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Experiencing erection problems? Whether you’re 25 or 60+ years old, you’re certainly not alone.
About 20 million American men are affected by erectile dysfunction, or ED. Interestingly, while ED is often thought of as a condition that affects middle aged and older men, around a quarter of all men under 40 experience ED on a regular basis.
Luckily, a range of treatments are available to treat the effects of ED and help you develop and maintain an erection without any problems.
The three most popular erectile dysfunction treatments on the market are sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). These are all first-generation ED treatments that were introduced in the 1990s and early 2000s.
There’s also avanafil, or Stendra -- a new, second-generation erectile dysfunction medication that treats erectile dysfunction with a lower rate of side effects than the first-generation drugs.
All four erectile dysfunction treatments provide the same key benefit -- better blood flow to the penis and fewer difficulties developing an erection. However, they also have some differences, ranging from shorter or longer half lives to different side effect profiles.
Below, we’ve compared sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) and avanafil (Stendra) to give you a more complete understanding of the most popular medications used today to treat erectile dysfunction.
Sildenafil (Viagra)
Sildenafil, better known by the brand name Viagra, is one of the most common and widely used erectile dysfunction treatments available today.
Originally developed as a treatment for high blood pressure, sildenafil was approved as an ED drug in the late 1990s. From its introduction until 2007, Viagra was by far the most widely used erectile dysfunction drug on the market, accounting for 92% of global sales in 2000.
While sildenafil isn’t quite as dominant as it once was, it’s still by far the most popular treatment for ED.
Sildenafil works by increasing blood flow to the spongy erectile tissue of the penis, making it easier for you to achieve an erection. It usually works within 30 to 60 minutes of consumption and lasts for three to five hours, depending on the person.
You can take sildenafil with or without food, although taking it after a big meal with a lot of fat might slow down your body’s absorption of the drug.
The potential side effects of sildenafil are the same as most other ED drugs -- headaches, nasal obstruction, flushed skin and heartburn. These side effects are usually mild and stop in three to five hours as the amount of the drug in your body declines.
Sildenafil can also potentially lead to more serious side effects, particularly in people with heart conditions or those who take other prescription medication. More specifically, it can interact with certain nitrates used to treat hypertension and cause issues related to low blood pressure.
Because of this, it’s important to talk to a qualified doctor before you consider using sildenafil or any other prescription ED treatment.
Sildenafil comes in a variety of doses, ranging from 20mg to 100mg. Higher doses are typically used to treat more serious cases of erectile dysfunction for people that don’t respond to the 20 or 50mg tablets.
All in all, sildenafil is popular for a reason -- it works. For most men, sildenafil makes it easier to develop and maintain an erection and acts as a reliable, safe treatment for erectile dysfunction.
Tadalafil (Cialis)
Developed in the 1990s and approved by the FDA in 2003, tadalafil is a longer-lasting ED drug that provides similar effects to sildenafil.
Tadalafil is better known by the brand name Cialis. With a 17.5 hour half life, tadalafil remains active for up to 36 hours after it's taken, making it the longest-acting of the erectile dysfunction drugs available today.
To put this in perspective, a typical dose of sildenafil lasts for about three to five hours. To get the same results as you’d get from one dose of tadalafil, you’d need to take multiple sildenafil tablets over the course of two days.
Tadalafil starts working anywhere from 15 to 45 minutes after you take it. Like sildenafil, it can be taken with or without food.
The side effects of tadalafil are similar to sildenafil, with headache, stuffy nose, heartburn and facial flushing the most common. Tadalafil can also cause muscle aches and back pain, which are usually a result of the drug’s vasodilation effect.
Like sildenafil, tadalafil can interact with some medications used to treat hypertension and other cardiovascular conditions. Because of this, you should let your doctor know if you use any other medication before considering tadalafil.
For most people, the biggest advantage of tadalafil over sildenafil is its longer half life. A single dose of tadalafil usually lasts for most of a weekend, eliminating the need to take the pill directly before sexual activity.
Compared to sildenafil, the typical dosages of tadalafil are far lower. The normal starting dose is 10mg taken one hour before sexual activity, with doses of 5mg and 20mg also used depending on the way people respond to treatment.
Overall, tadalafil is a good option for men who dislike taking a pill immediately before sex and want a long-lasting erectile dysfunction pill suitable for entire days and weekends.
Vardenafil (Levitra)
Vardenafil is another ED drug that works similarly to sildenafil and tadalafil. Like tadalafil, it was introduced in the early 2000s as an alternative to sildenafil with a slightly longer half life, making it a longer-lasting ED treatment.
The most common brand name for vardenafil is Levitra. Like sildenafil and tadalafil, vardenafil is available as a prescription medication in most countries, meaning you’ll need to talk to a doctor before you can use it.
Compared to sildenafil, which lasts for three to five hours, vardenafil typically lasts for between five and eight hours, after which it remains active in the body but doesn’t provide as strong an effect.
A normal dose of vardenafil takes action in about one hour. Like sildenafil and tadalafil, you can take vardenafil with or without food.
On a per-milligram basis, vardenafil is significantly stronger than sildenafil and is usually used at a lower dose. The normal starting dose of vardenafil is 10mg, with tablets available in 2.5, 5, 10 and 20mg dosages.
