Can You Take Cialis in The Morning and Viagra At Night

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Viagra and nitrates don’t mix, so how are some men still taking both?

Some men get overlapping prescriptions for the ill-advised pair and yet somehow seem to navigate taking them safely, new research finds.

As any sports fan knows, thanks to the incessant drumbeat of game-time Viagra and Cialis commercials, mixing erectile dysfunction drugs with nitrates for chest pain can cause an unsafe drop in blood pressure. Most medical guidelines strongly warn men not to take both types of medications.

Researchers in Denmark and the U.S., however, have recently found that a substantial number of men are nevertheless obtaining overlapping prescriptions for both classes of drugs. But evidence suggests that they don’t appear to suffer negative health outcomes, such as heart attacks, as a result.

“We were a little surprised that we didn’t find an increased risk,” said Dr. Anders Holt, a researcher at Copenhagen University Hospital Herlev-Gentofte. He is the lead author of a study published Monday in the Annals of Internal Medicine that identified a steep escalation in the co-prescribing of erectile dysfunction drugs and nitrates among Danish men. The researchers reported no conflicting ties to the pharmaceutical industry.

So how are men managing to navigate taking the drugs safely?

While the new study couldn’t tease out how men timed taking each medication, Holt speculated that one possible explanation for the lack of apparent health consequences is that people with coronary artery disease typically take longer-acting nitrate medications in the morning and tend to take erectile dysfunction drugs in the evenings. The span of time might be sufficient to prevent harmful drug interactions.

But medical groups such as the American Heart Association advise men to avoid taking nitrates within at least 24 hours of shorter-acting erectile dysfunction drugs, including Viagra (sildenafil) and Levitra (vardenafil), and within at least 48 hours of a longer-acting drug, such as Cialis (tadalafil).

Widely used medications

In 2019, more than 4 million men and women in the U.S. received prescriptions for the top three nitrates — nitroglycerine, nitrofurantoin and isosorbide — according to the drug statistics website ClinCalc.com’s list of the top 300 medications. About 1.4 million men were prescribed Viagra and Cialis.

A 2008 study estimated that 3 percent of men in the U.S. experience severe erectile dysfunction, 6 percent experience moderate dysfunction and 26 percent experience mild dysfunction. And a 2020 paper estimated that 2.4 million men ages 40 and older have physician-diagnosed chest pain.

Both erectile dysfunction medications and nitrates cause blood vessels to dilate, which can dramatically escalate if the drugs are taken close together, potentially causing a sharp drop in blood pressure. That raises the risk of major cardiovascular health events, such as heart attacks or strokes.

Experts also strongly advise against consuming amyl nitrate, known as “poppers” and used as a recreational drug, with erectile dysfunction medications.

Spacing out doses of erectile dysfunction and nitrate medications “will decrease the chances that there will be a drug interaction,” said Dr. Robert A. Kloner, a professor of medicine at the University of Southern California, who led some of the key studies that established the American Heart Association’s safety protocol. (Kloner is a paid consultant for Sanofi, which has an agreement with Eli Lilly to sell Cialis in several countries if it were to become an over-the-counter medication.)

Results from Denmark

In the new Danish study, Holt and his colleagues analyzed medical records from nearly 250,000 Danish men ages 30 to 85 with ischemic heart disease. About 42,000 of them had stretches during which they received ongoing nitrates prescriptions.

From 2000 to 2018, the researchers found, the rate at which men received erectile dysfunction drug prescriptions increased tenfold among the entire group while soaring twentyfold among those on nitrates. By the last five years of the study period, 9 percent of those in the latter group filled at least one prescription for a drug such as Viagra within three years of having started nitrates.

The authors looked at health outcomes during periods when the men received prescriptions for both drug types and compared them to outcomes during stretches when they received just one such medication. The data suggested that receiving concurrent prescriptions for the two drug classes wasn’t associated with any increase in heart health problems, such as cardiac arrest, heart attack or stroke.

