Viagra, Cialis and Levitra: efficacy in ED treatment

Erectile dysfunction (ED) is the inability to achieve and / or maintain a penile erection of sufficient duration and stiffness for a satisfactory and complete sexual relationship. Currently, phosphodiesterase 5 (PDE5) inhibitors constitute the first-line management for ED – they are Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil). A systematic review and meta-analysis comparing PDE5i vs. placebo in which randomized controlled trials of high quality of evidence are included, showed that PDE5i in a period of use less than 12 weeks, consistently improved erectile function and the effectiveness between the different types is similar. Studies on cardiovascular safety of sildenafil show that there is no greater risk of acute myocardial infarction and cardiovascular deaths, compared with placebo.

ED effects compared

Cialis is not affected by heavy and fatty meals, while the effects of the other two pills will be delayed and somewhat inhibited.

None of the three drugs is available in the usual pharmaceutical arsenal in primary care centers, however, they can be found in virtually all pharmacies in the national trade and in online stores. With regard to the cost of drugs, in general, the different trademarks of sildenafil are the most economical, especially if you buy those containing higher doses and with more tablets per box. Tadalafil (Cialis) and vardenafil (Levitra) have a similar price and both are generally more expensive than sildenafil.

Side effect compared

Sildenafil contained in Viagra is the medicine that has the largest number of safety and adverse effects studies. In it, we can see that 34% of the patients reported some adverse effect, however, only 0.012% of the patients discontinued the treatment attributing it to side effects.

When comparing the adverse effects of the different ED drugs, these are similar, not very serious and the discontinuation rates due to an adverse effect are very low. The use of Viagra is more likely to result in headaches and changes to color perception, while Cialis causes muscle aches. Other common side effects for all the three drugs include:

• indigestion
• facial redness
• nausea
• stuffy / runny nose

To choose the best ED drug, you should also consider other factors such as time of action, cost, adverse effects and patient and partner preferences.

Some practical recommendations on the use of Viagra, Cialis and Levitra

Generalities: Avoid smoking or consuming alcohol the hours prior to its use, control the other cardiovascular risk factors when appropriate, evaluate withdrawal and / or substitution of drugs that may aggravate ED and preferably include the opinion of the sexual partner in the diagnostic process and treatment

Dosage: Viagra, Cialis and Levitra are prescription medications whose appointment and dose should be regulated by a doctor. Start sildenafil with a dose of 50mg and if it is well tolerated but the response is not as expected, it could be increased to 100mg. You could even try 25mg if the response is good. Take the medicine 30 to 60 minutes prior to sexual intercourse (action window up to 4hrs) and take the drug away from meals (decrease absorption) and only once a day. The same concerns the doses for Cialis and Levitra: start with the median ones of 10mg and ask your doctor to adjust the it up to 20mg or down to 2.5mg-5mg (Cialis) or 5mg (Levitra) if needed.

Patient information: Inform that although most of the time, success occurs in the first 2 times of use, it could take up to 8 doses to reach the success of the treatment. Discuss with the patient the possible frequent side effects, check the concomitant use of nitrites (contraindicated). Use with caution in users of alpha adrenergic antagonists.

Finally, schedule a control to see the response to treatment, optimize dose and evaluate referral to urology in the next controls if there is no adequate response to treatment.

The PDE5 inhibitors are widely used medications given their proven effectiveness, safety profile, mild side effects and affordable cost in their generic versions. Except for contraindications, they constitute the therapy of first line for the ED.