The Low Down on Viagra, Cialis and Levitra
Confused on which one of these PDE-5 inhibitors to take? You’re not the only one. Sildenafil, otherwise known as Viagra is the most well known and hence popular of the 3 since it is the first drug to be approved by the Food and Drug Administration (FDA). However, popularity alone should not be a determining factor.
The success of Viagra made other competing drug companies come up with effective alternatives and hence Tadalafil (Cialis) and Vardenafil (Levitra) came into the market to compete for a share of the (highly lucrative) pie. Far from “me too” drugs, these competitors are also highly effective and very safe alternatives to Viagra, although they are not as popular yet. For a lot of people, deciding which the best alternative is the real issue here.
They are all PDE-5 inhibitors. For starters, these drugs all cause the dilatation of blood vessels in the corpus cavernosum of the penis in response to sexual stimulation, resulting in increased blood flow and an erection. However, this is where the similarities end. They are quite different drugs in practice. Let’s review the differences so patients can make an informed choice:
Viagra
Viagra was the first and hence probably the most researched drug. It works in about 70% of all men with all types of erectile dysfunction, although approximately 25% of them do not feel that the responses are optimal. When initially doing the studies on Viagra, the endpoint of efficacy was improvement in sexual function; In contrast, studies for the other two drugs were based on patients who had success with Viagra.
Its major disadvantage is decreased absorption due to food intake. You should take the pill on an empty stomach as absorption takes approximately 30 minutes and about one hour for maximum effect. Its half life is about 4 hours, meaning that Viagra loses 50% of its maximal concentration every four hours. Sexual stimulation is necessary to achieve erection.
One interesting preference among patients for Viagra is that it is easier to split the pill compared to Levitra or Cialis. However, it may compromise the effect, since of the three drugs, the maximal concentration for Viagra appears to be the therapeutic concentration. Hence, most people need 100mg per dose to achieve the necessary therapeutic effect.
Side effects include mild headaches, facial flushing, stomach upset and unusual eye disturbances including giving a bluish tint to vision and/or making whites look whiter. These are all harmless side effects and are not permanent. However, they seem to be slightly more common with Viagra than either Cialis or Levitra.
Levitra
Levitra was the second FDA approved drug for erectile dysfunction. In lab studies, it is six to 10 more times more potent than Viagra. However, it is highly bound by proteins in the blood and only 15% of the drug is active. Studies on Levitra included only patients had success with Viagra; In addition, the efficacy is based on sexual satisfaction or successful penetration rather than improvement, which were the endpoints for Viagra.
Levitra is considered more potent than Viagra. Patients with complications, e.g. diabetes or post-prostatectomy, will likely fare better with Levitra than Viagra.
In addition, absorption is less affected by food, or a high fat diet intake. Most patients can eat and take the drug without affecting its absorption and maximal concentration.
The half-life is five hours (somewhat similar to Viagra); however, as it is more potent, multiple half-lives may occur before the drug loses efficacy. In Europe, Levitra is considered a 24-hour drug. Most physicians consider it to be a drug that has efficacy longer than Viagra.
It is also faster acting, reaching its peak concentration at 40 minutes. In studies, 25% of patients had optimal responses within 16 minutes of intake.
Cialis
If duration is the goal, Cialis appears to be the champion. Indeed, it is known as the “weekend” pill, since its effects can last a whole weekend. Cialis has been approved for duration of 36 hours, yet, there are studies showing high efficacy out to 100 hours especially in older patients. Indeed, due to this advantage, patients are freed from the need to time intercourse with taking of the pill.
Other advantages include its intake not being affected by any food whatsoever and in fact can be taken with pure fat.
For patients with cardiac problems, Cialis seems to be the safest drug to take as it is the least likely to prolong the QTc interval of the heart.
A previous concern of Cialis relates to its possible effect on human fertility due to its effects on the PDE-11 enzyme system but these concerns have been addressed with studies which show no significant effects on semen quality. However, these studies are only 6 months in duration and longer studies need to be done.
