Sildenafil generic dosage

The 100-mg and 200-mg doses can be taken as shortly as 15 minutes before sexual activity.

As a second-generation medication, Stendra also seems to have milder side effects than Viagra and the other PDE5 inhibitors that came before it.

Side effects commonly caused by Viagra — but not Stendra — include dizziness, vision changes, nausea, and muscle aches. The only common side effect caused by Stendra but not Viagra is a sore throat. Each drug comes with the risk of drug interactions.

Since PDE5 inhibitors work on the body in similar ways, Viagra, Cialis, Levitra, and Stendra lead to similar interactions.

All four of these drugs interact with: nitrates, such as isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat) certain blood pressure drugs, such as calcium channel blockers alpha blockers, which can treat high blood pressure or an enlarged prostate certain pulmonary hypertension drugs, such as riociguat (Adempas) protease inhibitors, a class of HIV drugs antifungal drugs, such as ketoconazole and itraconazole (Onmel, Sporanox) antibacterial drugs, such as clarithromycin (Biaxin) Drinking excessive amounts of alcohol while on any PDE5 inhibitor should be avoided, and you shouldn’t combine different ED drugs. Cialis may also be less effective if used alongside antiseizure medications such as carbamazepine (Tegretol) and phenobarbital. For specifics on which medications are safe for you to use, it’s best to consult your doctor or pharmacist.

In some cases, using these medications may mean you need to completely avoid PDE5 inhibitors.

In other cases, adjusting your dosage of the medication can reduce the possibility of drug interactions while using PDE5 inhibitors. If you have ED, talk to your doctor about Viagra, Cialis, Levitra, and Stendra. 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.

When used correctly, each of these drugs has been shown to help men with ED.

If you have questions or concerns, talk with your doctor.

All of them lead to 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

If you’re not sure that drug treatment is right for you, you can also give natural ED treatments a try. Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis.

Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi Province China.

Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi Province China.

Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi Province China. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi Province China.

Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi Province China.

Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi Province China.

Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi Province China. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi Province China. Erectile dysfunction (ED) is a major care problem worldwide. Tadalafil and sildenafil are the two most common phosphodiesterase 5 inhibitors used to treat ED. This systematic review and meta-analysis were conducted to directly compare tadalafil with sildenafil for the treatment of ED. We designed a strategy for searching the PubMed, Embase, EBSCO, Web of Science and Cochrane library databases; the reference lists of the retrieved studies were also investigated.

A literature review was performed to identify all published randomized or non-randomized controlled trials

that

Two investigators independently and blindly screened the studies for inclusion.

A total of 16 trials that compared tadalafil with sildenafil for the treatment of ED were included in the meta-analysis. In the meta-analysis, tadalafil and sildenafil appeared to have similar efficacies and overall adverse event rates.

However, compared with sildenafil, tadalafil significantly improved psychological outcomes.

Furthermore, the patients and their partners preferred tadalafil over sildenafil, and no significant difference was found in the adherence and persistence rates between tadalafil and sildenafil.

Additionally, the buy generic viagra online no prescription myalgia and back pain rates were higher and the flushing rate was lower with tadalafil than with sildenafil.

Tadalafil shares a similar efficacy and safety with sildenafil and significantly improves patients’ sexual confidence. Furthermore, patients and their partners prefer tadalafil to sildenafil. Hence, tadalafil may be a better choice for ED treatment. Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse.

ED is one of the most common sexual dysfunctions, and an estimated 5–20% of men are affected by moderate to severe ED around the world [1]. The prevalence of ED is approximately 15.77% in southern India, 15.0–49.5% in China, 56.1% in Iran and 58.9% in south-western Nigeria [2–5].

The estimated global prevalence has been increasing, and approximately 322 million men worldwide could be affected by ED by the year 2025 [6].

Although ED is a benign disorder, it can affect physical and psychosocial health and may have a significant impact on the quality of life of patients and their partners. Currently, several treatment strategies are available for patients with ED, including non-invasive and invasive options.

Oral phosphodiesterase type 5 inhibitors (PDE5-Is) are the first-line therapy for sildenafil 100 mg tablet coupon ED [7]. PDE5-Is are similar to cyclic guanosine monophosphate (cGMP) in structure; thus, PED5-Is can bind to PDE5 competitively and inhibit cGMP hydrolysis, leading to a penile erection [8].

