Viagra, Cialis, Levitra, and Stendra: Which is best?




By Jon Johnson  


Reviewed by Alan Carter, PharmD



Function | Side effects and
interactions | Cost and availability | Who should take them? | Outlook


Viagra, Cialis, Levitra, and
Stendra are popular drugs for treating the symptoms of erectile dysfunction.
They all have approval from
the United States Food and Drug Administration (FDA), and they have the same
function, but there are some differences between them.
It is important to understand
these differences in order to make the best choice about which to choose.
Function

Viagra is the brand name for
the drug sildenafil, Cialis is the brand name for tadalafil, Levitra is the
brand name for vardenafil, and Stendra is the brand name for avanafil.
The drugs all work in a
similar way.
They are all PDE5 inhibitors.
This means they help to relax the muscles and increase blood flow to the body.
This makes it easier for blood
to get into the penis, and it allows people with erectile dysfunction (ED) to
experience a lasting erection during sexual activity.
The drugs act relatively
quickly. Manufacturers of PDE5 inhibitors recommend taking the pill at least 30
minutes to 1 hour before sexual stimulation, but the timing depends on the
drug.
How long the effect of each
drug lasts is one of the key differences between them:
  • Viagra is a drug that people
    use only when they need it. A person takes the drug 30 minutes to 1 hour before
    sexual activity, and the effects typically last for 3-5 hours.
  • Levitra may start working
    faster than Viagra, but it lasts for about the same amount of time.
  • The effect of a similar dose
    of Cialis may last up to 36 hours. For this reason, people looking for a
    long-lasting drug may choose Cialis.
  • Depending on the dose, Stendra
    will be effective after 15–30 minutes, and research shows it is effective for
    up to 6 hours.
Side effects and interactions

Viagra, Cialis, Levitra, and
Stendra all come from the same class of chemicals, and they have many similar
side effects and interactions.
For instance, manufacturers
recommend not taking PDE5 inhibitors with grapefruit or grapefruit juice,
because the fruit may affect how the drugs work. Nitrates will also interact
with these drugs, so people should not use them together.
There are some drug-specific
side effects to be aware of, however.
Viagra

The side effects include:
  • headaches
  • stomach pain
  • facial flushing
  • congestion
  • nausea or diarrhea
  • color blindness
  • blurred vision

Interactions and warnings


Interactions with Viagra do
occur, and it is important for people to be aware of them before choosing a
medication for ED. Any drugs for pulmonary hypertension may also interact with
Viagra, causing blood pressure to drop to unsafe levels.
A recent study in JAMA
Internal Medicine has suggested that Viagra could increase the risk of skin
cancer. The study found that 3.7 percent of skin cancer cases in men who used
the drug sildenafil might have been prevented by not taking it.
Cialis

The side effects include:
  • headaches
  • facial flushing
  • low blood pressure
  • congestion
  • dizziness
  • chest pain
Interactions and warnings

Cialis may have some more
serious side effects. People should not use it with guanylate cyclase
stimulators or blood pressure medications, as this combination can trigger an
unsafe dip in blood pressure.
A person who is taking Cialis
and has prostate problems should avoid prescription alpha-blockers, as Cialis
serves the same function. It will be like an additional dose.
People should also avoid
certain antifungal medications and antibiotics when taking Cialis.
Anybody who is considering
taking medications such as Cialis for ED should always involve their doctor in
the decision.
The doctor may ask if the
person has a history of any of the following:
  • heart problems
  • stroke
  • liver or kidney problems
  • stomach ulcers
  • abnormal penis shape
  • blood cell problems like
    sickle cell anemia
All of these conditions may
affect the doctor’s decision to prescribe Cialis.
Levitra

People who may have a weak
heart should avoid Levitra.
The side effects of Levitra
include:
  • headache
  • congestion
  • facial flushing
  • indigestion
  • upset stomach
  • dizziness
  • back pain
  • color blindness
Interactions and warnings
If a doctor has told a person
to avoid sexual activity due to health problems, they should avoid Levitra.
Sexual activity can put extra
strain on the heart, especially if it is already weak from heart disease.
As with Cialis, a person
should not use Levitra with:

