Medically reviewed by: Thomas Fischer (Pharmacist). This article has been written according to strict guidelines and medical standards.
Medically reviewed by: Thomas Fischer (Pharmacist)
It has long been accepted that as men grow older, sexual problems are typical. These days though, they tend to be more open about the issues. Modern medical advances have brought some solutions to the table to treat the conditions. The new treatments have made it possible for men to continue to be sexually active longer. Several medical problems can affect sexual health. Erectile dysfunction is one of the most common conditions that affect guys at some point in their lives.
How prevalent is erectile dysfunction in American men? It can happen at any age, but it indeed becomes a more common problem due to age. The University of Wisconsin says that 5% of men over the age of 40 experience complete erectile dysfunction. That increases to 15% for those over the age of 70.
Cialis, Viagra and Levitra are the most known treatments of erectile dysfunction (ED). What is the difference between them? Which medication is better? Taking a closer look at three drugs may resolve all these important questions.
What is Erectile Dysfunction?
Erectile dysfunction (ED) is the inability to reach and maintain an erection firm enough to engage in sexual activity. While very common, it can cause emotional stress, affect a man’s self-confidence, and contribute to problems in their relationships. It is a very complex activity that involves the muscles, nerves, hormones, brain, and blood circulation to all work together to achieve an erection.
The components for men to function sexually are:
- Have a healthy libido, or a desire and interest in sexual activity
- Need to be able to reach and maintain an erection
- Can ejaculate and climax
Erectile dysfunction happens when one or all of those components are affected. The ability to attain and keep an erection is most commonly affected. Treatment options are offered based on which part is affected and how the medication will fit within the lifestyle you lead.
Did you know?
Causes of Erectile Dysfunction
Physical Causes:
- Injuries to the spine or penis
- Heart disease
- Diabetes
- Obesity
- High cholesterol
- High blood pressure
- Medication interactions
Psychological Causes:
- Anxiety and Depression
- Stress
- Fatigue
Environmental Causes:
- Alcoholism
- Communication difficulties with a partner
- Drug abuse
- Smoking
What are Viagra, Cialis, and Levitra?
Viagra, Cialis, and Levitra are medications that are used to treat erectile dysfunctions. These drugs do not work on their own. Men need to engage in sexual activity to activate the medication.
These three drugs are similar in that they are all in a drug classification called phosphodiesterase type 5 inhibitors (PDE5). They block the enzyme PDE5 and boost the nitric oxide in your body, allowing the muscles in the penis to relax. When that is combined with sexual activity, blood flow to the penis is improved, and an erection can develop.
What Are the Differences Between Viagra, Cialis, and Levitra?
While Viagra, Calis, and Levitra are all PDE5 inhibitors, they all work differently. The first difference is that they all have separate active ingredients. Another contrast is that they have different onset periods and stay in the body for diverse lengths of time. This can affect how long sexual activity can last or how other medications work in your body.
Drug Name | Active Ingredient | Uses |
Viagra | Sildenafil | Treats erectile dysfunction and pulmonary arterial hypertension. |
Levitra | Vardenafil | Treats erectile dysfunction and can also treat premature ejaculation |
Cialis | Tadalafil | Treats erectile dysfunction, pulmonary arterial hypertension, benign prostatic hyperplasia |
Similarities |
| |
Differences |
| |
Which Drug Is More Effective?
To determine which ED treatment is best, a man needs to discuss his symptoms with his physician. They are all effective and safe to use. The most effective isn’t dependent on the drug; it is about the person. What may be the best for one man isn’t the same for another. The most likely deciding factor between the three medications will be other health conditions you may have, your lifestyle needs, and the cost of the medicines.
Levitra was found to be more potent than Viagra, and both were effective in treating erectile dysfunction. Viagra seems to work better when erectile dysfunction is associated with psychological issues; and men who have diabetes or prostate cancer. Men with coronary artery disease can take Viagra if they do not use nitrate-based medications to treat coronary artery disease.
Cialis effects last longer than Levitra or Viagra. Levitra does not have the side effect of altering color perception, as can happen with Viagra. Cialis seems to have fewer side effects than either Viagra or Levitra.
Viagra vs. Cialis vs. Levitra: Which Drug Is Cheaper?
The cost of each medication will be different depending on whether or not you have health insurance coverage, what your coverage is, and the dosage. Without insurance coverage, Viagra will cost about $60/pill, Cialis can range from $12-$44/pill, Levitra can cost up to $60/pill.
To lower costs when insurance coverage is not possible, some companies offer savings coupons or pricing for low-income patients. Some companies partner with drug companies and negotiate lower prices for medications. There are websites and mobile apps that track medication prices and can offer discounts and coupons.