The side effects of vardenafil are similar to other ED medications. The most commonly reported side effects include facial flushing, headaches, stuffy nose and heartburn. These typically pass as the medication’s concentration in your bloodstream decreases over several hours.
Like other ED drugs, it’s also linked to more serious side effects in people with pre-existing heart conditions who use other medications. Specifically, vardenafil can interact with nitrates similarly to sildenafil, tadalafil and other medications used to treat ED.
Because of this, it’s important to talk to a doctor before considering vardenafil or any other ED treatment.
On the whole, vardenafil is suitable for men who want something longer-lasting than sildenafil, but don’t need the 36+ hours of ED treatment that tadalafil provides.
Avanafil (Stendra)
Avanafil is a new, second-generation erectile dysfunction drug. Just like sildenafil, vardenafil and tadalafil, it’s a PDE5 inhibitor, meaning it improves blood flow to the penis and makes it easier to get an erection.
Developed throughout the 2000s, avanafil was approved by the FDA in April of 2012. In the US, it’s sold under the brand name Stendra. It’s also sold in some non-US markets under the brand name Spedra.
Unlike sildenafil and other first-generation erectile dysfunction treatments, avanafil is much more selective in the tissue it targets. This means it’s less likely to produce certain certain effects than older ED medications.
Avanafil is a fast-acting medication, taking effect in just 15 minutes. On average, avanafil works for up to six hours as a treatment for erectile dysfunction, meaning it lasts for slightly longer than sildenafil (Viagra).
The side effects of avanafil are similar to those of other ED medications, with headache, nasal congestion and facial flushing the most commonly reported. Because it specifically targets the PDE-5 isoenzyme, avanafil has a lower risk of causing side effects than other ED drugs.
Like other ED medications, avanafil can interact with some medications used to treat high blood pressure and other cardiovascular conditions, including nitrates.
Avanafil is available in several dosages, ranging from 50 to 200mg. The typical starting dose is 100mg for use 15 minutes before sexual activity, although doses of 200mg and 50mg can also be used to treat severe and mild cases of erectile dysfunction, respectively.
Overall, avanafil is an appealing option for men who want a newer ED medication with similar effects to Viagra and a lower risk of causing side effects.
Which ED Treatment is Best For You?
All four of the ED treatments covered above -- sildenafil, tadalafil, vardenafil and avanafil -- are widely used and scientifically proven to treat erectile dysfunction, meaning you should get good results regardless of which medication you use.
In general, the biggest difference between these treatments is the average amount of time each medication lasts. Some, such as sildenafil, are fairly short-acting, while others, such as tadalafil, are specifically designed to provide relief from ED that lasts for several days.
Ultimately, the best ED drug for you depends on your needs. If you’re interested in treating ED but don’t know which drug is the best choice, you should speak to an experienced ED doctor to learn more about the potential benefits and side effects of each treatment option.
This article was reviewed by Ho Anh, MD.
Important Safety Information
IMPORTANT SAFETY INFORMATION
Do not take Sildenafil (sildenafil citrate) if you:
- take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
are allergic to sildenafil, as contained in Sildenafil and REVATIO, or any of the ingredients in Sildenafil
Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate medical help
Sildenafil can cause serious side effects. Rarely reported side effects include:
- an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get medical help right away. If it is not treated right away, priapism can permanently damage your penis
- sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking Sildenafil and call your healthcare provider right away if you have any sudden vision loss
sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking Sildenafil and contact a doctor right away
Before you take Sildenafil, tell your healthcare provider if you:
- have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
- have had heart surgery within the last 6 months
- have pulmonary hypertension
- have had a stroke
- have low blood pressure, or high blood pressure that is not controlled
- have a deformed penis shape
- have had an erection that lasted for more than 4 hours
- have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
- have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- have ever had severe vision loss, including an eye problem called NAION
- have bleeding problems
- have or have had stomach ulcers
- have liver problems
have kidney problems or are having kidney dialysis have any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Sildenafil may affect the way other medicines work, and other medicines may affect the way Sildenafil works, causing side effects. Especially tell your healthcare provider if you take any of the following:
- medicines called nitrates
- medicines called guanylate cyclase stimulators such as Adempas (riociguat)
- medicines called alpha-blockers such as Hytrin (terazosin HCl), Flomax (tamsulosin HCl), Cardura (doxazosin mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl), Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of Sildenafil with alpha-blockers can lead to a drop in blood pressure or to fainting
- medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase), or atazanavir sulfate (Reyataz)
- some types of oral antifungal medicines, such as ketoconazole (Nizoral) and itraconazole (Sporanox)
- some types of antibiotics, such as clarithromycin (Biaxin), telithromycin (Ketek), or erythromycin
- other medicines that treat high blood pressure
- other medicines or treatments for ED
Sildenafil contains sildenafil, which is the same medicine found in another drug called REVATIO. REVATIO is used to treat a rare disease called pulmonary arterial hypertension (PAH). Sildenafil should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca tadalafil)
Sildenafil does not protect against sexually transmitted diseases, including HIV.
The most common side effects of Sildenafil: headache; flushing; upset stomach; abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision; stuffy or runny nose; back pain; muscle pain; nausea; dizziness; rash.
Sildenafil (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).
Sildenafil is not for women or children.