  • guanylate cyclase stimulators
    or blood pressure medications, as these can cause an unsafe dip in blood
    pressure that can lead to fainting
  • alpha-blockers for prostate
    problems
  • certain antifungal medications
    and antibiotics
A doctor may ask a person if
they have a history of any of the following:
  • heart problems
  • stroke
  • hearing problems
  • retinitis pigmentosa, an
    inherited eye condition
  • liver or kidney problems
  • stomach ulcers
  • abnormal penis shape
  • blood cell problems, such as
    sickle cell anemia
All of these conditions may
affect a doctor’s decision to prescribe Levitra. People who are taking drugs to
treat an abnormal heartbeat should also avoid taking Levitra.
Stendra

The manufacturers of Stendra
claim that it has a low rate of side effects.
However, like the other
treatments for ED, there is a risk of adverse effects, including:

  • a headache
  • flushing
  • a stuffy or runny nose
  • a sore throat
  • back pain
  • vision problems, including
    possible sudden vision loss in one or both eyes
  • hearing problems, including a
    decrease or loss of hearing and tinnitus
  • low blood pressure
  • priapism, an erection that
    will not go away
A person should seek medical
treatment if they experience:

  • vision or hearing loss
  • an erection that does not go
    away after 4 hours
Interactions and warnings
People should not use Stendra
if they have or have had:

  • heart problems or heart
    surgery
  • pulmonary hypertension
  • low or high blood pressure
  • a deformed penis
  • a stroke
  • severe vision loss
  • bleeding problems
  • a stomach ulcer
  • kidney or liver problems
Anyone with any kind of health
condition should speak to a doctor before taking Stendra or any of these
medications.
A person should not take
Stendra with the following drugs:

  • any type of nitrate
  • guanylate cyclase stimulators,
    such as riociguat (Adempas)
  • HIV protease inhibitors, such
    as ritonavir (Norvir)
  • some antifungal medication,
    such as ketoconazole (Nizoral)
  • some antibiotics such as
    clarithromycin (Biaxin)
  • alpha-blockers and other
    medications for blood pressure
  • other treatments for ED
People can take Stendra with
or without food and with up to three servings of alcohol. It is important not
to drink more than three alcoholic drinks, for example, three glasses of wine
or three measures of whiskey, as this can lead to adverse effects.
When to see a doctor

All four medications may
sometimes cause priapism, an erection that will not go away. If a person
experiences an erection lasts for more than 4 hours, they should seek medical
attention to avoid lasting damage.
In rare cases, these drugs can
cause serious side effects, including sudden loss of vision in one or both eyes
or sudden hearing loss. If a person experiences these symptoms, they should
stop taking the drug immediately and call their doctor.
Cost and availability

The other thing a person might
consider is the cost and availability of each of these drugs. Some drugs have
been around longer and may be more widely available than others.
Generic versions of Viagra,
Cialis, and Levitra have approval from the FDA. These may be cheaper than
brand-name drugs.
Viagra

Viagra has been available
since 1998 and is possibly the best-known drug for ED in the world. Its use in
the U.S. is widespread, and most pharmacies sell it.
Cialis

Cialis has been on the market
since 2003. It is widely available and may be a cheaper option than Viagra.
Levitra

Levitra received approval in
2003, and is available in most pharmacies in the U.S. There is a generic
version, but it is not widely available.
Stendra

Stendra received FDA approval
in 2012 and is widely available in the U.S.
Who should take them?

Every person is different, and
a drug that suits one person may not suit another.
Cialis is the only drug of the
four that has approval for use by people with benign prostatic hyperplasia
(BPH) or enlarged prostate. People with both ED and BPH should consider Cialis
as their treatment option. Cialis also helps to improve urine flow.
A person can take Cialis every
day to keep the body ready for sexual stimulation at any time. This allows for
some sexual freedom that may be missing with the other options.
Viagra or Levitra may be
better for people who do not engage regularly in sexual activity and would
rather take one pill each time they plan on having sex.
Stendra does not have any
significant advantages.
Personal reasons may also
guide a choice. Each body reacts to medications differently. Side effects vary
between people, and the potential side effects may help an individual to decide
which drug suits them best. For instance, if one drug causes nausea, they might
consider another drug.
Outlook

Viagra, Levitra, Cialis, and
Stendra will not cure ED, but they may provide relief from its symptoms.
There are many side effects
and interactions to consider, but, with the right choice and correct use,
studies show that these drugs can help a person to overcome ED and engage in
sexual activity.
It is worth remembering,
meanwhile, that none of these drugs will provide sexual stimulation. The person
will need stimulation in order to have an erection.
The only way to know which
drug is best for you may be through trial and error. People should work directly
with a doctor to track side effects and decide which drug is their best
treatment option.





SOURCE: MEDICAL NEWS TODAY
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.