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What is erectile dysfunction?
Erectile dysfunction is defined as regular difficulties getting or maintaining enough of an erection for satisfying sexual intercourse. The key word here is “regular.” It’s normal for men to have problems getting hard occasionally, but when successful erections become the exception rather than the rule, or when they flat out don’t happen anymore, that’s ED — and that can be a sign there’s something going on.
ED is really bothersome, but it usually isn’t serious. In about 20% of cases though, ED can be a warning sign that you might have an undiagnosed health condition such as heart disease, high blood pressure, high cholesterol, diabetes, or depression. Or maybe there’s another cause such as being overweight, smoking, drinking too much alcohol, certain medications, stress, relationship difficulties, or hormonal problems. Your doctor will run some simple tests to see if whatever is causing your ED is reversible. If so, treating those causes may well improve your ED without the need for ED medications. But even if they aren’t easily reversible, medications for ED are safe, available, and effective in 70% of cases.
What are Viagra, Cialis, and Levitra?
Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) belong to a class of drugs known as PDE5 inhibitors. To understand how they work, we’ll need a quick 101 on erections. For an erection to happen, 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. The erection is ended by another messenger, PDE5 (phosphodiesterase-5).
PDE5 inhibitors slow the erection “off switch,” helping the erection last long enough for satisfying sex. (These medications do not help with turning erections “on.”)
Viagra, Levitra, and Cialis have all been proven to be safe and effective in the treatment of erectile dysfunction. The main differences between them are:
- How they’re taken
- How long they last
- Side effects
For occasional use, most people start with sildenafil. For regular use, tadalafil can be a better fit. Some people prefer to alternate between medications, depending on their lifestyle and relationship status.
How oral medications differ
Although they work in similar ways, each oral medication has a slightly different chemical makeup. These minor differences affect the way each medication works, such as how quickly it takes effect and wears off, and the potential side effects. Your doctor will consider these factors as well as other conditions you have and possible interactions with other medications you take.
- Sildenafil (Viagra). This medication is most effective when taken on an empty stomach one hour before sex. It’s effective for four to five hours or more if you have mild to moderate erectile dysfunction.
- Vardenafil (Levitra, Staxyn). This medication also is most effective when taken one hour before sex and can be taken with or without food. A high-fat meal might keep it from absorbing as quickly.Vardenafil is effective for four to five hours or more if you have mild to moderate erectile dysfunction. A newer form of the drug that dissolves on the tongue might work faster than the pill that you swallow.
Tadalafil (Cialis). This medication is taken with or without food about one to two hours before sex. It’s effective for up to 36 hours. It can be taken in a small dose daily or in a larger dose as needed.
- Avanafil (Stendra). This medication is taken with or without food 30 minutes before sex, depending on the dose. It lasts up to six hours.
Because these drugs are similarly effective, the American College of Physicians recommends that the choice be based on your preferences, including cost, ease of use, how long the drug’s effects last and side effects. There are generic versions of sildenafil, vardenafil and tadalafil available.
|How to take it: Viagra shouldn’t be taken with food. Ideally, you should wait 1 to 2 hours after eating before taking it. If you really can’t wait, then try to stick to a light, low-fat meal. Fatty meals and alcohol can stop Viagra from working.|
|How fast it works: It can start to take effect in as little as 11 minutes, but usually, you’ll have to wait 1 hour before it reaches maximum effect. Then it keeps working for 3 to 5 hours.|
|Typical dose: The typical starting dose is 50 mg. If you’re getting side effects, it can be cut down to 25 mg. If it’s not working fully, it can be increased to 100 mg.|
|How to take it: Cialis is unaffected by food. It can be taken only when you need it, or regularly, every day.|
|How fast it works: It can start working in as quickly as 14 minutes, but you’ll have to wait 2 hours for it to reach the point when it’s most effective. Cialis stays in your body for about 17 hours, helping you with erections at any point in that time window.|
|Typical dose: 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. The daily dose for regular use is 2.5 mg.|
|How to take it: Like Viagra, Levitra shouldn’t be taken with food. Ideally, you should wait 1 to 2 hours after eating before taking it, but if that’s not possible, stick to a light, low-fat meal.|
|How fast it works: It can start working in as quickly as 14 minutes and reaches maximum effect after around 45 minutes. Then, it will keep working for 4 to 5 hours.|
|Typical dose: The typical starting dose of Levitra is 10 mg. It can be cut back to 5 mg or increased to a maximum of 20 mg.|
How effective are Viagra, Cialis, and Levitra?
Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) all work equally well. There are no studies that directly compare them against each other, but a systematic review and meta-analysis of a few hundred studies found that all three medications result in successful penetrative sex in 65% to 80% of users with ED (compared to 30% with a sugar pill).
What are common side effects of Viagra, Cialis, and Levitra?
The most common side effects of all PDE5 inhibitors are:
- Nasal congestion
- Vision changes
- Muscle pain
With Viagra, there is a higher risk of vision changes than with Cialis. Three percent of people who take Viagra or sildenafil get blue vision that lasts a few hours. On the other hand, Cialis has a slightly higher risk of muscle pain than Viagra and Levitra. Overall, users are not bothered much by the side effects of these medications, most of which do not last very long.
One serious side effect with all PDE5 inhibitors is that they 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, Cialis, and Levitra cost?
At the time this page was last reviewed, these were the lowest GoodRx prices for a 30-day supply of a typical dose of each medication:
- Sildenafil (generic Viagra): $119 for thirty 50 mg pills
- Tadalafil (generic Cialis): $119 for thirty 20 mg pills
- Vardenafil (Levitra): $119 for thirty 10 mg pills
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.
It’s common to alternate between sildenafil and tadalafil, depending on individual needs.
Vardenafil (Levitra) is an expensive drug with no 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.
The American College of Physicians (ACP) recommends that the choice of medication be left to you (the patient) and states that it may depend on the cost of the medication and your lifestyle.
Buying oral erectile dysfunction medications online
Treatments for erectile dysfunction are big business, and online scams abound. If you do buy medications over the internet:
- Check to see if an online pharmacy is legitimate. Never order medications from an online pharmacy if there’s no way to contact the pharmacy by phone, if prices seem too good to be true or if you’re told no prescription is necessary. Some illegal businesses sell counterfeit versions of legitimate medications, which can be ineffective or dangerous. In the U.S., the National Association of Boards of Pharmacy can tell you whether an online pharmacy is licensed and in good standing.
- Make sure you get the right prescription and dose. When you order medications — and when you receive them in the mail — make sure they’re the exact dose and type prescribed by your doctor.
- Don’t be fooled into buying ‘herbal viagra.’ Never take any medications that claim to be the “herbal” or nonprescription equivalent of an oral medication for erectile dysfunction. These aren’t an effective alternative, and some contain harmful substances.