Kloner, who wasn’t involved with the research, said the findings suggest “that health care providers are likely becoming more comfortable co-prescribing these two classes of drugs despite the guidelines and are at least educating their patients about not taking them right at same time.”

The study is limited by the fact that the study authors couldn’t know for sure when men were actually taking each of the medications. But when they adjusted their analysis to focus on periods from one to four weeks after the men received new erectile dysfunction drug prescriptions, the findings held.

The authors suggest that it’s also possible that some men may, indeed, experience drops in blood pressure from taking both drugs but that that doesn’t lead to health problems substantial enough for them to visit an emergency room. The researchers had access only to hospital data, not to medical records from general practitioners.

The study also couldn’t account for drugs men obtained on the black market — a common practice among those seeking medications like Viagra.

Similar findings in the U.S.

A U.S. study from the drugmaker Sanofi, published in The Journal of Sexual Medicine in August, reached similar findings. The pharma researchers analyzed electronic medical records covering 2012 to 2016 from more than 168,000 U.S. men who had at least one erectile dysfunction drug prescription. Out of 480,000 men who had one or more nitrate prescriptions, 3,167 received medications from both drug classes during overlapping periods — without any apparent increased risk of cardiovascular health problems.

The study also had access to health care providers’ appointment notes. Those records indicated that in perhaps half of the co-prescription cases, the physicians did caution their patients about the dangers of taking the medications together or instructed them about mitigating the risk of drug interactions.

Holt stressed that men’s sexual health and well-being are as important as the rest of their physical health.

“You can definitely possess both drugs,” Holt advised men who are candidates for both nitrates and erectile dysfunction medications. “But certainly don’t take them at the same time. We don’t have evidence that that’s safe.”

Raymond Rosen, an adjunct full professor of psychiatry and behavioral services at the University of California, San Francisco School of Medicine, said, “Erectile dysfunction drugs like Viagra have been a boon to many men and their partners who suffer from this common but potentially disruptive male disorder.”

“New evidence,” said Rosen, who wasn’t involved in either of the recent studies, “has challenged this long-held belief” that men can’t take both nitrates and erectile dysfunction drugs.

Still, he said, “men should always consult with their physician or health provider before making changes in either of these medications.”

Can You Take Cialis in The Morning and Viagra At Night?

If you’ve experienced erectile dysfunction (ED), you know it can cause embarrassing moments in your intimate life.

We put so much emphasis on virility as men that even a single incident of not being able to get it up can cause shame, depression or be a huge hit to our self-esteem.

ED is a common condition, and a lot of us may be tempted as a first instinct to go a bit overboard on treatments.

It seems to make sense if you don’t think it through. Viagra® (sildenafil) is a commonly prescribed treatment for short-term ED. You take it and get a few hours of confident reprieve.

Likewise, Cialis® (tadalafil) gives you a longer period of potency, as it’s a medication you take to get 36 hours of reliable erectile function.

So why not take both as a sort of insurance mechanism?

Believe it or not, that is, in fact, a terrible idea — and not just because it won’t actually work.

Taking two ED pills, even if they work slightly differently, can cause a multitude of problems, and we’re sorry to report that none of them will be a doubling in size of your member. The effects could be more dangerous — like a heart attack, or a stroke.

To understand more clearly why this is a bad idea for you and your penis, let’s walk through the background of how erections work and how ED happens.

How Erections Work

Erections are the result of two primary processes: increased blood flow to the penis’s blood vessels, and the trapping of that blood in the penis in two long champers called the corpora cavernosa.

When you become aroused, your brain sends chemical signals to your body to dilate the blood vessels in the penis, allowing blood to flow in. The blood becomes trapped in the corpora cavernosa, keeping you erect. That’s how it’s supposed to work, if you don’t have erectile dysfunction.

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ED: What’s Going Wrong

The National Institutes of Health (NIH) defines erectile dysfunction pretty clearly: “A condition in which you are unable to get or keep an erection firm enough for satisfactory sexual intercourse.”

