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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), and odds ratios (ORs) were calculated for dichotomy [both with 95% confidence intervals (CIs)]. 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 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 selling viagra online 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. Visit Back2BU for the latest updates and information on BU's response to COVID-19. Students can find additional information in the Undergraduate Student Guide and Graduate & Professional Student Guide. Goals Center for Sexual Medicine Faculty and Staff Make an Appointment For Health Care Professionals Training Opportunities. The most common sexual dysfunctions in men include lack of interest, premature ejaculation and erectile dysfunction. The latter affects 52% of men between the ages of 40 and 70, including mild, moderate and complete forms of ED. Organic or physical causes for sexual dysfunction in men include vascular, hormonal and neurologic factors. Concerning vascular causes, the risk factors for atherosclerosis (including smoking, high blood pressure, diabetes (diabetics do not respond well to pills like sildenafil (Viagra)) and high cholesterol are ALSO risk factors for erectile dysfunction. Since a straddle injury or use of a narrow saddle can obstruct and impair arteries to the penis, bicycle riding is also considered a risk factor for erectile dysfunction. Little attention has been paid to endocrine factors. Testosterone modulates desire, arousal and orgasmic function. Concerning the orgasmic response, testosterone modulates the integrity of genital sensory receptors. Concerning the arousal response, decreased testosterone blood levels can influence the efficacy of sildenafil (Viagra). If the sildenafil response is not reliably improving erection, the physician should first check if the patient is taking the pill correctly. The physician should also check the patient’s testosterone level. One investigator in Italy gave testosterone to patients with low testosterone who did not respond to sildenafil (Viagra). When daily testosterone was given, subsequent sildenafil (Viagra) use resulted in IIEF (the International Index of Erectile Function questionnaire used to determine erectile function) scores improving significantly. Other risk factors for erectile dysfunction include neurologic problems (multiple sclerosis, stroke), depression and medications for treating diabetes, hypertension, heart disease and depression. There are many oral therapies for erectile dysfunction, but the only approved medication in the US is the PDE 5 enzyme inhibitor sildenafil (Viagra). Unapproved therapies, some of which are available in the US and some elsewhere, some of which have data to prove efficacy and some not, include tadalafil (Cialis), vardenafil (Levitra), yohimbine, phentolamine, trazodone, apomorphine and neutraceuticals. PDE5 inhibitors act to relax penile erectile tissues with sexual stimulation thus enhancing your ability to get an erection. Sildenafil (Viagra) is effective for all sorts of erectile dysfunction in 69% of people. In some cases the erection is not hard enough, sometimes sildenafil (Viagra) just doesn’t work. Structurally vardenafil (Levitra) is similar to sildenafil, while tadalafil (Cialis) is very different. Vardenafil (Levitra) is almost 10 times more biochemically potent than sildenafil, therefore a lower dose is needed to facilitate the penile erection, potentially resulting in less side effects. Selectivity is the ability of the drug to attach to the specific enzyme PDE 5 found in penile tissues. Vardenafil (Levitra) is more selective than sildenafil and tadalafil (Cialis) to PDE5, which again means a lower dose is needed with potentially less side effects. Tadalafil is very specific for PDE5 and is also very specific for the enzyme PDE11. Unfortunately, we don’t know much about PDE11, which is found in the heart, in the pituitary gland in the brain and in the testicles. Pharmacokinetics, half-life, is how long the medication stay s in the blood. Sildenafil ( Viagra) has a half-life of 4 hours and vardenafil (Levitra) has a half-life of 4-6 hours while tadalafil (Cialis) has a half-life of 17.5 hours. This means that vardenafil (Levitra) should act longer than sildenafil (Viagra) but the clinical significance is not known. Tadalafil (Cialis) has the longest half-life and allows you to take the medication and not relate the sexual activity to the immediate use of the medication. The drawback is if you need nitrates after using tadalafil (Cialis), this medication lasts a long buy viagra no prescription time in your blood stream and may place you at a higher risk. Younger people might do well treated with tadalafil, ( Cialis) while older people with other health issues might be better off using sildenafil (Viagra) or vardenafil (Levitra) but more data are needed. The side effects of vardenafil (Levitra) are potentially less than sildenafil (Viagra), but more data are needed. In a recent study on men with erectile dysfunction and diabetes, vardenafil (Levitra) improved their erectile dysfunction. Tadalafil (Cialis) is as effective as sildenafil (Viagra), and vardenafil (Levitra) with similar side effects except for back pain that occurs occasionally with tadalafil, probably because of the long half-life. Many people stop taking drugs because they are experiencing side effects, they no longer have a partner, or they are worried about safety. Sexual activity is not a major contributor to the risk of a heart attack. Sexual activity, with or without sildenafil (Viagra) increases the chance of an MI during sexual activity by only 0.1%. If pills fail, there are vacuum devices, Muse, injections, bypass surgery and implants. The patient making a presentation has had penile bypass surgery. In addition he takes testosterone