Four PDE5-Is (sildenafil, tadalafil, vardenafil and avanafil) are currently approved by the US FDA and have comparable efficacy and side effect profiles [9].

Sildenafil and tadalafil are the two most common phosphodiesterase inhibitors (PDEIs) around the world.

Sildenafil, the original PDEI, was introduced in 1998.

Sildenafil has a quick onset of action of 30 min after the initial dose, a duration of action of 4–6 h and a maximum duration of 12 h [10]. Sildenafil is effective for the treatment of ED, although 20–50% of patients who respond to sildenafil discontinue its use [11].

Tadalafil is a selective, long-acting PDEI sildenafil generic dosage that was released in 2003.

Tadalafil has an onset of 20 min and should be taken 30 min prior to intercourse; additionally, this drug has the longest duration of action in its class and a maximum duration of 72 h. A total of 52% of patients can have successful intercourse within 30 min of taking tadalafil [12].

Recently, several systematic reviews and meta-analyses have comparatively analysed the role of PDEIs, including sildenafil and tadalafil, in the treatment of ED. However, because most of these review articles were indirect comparative analyses, the differences between sildenafil and tadalafil remain unclear [13–15]. Hence, this meta-analysis was conducted to directly compare sildenafil with tadalafil for the treatment of ED and to provide guidance for the clinical treatment of ED.

In January 2017, the PubMed, EBSCO, Web of Science, Cochrane library and Embase databases were searched for randomized or non-randomized controlled clinic trials of sildenafil and tadalafil. The search was performed by combining the term “erectile dysfunction or sexual dysfunction” with the following words describing the drug: tadalafil or Cialis and sildenafil or Viagra.

We also searched for additional relevant studies by examining the reference lists of the selected papers and reviews. The search process was not limited by language, country or year of publication. For the present systematic review, randomized or non-randomized controlled trials that met the following criteria were included: (a) the study included a comparison between sildenafil and tadalafil; (b) the study provided accurate data that applied to a meta-analysis, including the International Index of Erectile Function (IIEF)-EF domain, preference and treatment–emergent sildenafil teva 100mg tablets adverse events (TEAEs); and (c) the full text of the study could be acquired. When the same study was published in different journals or in different years, the most recent version was used for the meta-analysis. Abstracts, reviews and articles that did not contain accurate relevant data and a comparative analysis of sildenafil and tadalafil were excluded. Two independent reviewers evaluated all identified publications, and any disagreement between reviewers was resolved by a third reviewer.

The methodological quality was assessed using the Jadad score, with a Jadad score ?3 indicating a high-quality article [16]. Data extractions were performed by one reviewer and checked by a second reviewer.

Information was extracted from the studies that met the above-mentioned inclusion criteria using a structured form.

The first author, publication year, sample size, therapy that the patients received and assessment indices, including the IIEF, the men’s preference, the Self-Esteem and Relationship questionnaire (SEAR), total Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores and TEAEs, were collected for each study.

A meta-analysis of comparable data was performed using RevMan 5.0.

Statistical heterogeneity between studies was assessed using the I 2 statistic.

Pronounced heterogeneity was indicated by a P value ?0.05 and an I 2 value ?50%; in these cases, a randomized effects model was executed.

A P value ?0.05 and I 2 ? 50 indicated no obvious heterogeneity between the studies, and a fixed effects model was chosen for the meta-analysis. Continuous data are presented as weighted mean differences (

WMDs

Egger’s test was performed to evaluate the risk of publication bias. Additionally, a sensitivity analysis was performed to assess the stability of the outcome when low-quality and highly heterogeneous trials were included in the analysis. A total of 1657 articles were identified through the electronic databases and the manual review of the reference lists of the included studies.

Based on the search strategy, a total of 16 studies were included in the review [17–31].

A total of 5189 patients were recruited in the final meta-analysis, and the mean patient age ranged from 36.9 to 56.2 years. Seven articles were open-label, randomized, multicentre, controlled studies; nine of the studies had a crossover design; and the other sildenafil generic dosage studies were prospective and observational.

The common instruments used to assess these two PDEIs (sildenafil and tadalafil) were the IIEF-EF, preference, TEAEs, adherence and persistence.

The characteristics of the studies are listed in Table 1 .

