Comparing Viagra, Levitra and Cialis For Erectile Dysfunction

With its introduction in 1998, sildenafil (Viagra) helped bring erectile dysfunction out of the bedroom and into the doctor's office. Since then, the drug has become a first-line treatment for men hoping to improve erectile function. But it's no longer the only pill that treats this condition. Vardenafil (Levitra) and tadalafil (Cialis) are two other available options.

Erectile dysfunction — also referred to as impotence — most commonly refers to the inability to achieve an adequate erection for sexual activity. More men are seeking help for this problem. And doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better ways to treat it.

With new medications — and more choices on the horizon — men who find one medication that doesn't work for them have other options. Find out how these medications work, what their potential side effects are and what makes them different.

Many similarities, some differences

Viagra, Levitra and Cialis work in much the same way. They enhance the effects of nitric oxide, a chemical messenger that relaxes smooth muscles in the penis. This increases the amount of blood and allows a natural sequence to occur — an erection in response to sexual stimulation. These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation.

Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence. For instance, men with high blood pressure, heart disease, diabetes, spinal cord injuries and depression have reported favorable results.

These medications share many similarities, but they have differences as well. These drugs vary in dosage, duration of effectiveness and possible side effects. Other distinctions — for example, which drug is best for certain types of men — aren't yet known. No study has directly compared these three medications.

* A drug's full range of side effects isn't known until it has been in widespread use for many years.

Choosing the best oral medication for you may depend on several factors, including how well your body handles one drug over another and the amount of time you want the drug to remain in effect. Talk to your doctor about your options and personal preferences to help decide if one of these medications might work for you.

Not for everyone: A word of caution

Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. If you've had a heart attack, stroke or life-threatening heart rhythm during the last six months, don't take these medications. If you've been told that sexual activity could trigger a cardiac event, discuss other options with your doctor.

In addition, don't take Viagra, Levitra or Cialis with nitrate medications, such as the heart drug nitroglycerin. The combination of these medications, which work to widen (dilate) blood vessels, can cause dizziness, low blood pressure, and circulation and heart problems.

Rare reports of blindness caused by nonarteritic anterior ischemic optic neuropathy (NAION) have also been reported in men using impotence drugs. However, because NAION and erectile dysfunction share many of the same risk factors, it's unclear whether the drugs themselves are responsible for NAION or whether the underlying causes of impotence, such as age, high blood pressure and diabetes, are responsible. If you’re considering an impotence drug but have a significant vision problem, see your eye doctor before taking any of these medications.

Have realistic expectations

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Don't expect these medications to fix your impotence immediately, as that's not always the case. Dosages may need adjusting. Or you may need to alter when you take the medication. For example, Viagra is best absorbed on an empty stomach, so taking the pill right after a meal can reduce its affects. If these medications don't work for you, other treatments — such as injectable agents, medication placed in the urethra (MUSE), vacuum devices or penile implants — are available.

The cause and severity of your condition are important factors in determining the best treatment or combination of treatments for you. Before taking any medication, make sure to discuss with your doctor its potential benefits and side effects.

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By Mayo Clinic staff

Last updated: 6/05

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