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Viagra, Cialis, Levitra, and Stendra are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names: sildenafil (Viagra) tadalafil (Cialis) vardenafil (Levitra) avanafil (Stendra) About 30 million American men occasionally have a problem with getting or keeping an erection, according to tadalis soft tabs the Urology Care Foundation. When ED becomes a problem, many men turn to these oral ED medications. However, there are also some key differences, such as when you take them, how long they work, and what their side effects are.

Viagra, Cialis, Levitra, and Stendra are all in a class of drugs called PDE5 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.

Here are the basic features of each of these drugs: Brand name Viagra Cialis Levitra Stendra What’s the generic name of this drug? sildenafil tadalafil vardenafil avanafil Is a generic version available? oral tablet oral tablet oral tablet oral tablet What strengths does it come in?

25 mg, 50 mg, 100 mg 2.5 mg, 5 mg, 10 mg, 20 mg 5 mg, 10 mg, 20 mg 50 mg, 100 mg, 200 mg What’s the typical dosage? 50 mg 10 mg (when used as needed); 2.5 mg (when used daily) 10 mg; 5 mg (for men 65 years old and up) 100 mg When do I take it?

30-60 minutes before sex 30 minutes before sex 60 minutes before sex 15 minutes before sex (for 100 mg and 200 mg); 30 minutes before sex (for 50 mg) How long does it work? 4 hours up to 36 hours 4-5 hours 6 hours How do I store it? Around room temperature, between 68°F to 77°F (20°C to 25°C) At 25°C (77°F) At 25°C (77°F) Around room temperature, between 68°F to 77°F (20°C to 25°C) The drugs are available in a variety of doses, ranging from 2.5 milligrams (mg) to 200 mg. However, taking these drugs after eating a high-fat meal does slow the rate of absorption.

Most of them stay in your bloodstream for about four to five hours.

Cialis is the exception, as it remains in your bloodstream for up to 36 hours.

The length of time a drug stays in your system may be important if you’re taking other medications. You shouldn’t take any of these drugs more than once in a 24-hour period. Viagra, Cialis, Levitra, and Stendra are usually stocked at most pharmacies. In general, most health insurance companies won’t cover their costs.

However, if you have certain medical conditions, your health plan may pay for the drug with prior authorization.

The exact price you pay for any drug will depend on your insurance plan and your pharmacy.

Generic versions of Viagra, Cialis, Levitra can cost half as much as their brand-name counterparts, if not less. The side effects of these medications are mostly similar. Below are the drugs’ most common side effects, according to their manufacturers: Side effect Viagra Cialis Levitra Stendra Stuffy or runny nose x x x x Headache x x x x Dizziness x x Upset stomach x x x Nausea x Indigestion x x Vision changes x Rash x Flushing x x x x Back pain x x x x Pain in the limbs x Muscle aches x x Sore throat x.

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. This condition, known as priapism, is a risk associated with all of these ED drugs. Unlike Viagra and the other PDE5 inhibitors, Cialis is also approved to treat enlarged prostate. Both Viagra and Cialis can be taken 30 minutes before sexual activity.

However, Cialis lasts much longer and is noteworthy for the amount of time it remains in your body. You may feel the effects of the drug up to 36 hours after you take it. The fact that it comes in a low-dose (2.5 mg) version also means that Cialis can be taken every day. A daily dose will ensure that the drug’s always in your system.

This side effect isn’t associated with any other oral ED drugs. Viagra can take 30 to 60 minutes to work in the body, while Levitra takes 60 minutes.

Levitra does have fewer common side effects than Viagra, and it isn’t associated with a rash or muscle aches.

While vision changes are considered a common side effect of Viagra, changes to color perception are only a rare side effect of Levitra.

Stendra is the newest drug on the market, and no generic version is available for sale yet. 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 and error to find the dosage that works best for you.

If you’re not sure that drug treatment is right for you, you can also give natural ED treatments a try. View side-by-side comparisons of medication uses, ratings, cost, side effects, interactions and more.

Vardenafil Remove Vardenafil from your drug comparison Viagra Remove Viagra from your drug comparison. vardenafil may also be used for purposes not listed in this medication guide. vardenafil may also be used for purposes not listed in this medication guide. May also be prescribed off label for Sexual Dysfunction - SSRI Induced.