There are many factors that can cause erectile dysfunction. They include:

poor diet, obesity, blood flow issues, stress, anxiety, illicit or prescribed drugs and their side effects, certain habits, hormone imbalances, and more.

It’s a fairly common condition, affecting an estimated 30 million to 50 million men nationwide. And because it’s so common, the treatment options available have been tested and used extensively over the years. Two of these FDA approved and widely used treatments are Cialis and Viagra.

Cialis and Viagra are Very Similar Treatments

We’ve written about these drugs more extensively in our guide comparing the two, but Cialis and Viagra have a lot in common.

Both Cialis and Viagra are phosphodiesterase type 5 (PDE5) inhibitors, which work by blocking the breakdown of certain substances in your body leading to prolonged dilation of your blood vessels and subsequent increase of blood flow to the soft tissue of your penis.

Because PDE5 inhibitors cause dilation of blood vessels, they can also be used to treat certain types of hypertension.

Because of these effects, it’s important to talk to your healthcare provider before using Cialis or Viagra if you have a heart condition, or if you use medication for high blood pressure.

The key difference is that Viagra is a shorter term medication, typically resulting in four to six hours of effects, while Cialis can work from a day to a day and a half.

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Doubling the Side Effect Risk

You’re not going to get twice as hard from taking a double dose of either Cialis or Viagra, and likewise you’re not going to get twice as hard from taking both in the same day. The reason? It doesn’t work like that.

Cialis and Viagra both work as PDE5 inhibitors, and though they may work slightly differently in that process, they’re working on the same mechanism, which is to create the ideal conditions for an erection, not to cause one out of the blue.

Just because you’re taking these medications, doesn’t mean you’re going to get an erection — stimulation of some kind is still needed to make that happen.

But unfortunately, the fact that both drugs won’t complement each other’s positive effects, doesn’t mean that tadalafil and sildenafil(generic Viagra) won’t complement each other’s side effects. And that’s what is likely to happen.

Both Viagra and Cialis carry warnings for side effects, and most of the side effects overlap.

In addition to things like headaches, rashes, and dizziness, they can both cause sudden drops in blood pressure, which may sound like it might be a great thing for people with high blood pressure, but in fact a large drop could have serious consequences, including death.

Here’s the catch: taking both medications in overlap will likely double the amount of chance for side effects, which could effectively double the rate and degree of drop in blood pressure, and that’s where this can go from a risky choice to a deadly one.

Another possible consequence of taking two ED drugs or doubling the dose of your ED drug is priapism — an erection that lasts for several hours.

This is a painful and potentially damaging emergency that has to be attended to immediately.

And more importantly, and this can’t be stated clearly enough, there is absolutely no benefit to taking both drugs — neither Cialis nor Viagra actually cause you to have more erections.

Got that? These drugs don’t cause erections. They cause the proper conditions for erections, but you still need to be stimulated or otherwise aroused for it to happen.

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The Bigger Picture

We’re guessing you hit this story out of a sense of curiosity — we were curious too, until we did the research.

But if you were here wondering if doubling up on the pills would be a solution to your problem, you may have bigger issues you’ll want to address.

If you’re taking one or both of these medications and still not achieving erections, the cause could be psychological.

Everything from depression and low self-esteem to a problematic porn habit could be causing your erectile issues, and those are problems that you’ll want to bring to your healthcare provider, therapist or other medical professional.

There are other treatments for ED as well, including diet and lifestyle changes.

All we’re saying is that more pills are definitely not the answer if one pill isn’t working, and if one pill isn’t working, it’s time to talk to someone about other treatment options.

Don’t despair: there are plenty of options available, and your solution might be as easy as trying a different pill, dropping some bad habits or picking up some good ones.

If you’re just learning about ED, we have resources available to help you determine if either tadalafil (Cialis) or sildenafil (Viagra) are right for you.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Cialis vs Viagra: Which is Better for ED?

Many people wonder whether Cialis and Viagra are the same, including which is more effective.

Here, you can take a closer look at these most sought-after treatments.

