every day. It can start working in as quickly as 14 minutes, but you’ll have to wait 2 hours for it to be most effective. Cialis stays in your body for about 17 hours, helping you with erections at any point in that time window.
Dosing
The typical starting dose of Viagra is 50 mg. If you’re getting side effects, it can be cut down to 25 mg, or if it’s not working fully, it can be increased to 100 mg.
The typical starting dose of Cialis for occasional use is 10 mg. It can be dropped to 5 mg or upped to 20 mg depending on how you respond. If you want to take it daily, the daily dose is 2.5 mg.
How effective are Viagra and Cialis?
Viagra and Cialis work equally well. There are no studies comparing them against each other, but other studies report that both medications result in successful penetrative sex in 65% to 80% of users with ED (compared to 30% with a sugar pill).
What are the most common side effects of Viagra and Cialis?
The most common side effects of Viagra and Cialis—and all PDE5-inhibitors—are headache, flushing, nasal congestion, indigestion, vision change, and muscle pain. With Viagra, there is a higher risk of vision changes (3% of men get blue vision lasting a few hours) than with Cialis. On the other hand, Cialis has a slightly higher risk of muscle pain than Viagra. Overall, users are not bothered much by the side effects of these medications, most of which do not last very long.
One more serious side effect is that all PDE5-inhibitors can lower your blood pressure. This won’t necessarily affect you, but if you also happen to be taking a blood pressure medication, it could be a problem. A sudden drop in blood pressure can make you dizzy, fall, black out, or even cause a heart attack. The greatest danger is with nitrate medications such as nitroglycerin. If you take a nitrate drug, for angina or high blood pressure, you must never use sildenafil (Viagra), tadalafil (Cialis), or any similar medication.
How much do Viagra and Cialis cost?
Sildenafil (generic Viagra) costs as little as $28.79 for thirty 50 mg pills (most common dose) with a GoodRx coupon. The cheapest GoodRx price for tadalafil (generic Cialis) is $642.68 for thirty 10 mg pills (most common dose).
What about Levitra?
Levitra (vardenafil) is an expensive drug without significant advantages over Viagra or Cialis. It is worth trying if sildenafil hasn’t worked for you. It works just as well at fixing ED as sildenafil (Viagra) or tadalafil (Cialis), and the side effects are very similar.
Levitra is better taken on an empty stomach, and starts working in as quickly as 14 minutes, with a maximum effect at 45 minutes. It will keep working for 4 – 5 hours. The typical starting dose of vardenafil (Levitra) is 10 mg; this can be adjusted to 5 mg or 20 mg depending on need.
The cheapest GoodRx price for vardenafil (generic Levitra) is $469.41 for thirty 10 mg pills (most common dose).
The bottom line
Sildenafil (Viagra) is by far the cheapest drug for ED and the one with the longest safety record. It is good for the occasional user but must be taken on an empty stomach. Tadalafil (Cialis) is expensive but lasts longer, making it useful if you have a more active and regular sex life. It can also be taken with or without a meal which is useful. Many men alternate between sildenafil and tadalafil, depending on their needs.
The American College of Physicians (ACP) recommends that the choice of medication be up to you, which will vary depending on personal preference of cost and lifestyle.
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