Viagra is used to treat erectile dysfunction (ED), but will not have any effect in the absence of sexual stimulation. A headache, stomach upsets, and flushing are the main side effects.

Cialis Sildenafil Tadalafil Staxyn Levitra Caverject Impulse Alprostadil Edex Stendra Caverject Muse Avanafil.

For Erectile Dysfunction: I've been having problems maintaining an erection for 5 years, this medicine enabled me to perform like I was able to do when I was in my 20's!

She had no idea I could get that big or do what I did! For Erectile Dysfunction: It works great but I have had all different side effect at different points. I most always get flush face but then again you know it is working.

Than I have had a stuff nose after away and or slight headache.

I even once had the bright light effect at night but it all goes away in time. I find the next day I still have nice erections so it seems to work 24 hours for me.

For Erectile Dysfunction: My husband is 16 years older than me and was diagnosed with diabetes and ED. He use to take OTC herbal supplements which worked with with unreliable success but he finally talked to the dr and was given viagra samples.He takes 50 mg at a time. He takes it right before foreplay and is rock hard right on cue 30 to 60 minutes later.

Slight headaches sometimes but never enough to curb his appetite. Now his performance matches his desire and we both have multiple orgasms.

It definately works best on an empty stomach or eat low fat foods.

For Erectile Dysfunction: 58 year old with mild high blood pressure.

I'm in very good condition but was experiencing less than perfect erections.

I typically cut a 100mg pill into 4 pieces and take a 25mg piece.

For example, eat a normal lunch, come home from work at 5pm, take Viagra just before eating dinner - works for the rest of the evening.

For the absolute fastest results, for a little Saturday morning fun, take it right after waking up, wait 15 minutes (time to drink some coffee), and have at it. Vardenafil and tadalafil options for erectile dysfunction. Arnold, MD Associate professor of psychiatry Director, Women’s Health Research Program University of Cincinnati College of Medicine Cincinnati, OH.

Two new PDE-5 inhibitors have demonstrated efficacy and tolerability in clinical trials. Overview of phosphodiesterase 5 inhibition in erectile dysfunction.

Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil and tadalafil—review of the literature. Cialis (IC351) provides prompt response and extended period of responsiveness for the treatment of men with erectile dysfunction (ED). Earliest time of onset of erections with vardenafil determined in an at-home setting. Chicago, IL: American Urological Association annual meeting, 2003.

Minimal time to successful intercourse after sildenafil citrate: results of a randomized, double-blind, placebo-controlled trial.

The efficacy and tolerability of vardenafil, a new selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial.

Vardenafil for treatment of men with erectile dysfunction: efficacy and safety in a randomized, double-blind, placebo-controlled trial.

Vardenafil, a highly selective PDE5 inhibitor, improves erectile function in patients with diabetes mellitus.

Efficacy and tolerability of vardenafil in men with erectile dysfunction following radical prostatectomy.

Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. Effects of tadalafil on erectile dysfunction in men with diabetes. Efficacy and tolerability of tadalafil, a novel phosphodiesterase 5 inhibitor, in treatment of erectile dysfunction. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Sildenafil has revolutionized management of erectile

dysfunction

The PDE-5 inhibitors can potentiate erections by enhancing and prolonging the smooth musclerelaxant effects of the nitric oxide-cGMP cascade in the corpus cavernosum.

1 PDE-5 inhibitors have no effect without sexual stimulation. Sildenafil 100 mg Vardenafil 20 mg Tadalafil 20 mg Maximum concentration 450 ng/mL 20.9 ng/mL 378 ng/mL Time to maximum concentration 1.0 hour 0.7 hours 2.0 hours Half-life 4 hours 3.9 hours 17.5 hours Source: References 2 and 3. Although the three PDE-5 inhibitors have similar mechanisms of action, their selectivity differs for PDE-5 compared with the PDE-6 and PDE-11 isoenzymes.

Sildenafil and vardenafil have lower selectivity than tadalafil for PDE-5 over PDE-6, which plays a role in phototransduction, the process by which light impulses are converted into nerve impulses in the retina.

Thus, tadalafil is less likely than the other agents to cause visual disturbances such as abnormal color vision, increased brightness of light, or mild haziness.