What Is Cialis?

Cialis is a potent medication capable of alleviating erectile dysfunction and BPH (benign prostatic hyperplasia). Men with both BPH symptoms and erection problems often opt for a product like this.

The active ingredient in Cialis is Tadalafil. Cialis comes in 10 mg, 5 mg, 2.5 mg, and 20 mg tablets. Research indicates that a daily dose of 5 mg Cialis can curb lower urinary tract symptoms in men with or without erectile dysfunction.

Men can take the drug without or with food. But, it’s in your best interest to steer clear of fatty and greasy goods as they can impact the drug’s effectiveness. (2)

  • Avoid eating grapefruit or drinking grapefruit juice with Cialis. This could amplify the levels of the medication in the system, possibly triggering side effects. Grapefruit can cause problems with generic Viagra too.

What Is Viagra?

Viagra has been on the market for a long time. Over the years, this classic brand-name prescription medication for ED has gained momentum. It can help men keep or get an erection due to its active ingredient, sildenafil.

According to recent Viagra statistics, this product is one of the top-most used drugs in the United States. Since Sildenafil treatment can’t cure ED, countless men decide to use the product for an extended period.

Viagra is available in three dosages – 100 mg, 50 mg, and 25 mg tablets. The dosages are more profound than those for Cialis. To find out more, take a look at the benefits of Viagra vs Cialis.

Cialis vs Viagra Effectiveness

Which is more effective, Viagra or Cialis? When comparing Cialis vs Viagra, it’s important to discuss their potency and effect.

Both Cialis and Viagra have similar effectiveness. Cialis is reported to work for 81% of users, and Viagra for 82%.

Despite this minor difference, many men prefer Cialis over Viagra. This is mainly because it has a faster reaction time. Cialis can work as fast as 15 to 20 minutes after taking it. In contrast, Viagra needs roughly 30 to 60 minutes before it kicks in. (3)

Studies indicate that Tadalafil remained efficacious up to 36 hours after a pill. And men who took the product noticed better overall erections. In terms of potency and efficacy, sildenafil also comes in handy. However, the Viagra effects only remain for 4 to 6 hours. (4)

So, how does Cialis work vs Viagra? And do you need a prescription for Cialis or Viagra? Both products promote better blood flow to the penis. They can only work if the user is sexually aroused, though.

If your desire for sex has plummeted, and you struggle to keep or get an erection, then you might benefit from a prescription.

Does Viagra make you harder than Cialis?

Both medications are equally effective at alleviating ED. The easiest way to know if Viagra or Cialis is more effective is to see how the body reacts to it. Some people prefer Viagra, while others opt for Cialis.

Benefits of Cialis vs Viagra

There is a lot of buzz around Viagra and Cialis. Here is a quick look at their benefits:

  • Cialis (Tadalafil) is faster-acting than Viagra (Sildenafil).
  • You can take Cialis on short notice, like 30 min before intercourse.
  • You don’t have to skip a meal before taking a Cialis pill.
  • The effects of a Cialis erection last longer than Viagra.

If you don’t like to plan your sex in advance, then a fast-acting Viagra, like avanafil, can help. It takes half an hour for the body to react to its effects, thus paving the way for quicker erections.

How can I get Viagra or Cialis?

If you need a prescription for ED, see your health provider. It’s best to do a medical consultation to know which product can accommodate your needs. You can order online or visit your local pharmacy.

What Are the Main Differences Between Cialis and Viagra?

The primary difference between Cialis and Viagra is their duration and onset of effects. Even if you can use either option to have sex multiple times, Cialis lasts longer – up to 36 hours after consuming the pill. But, you can’t expect Viagra to stay effective in that same time frame. On the contrary, it can last for 4 to 6 hours at best.

So, what’s the difference between Viagra and Cialis? Another factor that sets them apart is the effect onset. You can pop a Cialis pill half an hour before sex. But, you should be taking Viagra at least 1 hour before intercourse.

Is Cialis as Strong as Viagra?