Our tip: How to buy ED treatments with online prescription
Can I Take Viagra, Cialis, and Levitra Together?
It is unlikely that a physician will prescribe all three medications for you to use at the same time. You should never use medicines that have not been prescribed to you. Talk to your doctor if you feel the dosage should be adjusted or the drug just isn’t working for you.
The danger of combining them is that they can make your blood pressure lower dangerously. If the current medicines you are using is not working, talk to your doctor about using another erectile dysfunction medication. It’s entirely possible your doctor will recommend switching to another one of the three, but never to combine them.
Which Medication Has the Fastest Reaction?
When using Viagra, it should be taken between 30 to 60 minutes before sex. With stimulation, the drug should begin to react in another 30 minutes. Levitra should also be taken about an hour before sex. Generally, though, it tends to kick-in a little earlier than Viagra.
Cialis can be used in two different ways. It can be taken daily in small doses, which means an erection can be achieved with some sexual stimulation. If Cialis is consumed on an “as needed” basis, it should also be taken about 30 minutes before sex and start to work 30 minutes later. The dose used for an as-needed basis is higher than the daily dose.
Viagra vs. Cialis vs. Levitra: Comparing Hardness
The main difference between the 3 drugs is the amount of time they stay in the body. Both Levitra and Viagra tend to remain for around 4-5 hours. It’s possible to have sex an additional time during this window. Cialis is the exception. For patients choosing the as-needed option, it can remain in the body for up to 36 hours. For those taking the daily dose, sexual encounters can be successful at any time as it is always present in the bloodstream.
As for hardness, none of the drugs have been reported to be better than the other. Once the active ingredient begins, in most cases, the penis can successfully generate a satisfactory erection.
Side Effects In Comparison
The 3 medications share a number of the same side effects, and all have their own unique ones, this table clearly summarizes it:
Side Effect | Levitra | Viagra | Cialis |
Headache | ✔ | ✔ | ✔ |
Stuffy or Runny nose | ✔ | ✔ | ✔ |
Stomach Upset | ✔ | ✔ | ✔ |
Flushing | ✔ | ✔ | ✔ |
Dizziness | ✔ | ✔ | |
Back pain | ✔ | ✔ | ✔ |
Nausea | ✔ | ||
Muscle pain | ✔ | ✔ | |
Color vision changes | ✔ | ||
Rash | ✔ | ||
Flu-like symptoms | ✔ | ||
Memory problems | ✔ | ||
Diarrhea | ✔ | ||
Limb pain | ✔ |
Contraindications in Comparison
With any medication, there are always contraindications. These are factors that can cause harm to a person if they use the drug while having certain medical conditions. There are several conditions that all three medicines do not work well with. With all three of these ED medications, there are the same significant contraindications that they have.
Men who take nitrate drugs to treat chest pain should not take erectile dysfunction medicines. Some of these medications are isosorbide dinitrate, isosorbide mononitrate, and riociguat. Nitrates can cause a drop in blood pressure severe enough to cause death.
Men who have a health history of heart attack or stroke in the previous six months should not take erectile dysfunction medications. The drug can cause blood clots to form, and it can be dangerous for people who have a risk of stroke or heart disease.
Men who have a history of high blood pressure should not use Viagra, Levitra, or Cialis. ED medications can cause a life-threatening drop in blood pressure.
If you suffer from any of the following conditions, inform the physician before taking Viagra, Cialis, or Levitra:
- Angina
- Bent penis with erection
- Chronic heart failure
- Fibrous tissue formation in the penis
- Hearing loss
- Hereditary retinal dystrophy
- Hypertrophic cardiomyopathy
- Irregular heart rhythm
- Leukemia
- Liver problems
- Low blood pressure
- Multiple myeloma
- Narrowing of the aortic heart valve
- Peyronie's disease
- Pigmentary retinopathy
- Previous heart attack
- Previous stroke
- Problems with food passing through the esophagus
- Pulmonary Veno-Occlusive disease
- Severe insufficiency of the autonomic nervous system
- Severe renal impairment
- Sickle cell anemia
- Sudden vision loss due to loss of the blood supply to the front of the optic nerve
- Uncontrolled high blood pressure
Cialis Has Additional Contraindications With These Conditions:
- Alcohol intoxication
- Increased risk of bleeding due to a clotting disorder
- Pigmentary retinopathy
- Restrictive cardiomyopathy
- Seizures
- Stomach ulcer
- Sudden vision loss due to loss of the blood supply to the front of the optic nerve
Levitra Should Not Be Used With Individuals Who Have This Additional Contraindication:
- Prolonged Q.T. interval on EKG
Medication Interactions
There can be interactions with other medications you may take as well. Make sure your physician knows if you take any of these medications. Some of those drug interactions are:
- Alpha blockers such as Flomax, Uroxatral, Cardura, Terazosin, Tamsulosin
- Amlodipine, Norvasc, Amturnide
- Antifungals such as Ketoconozole, Onmel, Itraconazole
- Beta-Blockers such as Nadolol, Labetalol, Inderal LA, Toprol XL, Propranolol, Atenolol, Lopressor
- Blood thinners such as Warfarin, Coumadin
- Bosentan
- Cimetidine
- Diflucan
- Efavirenz, Sustiva
- Erythromycin
- HIV protease inhibitors such as Prezista, Atazanavir, Saquinavir, Lopinavir, Fosamprenavir, Darunavir, Indinavir, Tipranavir
- Illegal or "street drugs"
- Multaq
- Nelfinavir
- Nitroglycerin
- Noxafil
- Rifadin, Rifater, Rimactane
- Seizure medications such as Phenytoin, Tegretol, Phenobarbital, Dilantin, Epitol, Carbamazepine
- St. John's Wort
- Tracleer
- Viramune
Food Interactions
Even foods can cause medication interactions. Foods and drinks to avoid while taking these medications are:
- Alcohol
- Food, especially high-fat meals, can slow the effect of ED. Cialis is the exception to this.