Tadalafil shows lower selectivity than tadalis soft tabs sildenafil or vardenafil for PDE-5 over PDE-11, meaning that tadalafil inhibits PDE-11 at clinical doses. PDE-11 is found in various tissues, but its physiologic significance and consequences of its inhibition are unknown. Vardenafil, tadalafil, and sildenafil have different pharmacokinetic characteristics ( Table 1 ). A lower starting dosage is required with vardenafil than with sildenafil because of the former agent’s greater in vitro and in vivo potency, but whether this results in greater clinical efficacy or tolerability is unknown. Vardenafil and sildenafil reach maximum plasma concentration within 30 minutes to 2 hours (median 1 hour for sildenafil and 0.7 hour for vardenafil).

By contrast, tadalafil reaches maximum concentration within 30 minutes to 6 hours (median 2 hours).

However, studies of time to onset of erection indicate that about one-third of patients using the maximum recommended doses of any of these agents will experience onset within 14 to 16 minutes. Absorption rates for sildenafil and vardenafil are reduced when they are taken with a high-fat meal.

High-fat foods do not affect tadalafil’s absorption rate. Drug brand name: Levitra Class: Phosphodiesterase-5 inhibitor FDA-approved indication: Erectile dysfunction Approval date: August 19, 2003 Manufacturer: Bayer Corp. (distributed by GlaxoSmithKline) Dosing forms: 2.5 mg, 5 mg, 10 mg, 20 mg Dosing recommendations: Start at 10 mg about 1 hour before sexual activity. Maximum recommended dose is 20 mg; maximum dosing frequency is once per day.

Consider 5-mg starting dose for patients age 65 and older. Because of its 17.5-hour half-life, tadalafil has a longer period of activity than the other PDE-5 inhibitors.

Most patients can complete sexual intercourse up to 36 hours after taking tadalafil, which potentially allows spontaneous sexual activity.

Sildenafil and vardenafil each are effective for about 4 hours.

All three PDE-5 inhibitors are eliminated by hepatic metabolism, mainly by the CYP 3A4 hepatic enzyme. Therefore, concomitant use with

CYP

Drug brand name: Cialis Class: Phosphodiesterase-5 inhibitor FDA-approved indication: Erectile dysfunction Approval date: November 21, 2003 Manufacturer: Eli Lilly and Co. Dosing forms: 5 mg, 10 mg, 20 mg Dosing recommendations: Start at 10 mg before anticipated sexual activity.

Maximum recommended dose is 20 mg; maximum dosing frequency is once per day. In a placebo-controlled, 12-week trial, 7 601 men with mildly to severely impaired erectile function received placebo or 5, 10, or 20 mg of vardenafil.

Subjects receiving vardenafil at any dose saw significantly greater improvement in erectile function than did the placebo group.

Percentage of successful intercourse ranged between 71% and 74% for the three vardenafil doses.

For the 20-mg dose, 80% of patients experienced improved erections compared with 30% of those taking placebo.

In another trial of 805 men with mild to severe ED, 8 vardenafil in 5-mg, 10-mg, and 20-mg doses demonstrated efficacy versus placebo. Eighty-five percent of men using vardenafil, 20 mg, reported improved erections at 26 weeks compared with 28% in the placebo group.

Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction.

1 The University of Queensland, School of Biomedical Sciences, Australia.

Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction.

Search in PubMed Search in NLM Catalog Add to Search. 1 The University of Queensland, School of Biomedical Sciences, Australia.

Erectile dysfunction (ED) affects up to 50% of men, between 40 and 70 years of age. In the first major trial of sildenafil in ED, at 24 weeks, improved erections were reported by 77 and 84% of men taking sildenafil 50 and 100mg, respectively. Subsequently, sildenafil has been reported to be effective in men with ED associated with diabetes and prostate cancer, and in psychogenic ED.

Sildenafil is safe in men with coronary artery disease, provided it is not used with the nitrates (a contraindication). The most commonly reported adverse effects with sildenafil are headache, flushing and dyspepsia. Vardenafil is more potent and more selective than sildenafil at inhibiting phosphodiesterase-5. Vardenafil is similarly effective to sildenafil in the treatment of ED.