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Viagra vs Cialis vs Levitra

Viagra, Cialis and Levitra are PDE5-inhibiting orally administered drugs meant to treat male sexual function disability. All three medications received FDA approval and are effective for achieving and maintaining an erection.

As phosphodiesterase type 5 inhibitors, Viagra, Cialis and Levitra block the degradative influence of PDE type 5 in the cells of smooth muscle which line the blood vessels of the penis. After sexual stimulation the nitrate oxide is released, resulting in the relaxation of the muscle and a more intense blood flow into the penis, i.e. erection. That is why, drugs containing PDE5-inhibiting substances that widen the vessels are successfully used for treating erectile dysfunction.

Viagra, Cialis and Levitra act only after sexual stimulation. In means that taking these medications you will have an erection only when you are with your partner, in the appropriate time and place, and not when you are driving or sitting in a restaurant.

Viagra

Viagra � or sildenafil � was patented in 1993 by Pfizer and, after numerous clinic studies being conducted, the drug received FDA approval in 1998. Originally Viagra was developed to treat heart disease and angina, but during medical trials volunteers reported some unexpected side-effects. By nowadays Viagra has been tested by more than 23 million of men of different ages. The medication comes in 25mg, 50mg and 100mg pills and should be used on empty stomach, from 30 minutes to 4 hours before anticipated sexual activity. The action lasts up to 5 hours. Among the most common side effects upset stomach, face flushing, headache and dizziness should be mentioned.

Cialis

Cialis, known under the generic name of tadalafil, was patented in 2002 by Lilly ICOS. It has been tested by about 15,000 men who participated in clinic trials, let alone more than 8 million of men worldwide who chose this drug for ED treatment and found it efficient. Cialis comes in 2.5mg, 5mg, 10mg, and 20mg pills and is usually taken 30 minutes before having sex. Cialis has the same side effects and list of interactions as Viagra and Levitra, but is distinguished by the exceptional durability of its action: up to 36 hours. Moreover, in 2007 Lilly ICOS carried out a clinical development program and ascertained that chronic use of Cialis (2.5mg-5mg) was available for those who suffered from ED but didn’t want to lose the spontaneity of sexual relationships.

Levitra

Levitra (vardenafil) was patented in 2001 by Bayer. To believe clinic studies, Levitra works more efficiently than Viagra, because it needs only 16 minutes to cause an erection, while the effect lasts up to 6 hours. In addition, Levitra doesn’t have either food or drink limitation. As for the price, Levitra is more expensive than Viagra and Cialis. The drug has the same side effects as Cialis and Viagra, which are provoked by the PDE5-inhibiting substance being present.

Comparison

No head-to-head comparison tests of Viagra, Cialis and Levitra have been conducted yet. Nevertheless, a few main differences can be mentioned. The most long-lasting ED medication is Cialis, with its 36 hours, then 6-hour Levitra follows, and Viagra (up to 5 hours) is the least durable one of three. Viagra, Cialis and Levitra showed on average 70% result, so considering efficiency in ED treatment, all these drugs are helpful. Viagra and Cialis aren’t recommended to be mixed with food, while with Levitra romantic dinners are still possible. Viagra, Cialis and Levitra have the same side effects, such as headache, facial rash and upset stomach, but Viagra may also provoke blue discoloration of vision, while Cialis sometimes leads to muscle aches (not more than 5% of patients). The most popular of the three is Viagra which had a very powerful promotional campaign, however, Cialis and Levitra, featuring better characteristics, are widely known as well.

Viagra

Compare Viagra, Levitra, Cialis

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

Cialis vs. Levitra vs. Viagra: How Each Stacks Up

Three of a kind?

Cialis, Levitra, and Viagra are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names, tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra).

About 30 million men occasionally have a problem with getting or keeping an erection, according to the Urology Care Foundation. When ED becomes a problem, many men turn to oral ED medications. These drugs often help. Cialis, Levitra, and Viagra each work in similar ways. But there are also some differences, such as when you take them, how long they work, and what their side effects are.

Drug features

Cialis. Levitra. and Viagra are all in a class of drugs called PDE-5 inhibitors. These drugs work by blocking an enzyme called phosphodiesterase type 5. They also boost a chemical in your body called nitric oxide. This action encourages the muscles in your penis to relax. Relaxed muscles allow blood to flow freely so that when you’re aroused, you can get an erection. It also helps you maintain the erection long enough to have sex.

Levitra and Viagra stay in your bloodstream for about four to six hours. Cialis remains in your bloodstream for 17 to 18 hours or longer. The length of time a drug stays in your system may be important if you’re taking other medications.

Here are more basics on each of these drugs:

Be sure to take this drug exactly as your doctor tells you to. If you have questions or concerns, talk with your doctor.

Cost, availability, and insurance

Cialis, Levitra, and Viagra are usually stocked at most pharmacies. All three of these drugs cost about the same amount. In general, most health insurance companies won’t cover their costs. But if you have certain medical conditions, your health plan may pay for the drug with prior authorization.

Side effects

The side effects of these medications are similar. Most men have only mild side effects.

The chart below compares the side effects of these drugs.

Tell your doctor if you have any side effects that linger and don’t go away on their own. If you have an erection that lasts longer than four hours, call your doctor right away.

Drug interactions

Each drug comes with the chance of drug interactions. Since PDE-5 inhibitors work on the body in similar ways, Cialis, Levitra, and Viagra come with similar interactions.

If you have an erection that lasts longer than four hours, call your doctor right away.

All three of these drugs interact with nitrates. They also all interact with blood pressure drugs such as alpha-blockers. For Cialis, these also include the drugs bendrofluazine, enalapril. and metoprolol. For Viagra, these also include the blood pressure drug amlodipine .

Viagra also interacts with the drug ritonavir .

Cialis can also interact with alcohol. Drinking alcohol with Cialis can cause low blood pressure when you stand up from a sitting or lying position. This may result in dizziness or a headache. To learn more, read more about the effects of mixing Cialis and alcohol.

Levitra and Viagra do not seem to cause low blood pressure when taken with alcohol. However, alcohol may interfere with your ability to get an erection, even while you’re taking any of these drugs.

Outlook

If you have ED, talk to your doctor about Cialis, Levitra, and Viagra. Tell your doctor if you take other over-the-counter or prescription drugs or supplements. Be sure to mention all other health conditions you have.

Each of these three popular drugs has been shown to help men with ED when they’re used correctly. All three drugs have good results, but it may take a little time and patience to get it right. If one drug doesn’t work or produces unpleasant side effects, you can try another drug. It may also take some trial and error to find the dosage that works best for you. And if you’re not sure that drug treatment is right for you, you can give these natural treatments for erectile dysfunction a try.

Article resources

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