- Grapefruit and grapefruit juice, as they are known to thin the blood too
How To Buy Your Erectile Dysfunction Medicine With An Online Prescription
Because all of the ED medications are available by prescription only, a patient must consult their physician before using them. Virtual pharmacies offer convenience, good accessibility, especially for people who live in rural areas and can have lower costs. A patient may feel more comfortable ordering sexual health medications from website pharmacies rather than at their regular drug store.
An excellent web-based pharmacy will have a licensed pharmacist who is willing to answer any questions you may have. Check with your usual drug store; many have online patient portals where you can fill and manage your prescriptions online. If that is not available, then you can use other telehealth services.
It should have a physical address in the US, but not a post office box only. Look for a US-based phone number to contact them. They should also have policies put in place to protect your financial and personal information.
The doctor will review your medical history to decide which drug will be most useful to treat ED. Tell the doctor about your concerns, lifestyle, existing medical conditions, and ask any questions you have about any treatments that they suggest.
You’ll need to have a phone or video consultation with them. Then, if the physician feels that a prescription for either 3 drugs is appropriate, you can fill it either at your regularly used pharmacy or as part of the online transaction.
Article Sources
- The management of phosphodiesterase-5 (PDE5) inhibitor failure. Lau D.H., Kommu S., Mumtaz F.H., Morgan R.J., Thompson C.S., Mikhailidis D.P. Curr Vasc Pharmacol. 2006 Apr; 4 (2): 89-93
- Therapeutic effectiveness and patient satisfaction after 6 months of treatment with Tadalafil, Sildeanfil and Vardenafil: Results from the Erectile Dysfunction Observational Study. Antonio Martin-Morales et al. European Urology; Volume 51, Issue 2, February 2007, Pages 541-550. URL: sciencedirect.com
- A multicenter, randomized, double-blind crossover study to evaluate patient preference between Tadalafil and Sildenafil. Alexander von Keitz et al. European Urology; Volume 45, Issue 4, April 2004, Pages 499-509.
- “Sustained efficacy and safety of vardenafil for treatment of erectile dysfunction: a randomized, double-blind, placebo-controlled study” Valiquette L et al., Mayo Clin Proc. 2005 Oct;80(10):1291-7.
- Frantz, Robert et al. Conversion From Sildenafil to Tadalafil. Results From the Sildenafil to Tadalafil in Pulmonary Arterial Hypertension (SITAR) Study. Journal of Cardiovascula Pharmacology and Therapeutics Volume 19, 04/2014. Sage Publications.
- Sáenz de Tejada, Iñigo et al. Effects of Tadalafil on Erectile Dysfunction in Men With Diabetes. Diabetes Care Volume 25, 12/2002. In: American Diabetes Association. URL: diabetesjournals.org
- Sustained efficacy and safety of vardenafil for treatment of erectile dysfunction: a randomized, double-blind, placebo-controlled study. In: Valiquette L et al., Mayo Clin Proc. 2005 Oct;80(10):1291-7. URL: ncbi.nlm.nih.gov
- Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil and tadalafil–review of the literature, Gresser U et al. URL: ncbi.nlm.nih.gov
- U.S. Food and Drug Administration. VIAGRA® (sildenafil citrate) Tablets. URL: https://www.accessdata.fda.gov.
- Huang SA, Lie JD. Phosphodiesterase-5 (PDE5) inhibitors In the management of erectile dysfunction. P T. 2013;38(7):407-19. URL: https://www.ncbi.nlm.nih.gov