Other disadvantages are muscle aches and pains especially in the low back and gluteal area are more common with Cialis (7%) versus Levitra or Viagra (less than 1%). It seems that younger men, particularly those who are more muscular are affected. Hence, a case can be made that in these younger men to use Viagra or Levitra as a first line of treatment. Notwithstanding, physical activity makes the pain disappear and should be advised if such pain occurs.
Conclusion
Cialis, with its long duration of action, appears to be the easiest and with least restriction on spontaneity of the sexual experience. Two or three pills per week may be all that is necessary without concern for time and spontaneity.
It is possible as well that the treatment of choice will be to combine Cialis with one of the shorter-acting drugs. A booster of Levitra or Viagra prior to sexual activity after taking Cialis on Tuesday and Friday may be the ideal choice for many patients who do not get an optimal response to 20 mg of Cialis every 36 hours.
For patients with other medical problems that may impede erectile function e.g. diabetes, Levitra seems to be the drug of choice. Compared to Viagra, Levitra has a much longer duration of action and in many men a 20 mg Levitra tablet will be effective with stimulation up to 20 or 24 hours.
As Levitra tends to work very rapidly with as much as a quarter of patients getting an optimal response within 16 minutes of taking the drug, individuals who cannot plan their sexual activity until the last minute, may find Levitra to be their drug of choice.
Those patients, who are currently using Viagra and satisfied with their response of the drug, probably need not make a change.
About Dr Ong
Dr Ong obtained his Bachelor of Medicine and Surgery from the National University of Singapore (now called Yong Loo Lin School of Medicine) in 2004.
40 Comments
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Our Chief Medical Officer
How do i go about purchasing Cialis? I am in my late 30s and loses stamina due to fatigue
Hi Siva,
First, see our doctors either at Robertson Walk or OUB Centre. Our doctors will prescribe you Cialis after assessing your situation. Subsequently, you will be able to purchase Cialis without seeing the doctor.
rgds
Dr Tan
Hi Dr Tan,
I just passed 60 and I am relatively fit with no problems carring out my daily life. I do not see doctors for the slightest reasons and as such, though my mother had diebetes, but, not of serious nature before she passed on,
I on the other hand, do not go for check-ups as advised by the main stream people.
However, my sex life seems to be not what it was before when I was much younger. I use 100m cialis each time when I have sex and it seemed to work for a while, but yet did not give me the desired strength which I would have liked.
I don’t know why this is so, maybe it’s because I seem to take the pill much too early be the act itself.
Recently, I took a 200m cialis pill, also, earlier than the time of the act say about 3 hours before and this time, I could not even get an satisfatory errection for sucessful penitration. This leaves my partner dissatisfied.
Please advise what should I do to correct this problem so that I can continue to have a full and happy sex life.
With Best Regards
Jay
Hi Jay,
You have erectile dysfunction. This is an early marker of blood vessel disease. Multiple studies have shown that men with ED have a much higher chance of developing heart disease. So the first thing you need to do is have a thorough health screen including measuring your blood pressure, blood sugar and cholesterol. Take the chance to also test your testosterone level and check your prostate. Once you have done this, you can talk to a doctor about treatment for ED. There are many options available and this forum is really not the platform for such a detailed discussion. You need a formal medical consultation for this.
rgds
Dr Tan
Hi doc,
I m not sure if I have this problem called erectyle dysfunction…because my pelvis will tend to erect while I was lying down..but when I about to do the
intercourse with my wife..it will just “turn off’. Its happen quite a few time and I m quite worried bout it..and I m just 26 years old….i hope you can telk me what wrong with me
Hi akbar,
You mean you cannot sustain an erection when having sexual intercourse with you wife. But you have morning erections. It really does not sound to me like you have a medical issue. If anything, it sounds more psychological. However, you should still see your doctor to rule out any possible medical issues.
rgds
Dr Tan
Hello Doc,
I am 29 years old and married from last 15 months. I usually have morning erection. I am fit and doing exercise daily. but seems while doing intercourse with my wife, sometimes I am not able to do it as its not hard enough. earlier it happened very rare but in last month, its happened 3-4 times. Sometimes I take Penegra 25 mg. please let me know, how to get rid of this problem? also would like to know, if it can be cured easily or not? is it a common problem with Men? … I would like to make an appointment for this as well. please let me know if you have any clinic near Tampines.
