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All PDE5 inhibitors are contraindicated with nitrates.

1,2 The longer duration of action of Cialis means it is at higher risk for drug interactions, 1 and dosages may need reducing in men with kidney or liver disease.

Cialis is not recommended in men who have had a heart attack or stroke within the past 6 months, with either uncontrolled high blood pressure or severely low blood pressure, unstable angina, or other conditions that make sexual activity inadvisable.

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 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 purchase viagra no prescription 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. Cialis (tadalafil) and Viagra (sildenafil) are phosphodiesterase-5 (PDE5) inhibitors used for treating impotence (erectile dysfunction, or ED). Common side effects of Cialis and Viagra that are similar include flushing (redness or warmth of the face, neck, or chest), headaches, stomach pain or upset, flu-like symptoms (such as stuffy nose, sneezing, or sore throat), memory problems, muscle or back pain, blurred vision and changes in color vision (such as an inability to differentiate between the colors green and blue), dizziness, diarrhea, nausea, low blood pressure, abnormal ejaculation, and prolonged erections (priapism), loss of hearing, and ringing in the ears.

One difference between the drugs is how long they stay in your system. Cialis provides penile hardness (the ability to obtain an erection) over a longer period than Viagra because it lasts up to 18 hours, while Viagra only lasts for about 4 to 6.

Cialis (tadalafil) and Viagra (sildenafil) are oral drugs that are used for treating impotence (the inability to attain or maintain a penile erection) and benign prostatic hyperplasia (BPH). They are in a class of drugs called phosphodiesterase-5 (PDE5)

inhibitors

Nitric oxide then activates the enzyme, guanylate cyclase, which causes the production of cyclic guanosine monophosphate (cGMP).

It is the cGMP that is primarily responsible for the erection by affecting the amount of blood that the blood vessels deliver and remove from the penis.

Cialis and Viagra inhibit an enzyme called phosphodiesterase-5 (PDE5) which destroys the cGMP.

Thus, Cialis and Viagra prevent the destruction of cGMP and allows cGMP to accumulate and persist longer.

The longer cGMP persists, the more prolonged the engorgement of the penis. If you are taking Cialis and you have nausea, chest pain or dizziness during sex, seek medical help immediately as you may have a life-threatening condition.

The most common side effects of tadalafil are: facial flushing (reddening), headaches, stomach upset, diarrhea, flu-like symptoms, and nausea. Tadalafil also may cause: low blood pressure, blurred vision, changes in color vision, and abnormal ejaculation. Priapism, or an erection that lasts more than four hours that can damage the penis. If you are taking Viagra and you have nausea, chest pain or dizziness during sex, seek medical help immediately as you may have a life-threatening condition. Approximately 15% of persons taking Viagra experience side effects. The most common side effects are: facial flushing (1 in 10), headaches (1 in 6), stomach pain, nasal congestion, nausea, dizziness, rash, urinary tract infections (UTIs) diarrhea, and an inability to differentiate between the colors green and blue. Priapism, or an erection that lasts more than four hours that can damage the penis.

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Cold Stages of Lyme Disease Flu Shot Alopecia Areata Chiggers Bites. For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity (tadalafil for use as needed). Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day. Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions).

For once daily use without regard to sexual activity, the recommended dose is 2.5 to 5 mg daily. Tadalafil should not be taken more than once daily.

The recommended dose for BPH, or BPH and ED is 5 mg daily taken about the same time each day. Tadalafil may be taken with or without food since food does not affect its absorption from the intestine.

The dose of tadalafil may require adjustment for patients with reduced kidney or liver function.

The usual recommended dose is 25 to 100 mg 1 hour before sexual activity.

The elderly (over 65 years of age) should start at 25 mg before sexual activity.

Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state.

When sildenafil is taken with a high fat meal, the rate of absorption is reduced, with an average delay in the time to maximal concentration of 1 hour. The breakdown and elimination of tadalafil from the body may be decreased by erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Therefore, these drugs may sildenafil generics pharmacy increase the levels of tadalafil in the blood. If these drugs are being used at the same time as tadalafil, the dose of tadalafil should be reduced to 10 mg every 72 hours when used as needed or 2.5 mg when used daily in order to avoid side effects from high levels of tadalafil.

Rifampin, carbamazepine (Tegretol, Tegretol XR, Equerto, Carbatrol), phenytoin (Dilantin, Dilantin-125), mcdonald pharmacy viagra and phenobarbital may decrease blood levels of tadalafil, possibly reducing the effect of tadalafil.

Tadalafil exaggerates the increases in heart rate and lowering of blood pressure caused by nitrates, for example, nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating heart pain (angina). In patients who take nitrates for angina, tadalafil could cause heart pain or possibly even a heart attack by exaggerating the increase in heart rate and the lowering of blood pressure.

Therefore, tadalafil should not be used with nitrates.

Tadalafil also exaggerates the blood pressure lowering effects of some alpha-blocking drugs for example, terazosin (Hytrin) that primarily are used for treating high blood pressure or enlargement of the prostate (BPH). Individuals who take these alpha-blockers should be on a stable dose of the alpha-blocker before tadalafil is started. In such situations, tadalafil should be started at the lowest dose.

If the patient is already taking tadalafil, the alpha-blocker should be started at the lowest dose. Combining tadalafil with alpha-blockers for treatment of BPH is not recommended. Therefore, combining tadalafil with alcohol may cause excessive drops in blood pressure and cause dizziness, headaches, and increased heart rate.

PDE5 inhibitors may affect platelet function and therefore prolong bleeding. Tadalafil should be used cautiously in patients with bleeding disorders or active ulcers. Tadalafil should not be combined with Adcirca (another form of tadalafil) or other PDE5 inhibitors, for example, vardenafil (Levitra) or sildenafil (Viagra, Revatio).

Viagra increases the effects of the blood pressure lowering medications.

It also increases the blood pressure lowering effects of nitrates, for example, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating angina.

Patients taking nitrates should not receive Viagra. Patients should not combine Viagra with other PDE5 inhibitors (for example, vardenafil [Levitra], tadalafil [Cialis]).

Cimetidine (Tagamet), erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), atazanavir (Reyataz), and mibefradil (Posicor) can cause marked increases in the amount of Viagra in the body. Patients taking these medications should be observed carefully if sildenafil is used. It is expected that rifampin will decrease blood levels of Viagra and probably reduce its effectiveness.

Are Cialis and Viagra safe to use while pregnant and breastfeeding? Tadalafil is not approved for women and has not been evaluated in women who are breastfeeding. Although extensive testing in animals has demonstrated no negative effects on the fetus, Viagra has not been studied in pregnant women.

There is no effect on sperm count or motility of sperm in men.

It is not known whether sildenafil is excreted into breast milk.

Subscribe to MedicineNet's General Health Newsletter. By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time. Cialis (tadalafil) and Viagra (sildenafil) are oral drugs that are used for treating impotence (the inability to attain or maintain a penile erection) and benign prostatic hyperplasia (BPH). They are in a class of drugs called phosphodiesterase-5 (PDE5) inhibitors that also includes vardenafil (Levitra, Staxyn ODT), and avanafil (Stendra).

Learn mcdonald pharmacy viagra about erectile dysfunction causes and treatments such as drugs. Enlarged Prostate (BPH) Symptoms, Diagnosis, Treatment.

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