and sildenafil as needed.. This is a classic example of why people with ED need complete care: a psychological exam, history and physical exam, and diagnostic studies with long term follow-up care. Patients with ED should not just be prescribed sildenafil (Viagra) and then be lost to follow-up. These medications have the same active ingredient and the same effect, medically. The difference between them is in the branding and availability. Generic medications like Sildenafil are cheaper, but just as effective as branded ones like Viagra. It can be easier and cheaper to get Sildenafil, either online or through the NHS. Please check your spelling or try another treatment name. Viagra and sildenafil have different names, so you’d be forgiven for thinking that they were two completely different drugs. In fact, Viagra and sildenafil are identical in all of the following ways : Their active ingredients (sildenafil citrate) Dosages (drug strength) Efficacy (how well they work) How long they take to start working How long they work for Safety and side effects The size of the packs they come in Restrictions based on your current health status or other medications you're taking. – it’s really common for medicines to have more than one name. These are – their generic name (usually the name of the active ingredient of the drug), and one or more different brand names (chosen for marketing purposes). In this case, sildenafil is the generic name, and Viagra is one of the brand names, for a medication with the active ingredient sildenafil. In other words, Viagra is the brand name given to the generic medicine sildenafil. – when a new drug is discovered, the pharmaceutical company that discovers it takes out a legal patent so that other companies can’t market that same drug for a certain length of time. This means that they are the only people selling it on the market, and therefore reddit buy cialis have control over the pricing. In this case it was Pfizer owning the patent for Viagra until 2003. There are still some differences – despite containing the same active ingredients, and working in exactly the same ways, there are some differences between the two drugs. Viagra and sildenafil are different in terms of : Price (Viagra is more expensive) Manufacturer (they are made by different companies) Availability on the NHS (only certain people will be able to get an NHS prescription for Viagra, whereas sildenafil is more commonly prescribed and widely available) Medical studies under the brand name – there is also a wider range of evidence from drug trials about Viagra available. This is simply due to the fact that it has been on the market for much longer, and doesn’t mean that it is any more or less safe than sildenafil. Changes to non-medical ingredients – some branded and unbranded drugs also contain small differences in their inactive ingredients, the other ingredients in the drug used to make the medicine. This is why some medicines that work in the same way can look different, but the differences are rarely ever significant. Branded and unbranded medicines are usually interchangeable. Online availability – at Zava, both sildenafil and Viagra are available to order, as well as a wide range of other drugs used in the treatment of erectile dysfunction (ED). However, only Viagra is currently available in our erectile dysfunction trial pack of three different medications – Viagra, Levitra and Cialis. Whether brands are important to you – often, the choice between Viagra and sildenafil comes to personal preference and an instinctual feeling of safety with branded medicines. However, this is simply an effect of the marketing, as both drugs are exactly the same. How much you want buy viagra no prescription to pay – price-wise, Viagra is more expensive, and is only available to a certain few on NHS prescription. Most of the time, you will have to go privately to get Viagra, whereas sildenafil is much more readily available and cheaper too. Where you are getting your treatment from – the only real difference between buying Viagra or sildenafil would come about if you are getting your prescription in-person from your GP. If you buy your ED treatment using a registered online doctor’s service, your method of purchase will be exactly the same for both drugs. What’s the difference between branded and generic medication? No medical difference – medically-speaking, branded and generic medication is the same. They both contain the same active ingredient and work in the same way. Viagra) is medication given a brand name by its manufacturer for marketing purposes. Generic medication is usually named after the active ingredient of the drug itself (e.g. Cost to you – branded medication tends to cost more than generic medication, because of the popularity of the brand name. However, both are just as safe to use, and both are regulated in exactly the same way (by the MHRA). This is why lots of people choose the cheaper option of buying generic medication over more expensive branded medication, to save money. Are there other branded/generic medications for erectile dysfunction? Tadalafil and vardenafil are the two other generic medications that are available in the UK. Tadalafil is the generic version of Cialis, and vardenafil is the generic version of Levitra. Other branded medicines include: Tadalafil and Cialis has the same relationship – Tadalafil (the generic medicine) and Cialis (the branded medicine) both contain the same active ingredient, and work in exactly the same way, just as with sildenafil and Viagra. Different active ingredients are medically different – ED treatments with different active ingredients work differently on different people, depending on the root causes of your ED, and your different personal needs. Talk to your nurse or GP if you want more information on which ED treatments could work best for you, or order our trial