Hi shek,
It does not sound to me like you have a medical problem. However, the onus will be on your doctor to rule out any potential medical issues. How easily this can be ‘cured’ really depends on what is the underlying cause. ED is a very common problem although not at your age. We do not have a clinic at Tampines. Our clinic locations are: http://www.drtanandpartners.com/where-to-find-us/. btw what is Penegra?
rgds
Dr Tan
Hi Doc,
Thanks for you reply.
Penegra containts Sildenafil Citrate and its bit useful for me (even 10mg works for me). As per you what could be reason of ED at the time of intercourse only at this age? and one more query I have that once ED is cured it will not occur again after some time … I mean in 1 or 2 years?
Hi shek,
I have never heard of generic Viagra. Please be careful when using such medicines. They really should only be used under the guidance of a doctor. I really would not want to hazard a guess as to your diagnosis. You need to see a doctor and get some tests done. Again, the cure for ED and risk of recurrence depends entirely on the underlying cause.
rgds
Dr Tan
Hi,
I visited GP today. I explained him that I have mild pain in lower abdominal and cant maintain Erection while doing intercourse.
I did urine test and said I dont have blood in urine then
He referred me to Singapore Urology centre. I have to go on Wednesday for check up.
I tried sex again and it got erection but as soon as I was trying to insert it I felt some pain in lower abdominal and it became soft after sometime (5 mins) it again got hard but again same issue (felt pain while penetrate and it became soft) could it be related to my pain ? and could you please let me know whats usual fee of doc for ED treatment?
Hi shek,
Your ED is very likely due to the pain. In my view, the important thing is to find out what is causing your pain first. It could be the bladder, prostate or large intestines. You should keep your appointment with the Urology Centre.
rgds
Dr Tan
Hello Doc,
I consulted a doc for ED and pain problem. They asked me to do lot of tests (CT Scan, Testicles Test, Harmon Test) but every thing was fine. He asked me to take some oral medicine for ED issue and after taking medicine I didn’t have any problem (expect some headache) (FYI: I did not try without medicine yet. Apart from Lavitra(20 mg). he gave me some other vitamin tabs. He asked me for sperm test as well. As per him I should not ejaculate within 5 days duration of test. So I ejaculated on Monday for sat morning test but it got ejaculated automatically on sat morning (test day) but without canceling test appointment and without telling doc. I collected my sperm and gave it for test (that mean ejaculated 2 hours before sperm collection) … could it be make difference in sperm report ( i.e. slow sperm). Shall I tell them that I ejaculated on the same day as well before collection? and give it again for testing (5 days after)? Please advise
Hi shek,
Please direct all future questions to your doctor treating you for this problem. It is not right for me to interfere.
Rgds
Dr Tan
Dear sir,
I visit your clinic one time about my erection problem. U take a blood test then u say no problem. my wife in India I’m working in Singapore. I just marrie.i say my
Holiday go India I plane to make baby. Then U give tablet u say this is improve your activities.I fail to make baby. Holiday time i can make sex one day one time only. And your tablet finish then I can’t active I don’t have erection. And now I come back Singapore. I need your advice again. I can feel I getting week. Last 2 years I don’t have morning erection. And all ways my penis so small and week. Advice me. next month I plane to bring my wife in Singapore
Hi Basheer,
It sounds like the medications worked but was not of an adequate duration. It sounds like you will need to be on these tablets until your wife is successfully pregnant.
Rgds
Dr Tan
But it’s not work. And now my main problem. I can’t doing sex fully. I have a erection problem. Advice about that.