Author Year Number Intervention Control Assessment Jadad score Bai et al. 2016 383 Tadalafil: 20 mg Sildenafil: 100 mg preference, TEAEs 2 Buvat et al. 2013 770 Tadalafil: 5 mg OaD, 10 mg PRN Sildenafil: 50 mg PRN IIEF score, TEAEs 2 Helen et al. 2008 100 Tadalafil: 20 mg Sildenafil: 100 mg Preference, IIEF-EF, TEAEs 2 Eardley et al. 2005 291 Tadalafil: 10 mg, 20 mg Sildenafil: 25,50,100 mg Preference, IIEF, TEAEs 2 Govier et al. 2003 215 Tadalafil: 20 mg Sildenafil: 50 mg Preference, TEAEs 3 Hatzimouratids et al. 2014 770 Tadalafil: 2.5, 5 mg OaD; 10, 20 mg PRN Sildenafil: 25, 50, 100 mg PRN IIEF 3 Rubio-Aurioles et al.

2012 418 Tadalafil: 5 mg OaD, 20 mg PRN Sildenafil: 100 mg PRN IIEF, TEAEs 2 Rodriguez Tolra et al.

2006 90 Tadalafil: 20 mg Sildenafil: 50 mg, vardenafil: 20 mg IIEF, preference, TEAEs 2 Von Keitz et al. 2004 265 Tadalafil: 20 mg Sildenafil: 50 mg preference, TEAEs 3 Li et al.

2016 63 tadalafil: 20 mg sildenafil: 100 mg preference, IIEF 2 Cairol et al. 2014 104 Tadalafil Sildenafil, vardenafil, lodenafil IIEF, persistence and adherence 2 Stroberg et al.

2003 147 Tadalafil: 20 mg Sildenafil: 25, 50, 100 mg preference, TEAEs 2 Ahn et al.

2007 160 Tadalafil: 20 mg Sildenafil: 50, 100 mg preference, TEAEs 2 El-Meliegy et al. 2013 493 Tadalafil Sildenafil, vardenafil persistence, adherence, IIEF, 2 Taylor et al.

2009 409 Tadalafil Sildenafil, vardenafil TEAEs 2 Rubio-Aurioles et al.

2013 511 Tadalafil Sildenafil, vardenafil persistence, adherence IIEF 2.

TEAE treatment–emergent adverse events, IIEF International Index of Erectile Function, OaD once a day, PRN on demand. Egger’s test was conducted to assess the presence of possible publication bias. No evidence of publication bias was found for the IIEF-EF, preference, overall adverse events, back pain, dyspepsia, nasopharyngitis, adherence and persistence (Egger’s test P ? 0.05). The Egger’s test results found publication bias for headache, flushing and nasal congestion ( P ? 0.05).

The other parameters were not evaluated using Egger’s test because only two studies included relevant data (Tables 2 , ? ,3; 3 ; Figs. Study quality was evaluated with the Jadad scoring system, and the results are shown in Table 1 . According to a recent network meta-analysis published in 2015 that indirectly compared the efficacy and safety of PDEIs, sildenafil had the greatest efficacy but the highest rate of overall adverse events, whereas tadalafil had intermediate efficacy and the lowest overall rate of all adverse events [15].

However, our study, which differs from previous systematic reviews, is the first meta-analysis to directly compare the efficacy and safety of sildenafil and tadalafil. PDE5-Is selectively block the PDE5 enzyme, which catalyses the hydrolysis of cGMP to GMP and thus prolongs erectile function [32]. PDEIs are the most commonly used drugs to treat ED, and the effects of the PDEIs used to treat ED have been investigated.

The IIEF is a widely used, validated and self-administered questionnaire that has demonstrated a high degree of sensitivity and specificity for the assessment of ED [33].

First, we used the IIEF to evaluate the overall efficacy of sildenafil and tadalafil.

Previous studies reported that PDEIs were more effective than placebos for treating ED and were generally safe and well tolerated [13].

Interestingly, our efficacy analysis revealed that sildenafil and tadalafil had equivalent abilities to improve IIEF-EF scores. No significant between-group differences for tadalafil and sildenafil were evident for the IIEF sexual desire, IIEF intercourse satisfaction and IIEF overall satisfaction domains. This finding is somewhat unexpected and may result from differences in the distribution of efficacy profiles within the different treatment strata assessed.

However, a high level of significant between-trial heterogeneity was evident across the articles included in this meta-analysis, and the time or dose of administration of the PDEIs was diverse. The sensitivity analysis based on various exclusion criteria did not alter the forest plot and pooled effect, which strengthened our result.