Medications for Treatment of Erectile Dysfunction: What’s Better, What are the Differences?

by Alex Shteynshlyuger MD

If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call 1-(646) 663-5211.

If you experience ED, it is important not to ignore the problem. Get a prompt evaluation for ED from your doctor. If you don’t see your doctor, these problems will go undetected and untreated.

What Are the Differences Between Viagra, Cialis, Levitra, And Stendra?

There a few different perspectives on this topic. Medications such as Viagra (sildenafil), Cialis (tadalafil), Stendra (avanafil) and Levitra (vardenafil) are commonly used for the treatment of erectile dysfunction in men.  In some ways, these medications are like Pepsi and Coke, very similar but each has its own fans.

The goal of using medications such as Viagra and Cialis is to allow men to (1) get an erection, (2) keep an erection, (3) get hard erections.

Cialis and Viagra for Treatment of ED

Cialis and Viagra for Treatment of ED

All oral pill medications for ED (Viagra, Cialis, Stendra), called PDE-5 (phosphodiesterase) inhibitors, work through the same mechanism, by prolonging the effect of nitric oxide molecule in the walls of blood vessels of the penis. Nitric oxide presence leads to increased blood flow to the penis.

The discovery of the role of nitric oxide on the walls of blood vessels was recognized with a Nobel Prize in 1998 as one of the most important discoveries in medicine.

Major differences between these medications are attributable to the speed and duration of their action. Individual patients also respond differently to medications such as Cialis and Stendra with one patient responding better to one medication than to the other.   This is likely due to genetic differences among individual patients.

Different patients respond better to different medications. There is no one medication that is better for everyone.

TIMING: How Fast They Kick In and How Long Do They Work

The medications that tend to work fast, tend not to stay in the system for long thus limiting the duration of time that the medications are effective.

Some patients who are less able to plan sex, like fast-acting medications such as Stendra or sublingual vardenafil.  Other patients like long-acting medications such as Cialis that can stay effective for a few days.

Stendra, also known as avanafil, is one of the fastest acting medications for erectile dysfunction.  It starts to work in his little as 15 minutes.  However, it tends not to work for more than 6-8 hours.

Viagra (sildenafil) and Levitra (vardenafil) tend to have an intermediate, onset and they tend to be effective in as little as 30-60 minutes.  They tend to be in the system and work for up to 6-12 hours.

Cialis (Tadalafil) usually takes about an hour to start working but stays in the system for as long as 2-3 days thus earning the name of “weekend” drug.  As a result, 1 pill can be taken every 2-3 days, usually 10 or 20 mg.  An alternative way to take Cialis to take a small dose daily usually 2.5 mg or 5 milligrams.

Effectiveness of Medications for ED

While all oral pills used for the treatment of ED are very similar, they have a slightly different effect on different men.  One medication may be more effective for one man, and another medication may be more effective for another man.

Side Effects of Medications for Impotence

Side effects of medication class known as PDE-5 inhibitors (Cialis, Stendra, Viagra, and Levitra) are similar but not identical, as they are chemically similar but not identical.

It is important to recognize is that while the side effects themselves are similar, different medications may have a different effect on an individual person.  For example, one medication may cause a given side effect but another medication may not. This is the rationale for changing from one medication to another if a patient experiences side effects of a particular medication.

Additional Benefits

Cialis 5 mg daily is particularly useful for men with urinary symptoms such as frequent urination, an urgency to urinate and for treatment of other symptoms of enlarged prostate

The common side effects of PDE-5 inhibitors are as follows:

  • headaches
  • Visual disturbances
  • Hot flashes like symptoms
  • Upset stomach or dyspepsia
  • Muscle pain
  • Urinary tract infections
  • headache
  • flushing
  • upset stomach
  • abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
  • stuffy or a runny nose
  • back pain
  • muscle pain
  • nausea
  • dizziness
  • rash

Very Rare Side Effects that You Need to Know about:

  • sudden hearing decrease or hearing loss – very rare
  • sudden vision loss in one or both eyes – very rare – must go to the ER immediately
  • an erection that will not go away for >4 hours (priapism) – very rare – – must go to the ER immediately

Key to Using Medications for Erectile Dysfunction:

Medications used for the treatment of erectile dysfunction (Viagra, Cialis, Levitra, Stendra, etc)  work better if separated from food by 1-2 hours (no food before or after taking the pill for 1-2 hour).

  • Medications do not magically produce an erection. They only help with producing an erection.
  • Medications such as Viagra and Cialis will not improve sexual desire (libido).  For pills to work, man needs to be aroused and stimulated, manually – masturbation or partner stimulation.

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What You Need to Know:

If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call 1-(646) 663-5211.

We offer affordable, highest-quality urology care with or without insurance for patients from New York, other states, and international patients.   Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.


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