Hi Basheer,
What do you mean it didn’t work? You said you had sex once a day. That is not good enough? Or you mean your wife is still not pregnant? Nothing can guarantee pregnancy. Not even IVF.
Rgds
Dr Tan
IVF?
Sir now my question. In future with out tablet I can’t perform normally? And how to clear my ere tion problem. Kindly advice me that one,
Hi Basheer,
So you are saying the medicines work now but you are afraid they will stop working? Aren’t you getting a little ahead of yourself? Tackle the problem if and when it arises.
Rgds
Dr Ta
Hi sit
The medicine work. The medicine only you give one month. It’s finish. And now I come back. My question is I take the medicine time I can sex once a day. Once finish then. I can do sex. Y?
Hi Basheer,
Because you are dependent on the medicines. Unfortunately your condition cannot be solved permanently. You will be ok as long as you take your meds.
Rgds
Dr Tan
Hi sir,
That mean. I need to take the medicion all the time?
My problem can’t solved permanently?
Hi Basheer,
Most likely yes.
Rgds
Dr Tan
Hi Basheer,
That is most likely the case.
rgds
Dr Tan
Hi sir,
If possible to make my wife pregnant? Have any treatment for that my problem?
Hi Basheer,
A little patience would help. For your age, doctors will only step in if you have tried for 1 year to get your wife pregnant and was not successfull.
rgds
Dr Tan
Dear sir.
Today I do my self to come out my spurm. It’s very hard to wake up my penis. And. Finely wake up all so it’s not so strong. And the spurm come out like yellow color and. Not forcely come out. Day by day I feel I getting loos my power. Last time u say abt my report. It’s normal but in my age is something low. Then y I like that. I bring my wife next 2 month latter. Kinky advice me.
Hi Basheer,
Apologies but I really do not know what you are trying to tell me. Perhaps its best if you come down for a consult.
rgds
Dr Tan
Help test out our new forum at http://www.askdrtan.com
Can clear my erection problem?
Hi Basheer,
Come and see me when I am back. Anytime after 27th Feb.
Rgds
Dr Tan
Hi sir.
Ok I will see after 27th
Hi Doc… Im really feel down with myself.
I felt that iam healthy & fit… Bt each time when me & wife have our “moment” it do becomes hard bt aftr sometime it went soft again… Bt the thing is im still
Excited only my “brother” keep disappointing me… Im really would wana seek your advice & medical appointment. Thank you. Pls email.
Hi Raden,
You have erectile dysfunction. This requires a formal consultation to diagnose and treat. Please see me at my clinic.
rgds
Dr Tan
I am 52 do I need to be on medication all the time for ED
Hi Bryan,
It really depends on what is causing your ED. You need to be checked for chronic diseases like Diabetes, High Blood Pressure and High Cholesterol. These conditions need to be treated first. Furthermore, certain medications can also cause ED. If you have clinical symptoms of low Testosterone, this has to be checked too. Once all secondary causes have been ruled out and you are dependent on PDE5I medication then it is likely you will need to be on it for life.
rgds
Dr Tan
Hi
I’m 27. I feel I have erection problem. I don’t have normal morning erection. I feel all ways tired and sleepy. If I wake up all so feel tired. Normally my penis is small. If I touch all so don’t have feeling. And my sex feeling all so getting low. I with my wife I want to do but starting have erection but not so strong after that totally getting low. I can enter in my wife. Wt is this call.
Dear Forum,
We have moved the forum over to http://www.askdrtan.com
Please post your questions on http://www.askdrtan.com
See you there!
Dr Tan
Hi dr tan, I am 25 this year.. However I do have some problem in having sex because I cannot really get an erection whenever I want to / need to..I dare not speak to anyone as I am still at the age of 25 which is consider young. Can adv me? Thank you.
Hi Seanny,
Please see http://www.askdrtan.com/forum/question/267 for my reply.
Please post any follow up questions you have in the forum.
Rgds
Dr Tan