pack to see which suits your needs. Dr Nicholas Antonakopoulos graduated from the University of London in 2006. He did his postgraduate training in hospitals in the London area, and he trained for four years in Trauma and Orthopaedic Surgery before completing his training in General practice in 2015. Is Viagra the World's Most Popular Male Sexual Performance Drug? by Michael Castleman, December 11, 2013 | Comments: 0. In four studies where couples used Viagra, then Cialis (or vice versa), the women strongly preferred the latter. En espanol | In the pantheon of globally recognized buy generic viagra without prescription brand names, Viagra is right up there with Coca-Cola and Rolls-Royce. In terms of user satisfaction, however, Viagra (sildenafil) runs a distant second to Cialis (tadalafil). I found 12 studies — none of them funded by the drug companies themselves — in which men from various countries tried both drugs and then reported which one they chose to continue. And the 8,300 participants favored Cialis by a wide margin — 3 to 1, on average. In studies that also included the third major erection drug, Levitra (vardenafil), Cialis was still substantially more popular than either competitor. In four studies where couples used Viagra, then Cialis (or vice versa), the women strongly preferred the latter. Blindfolds: A classic sex accessory A better sex life? Take the slow route Date night ideas for couples in a rut. Join AARP Today — Receive access to exclusive information, benefits and discounts. Viagra and Levitra are effective for approximately four hours, Cialis for 36. If a man takes Cialis on Friday evening, he can count on erection assistance through part of Sunday. Both men and women say they like the fact that Cialis allows them to take their eyes off that ticking clock and make love whenever they wish. So for dating couples or new lovers who prize sexual spontaneity, Cialis has a clear advantage. Oddly, Cialis is favored by a less sexually impulsive group as well: long-term spouses, who are likelier to schedule sex dates. The drug's more wide-open window of opportunity apparently makes for friendlier spousal negotiations over time and place. Except for their duration of action, all erection medications function in similar fashion. They work equally well if taken on an empty stomach or after a meal. None produce spontaneous erections, so no mortifying bulges in the produce aisle; they enhance firmness only in the context of erotic stimulation. Their side effects are quite similar, too: headache (16 percent of users), upset stomach (7 percent) and nasal congestion (4 percent). (Important note: Never use erection generic viagra 150 mg pills medications if you're taking nitroglycerin for angina; the combination can be fatal . Remember how close we came to losing Jack Nicholson in Something's Gotta Give? ) And you might be surprised to learn how few older men use any erection drug at all: Sales of "vitamin V" have never reached more than about half of what experts predicted when such medications were first approved in 1998. When Cornell researchers surveyed 6,291 older men on the subject, 48 percent reported some degree of erectile dysfunction, but only 7 percent had ever tried an erection drug. One reason is that, compared with women, men are less willing to take medication. But the main reason is that the drugs enhance intercourse, whereas older couples generally evolve away from the old in-out toward hand massage, oral sex and vibrator play. A "fact of life" for many older order real viagra lovers is that intercourse is a hassle. Even with drugs, erections may be iffy; even with lubrication aplenty, vaginal dryness or atrophy may cause pain during intercourse. That's why many older lovers move on from intercourse to other pleasures. And if you're no longer having intercourse, erections aren't necessary, so why take a drug? In addition, men don't need erections to have orgasms. You read that right: Given sufficient fondling, a man can have a marvelous orgasm with a semifirm or even flaccid penis. Among men who try erection medications, only half refill their prescriptions. The manufacturers claim the drugs are 70 to 85 percent effective, but research shows their effectiveness to be more in the 50 to 60 percent range; for men with diabetes, heart disease, or high cholesterol or blood pressure, it can be even lower. And wait until you hear how the studies define "effectiveness": We're not talking rock-hard porn-star erections here, but rather any increase in firmness that enables intercourse. That means even drug-fueled erections can be on the soft side, leaving many men feeling disappointed. Bottom line: If you've never tried an erection medication, you're in the majority. But if you use one, you — and your partner — will likely be happiest with one that lasts the longest. For now, according to the latest surveys, that's Cialis. Michael Castleman, publisher of the website GreatSexAfter40. com, writes about sex for AARP. Why long-married couples are splitting up One job where it pays to be in your 60s Affordable Care Act questions? See the AARP home page for deals, savings tips, trivia and more. Posted on 16 May 2016 24 October 2019 by Dr Tony Steele - Dr Fox is a CQC , GPhC , & MHRA regulated service. Both Viagra and sildenafil are widely used to treat erectile dysfunction. Viagra is a brand name for the sildenafil produced and sold by the company Pfizer. Sildenafil is also sold as a generic drug, which is medically identical to Viagra. Sildenafil citrate was created in 1989 by British scientists Albert Wood and Peter Dunn as a possible treatment for hypertension and angina; conditions associated with coronary heart disease. Nicholas Terrett, now often referred to as the father of Viagra, was named in the British patent for the drug as a heart medication.
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