People want to know the impact of Cialis vs Viagra and whether they can rely on Cialis to be better than Viagra. Cialis is a modern alternative to Viagra.

Viagra has been on the market for longer than Cialis, so it has a better reputation. But Cialis provides a quicker onset.

So, is Cialis stronger than Viagra? Data shows their strength is similar. However, Cialis lasts for an extended time. This, therefore, makes it a popular medication.

Which Drug Works Faster?

When you think about whether Cialis or Viagra is better, another thing that comes to mind is how soon you can notice the results. Cialis acts quicker than Viagra. Sometimes it can work in 15 to 20 minutes or 30 minutes. But, this will vary from person to person.

Which Medication Lasts Longer?

Cialis lasts longer than Viagra. You can feel its impact for up to 36 hours. The product remains in the body for an extended amount of time.

On the other hand, the effects of Viagra typically last for two to three hours. But in some people, Viagra lasts up to five hours.

What about drug interactions?

Because Cialis acts longer, the risk for drug interactions is bigger. Some patients with liver or kidney ailments might need to decrease the doses. Talk to a doctor if you have any ailment before taking ED treatments.

Which Medication Has Fewer Side Effects?

Like any medication, adverse events with Viagra and Cialis can happen. The side effects of Viagra and Cialis are very similar.

They can lead to a runny or stuffy nose, headaches, upset stomach, and skin flushing. Viagra can also trigger a bluish or greenish tinge.

For a better perspective, you can see the impact of the side effects of Cialis vs Viagra when you take a look at how long they last. Since Cialis stays in the bloodstream for longer, its side effects can also take a while to dissipate. Viagra leaves the system at a faster rate, so the duration of the side effects is shorter.

So, which is safer, Cialis or Viagra? Both products can be safe to use. But, the adverse reactions with Viagra don’t last as long as they do with Cialis. For those who worry about the extended Cialis vs Viagra side effects, Viagra can be a slightly better choice.

Which Medication Is Cheaper?

Is Cialis cheaper than Viagra? This is another notable distinction to mention. The major difference between the Cialis vs Viagra is cost and the product’s duration.

Because Cialis stays in the bloodstream for a while, this is also reflected in its price. Viagra is a bit cheaper than Cialis.

But, the Viagra vs Cialis costs will vary based on the strength of the tablet you purchase. For a 50-100 mg Viagra strength, you can expect to pay roughly $80 per tablet. While with Cialis, you will be spending about $70 for a 20 mg product per tablet, or $12 for the 5 mg alternative.

Can Cialis And Viagra Be Taken Together?

Countless men want to know, can Cialis and Viagra be taken together? And what happens if you take Viagra and Cialis together?

People ask whether you can mix Viagra and Cialis because they want faster and better results. The truth is, you shouldn’t combine these meds. Mixing them will only do more harm than good and going overboard with the doses can amplify the risk of side effects.

How long after taking Cialis can I take Viagra?

Don’t use Viagra in the next 36 hours after using Cialis. Talk to a specialist if you plan on switching from Viagra to Cialis.

If your erection isn’t satisfactory, then something else could be the root of the problem. ED medications might not work if you have an underlying health condition. Like complications with hormones, blood vessels, or nerves.

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Are There Any Natural Alternatives to Cialis and Viagra?

Some people who are taking Viagra and Cialis experience adverse reactions. As a result, many are opting for natural alternatives. Supplements can make a practical addition to your ED management kit. Particularly options like:

Horny Goat Weed

Studies show that horny goat weed can have a range of beneficial compounds in treating sexual dysfunction, mainly impotence in men.

Traditional Chinese medicine uses the potent qualities of the plant to enhance sexual activity. It can promote adequate blood flow to reach the penis and get an erection. (5) (6)

Korean Ginseng

Korean Ginseng is another remarkable natural alternative. People are using ginseng for sexual function.

In one study, 119 men with mild-to-moderate erectile dysfunction received four tablets of Korean ginseng berry or a placebo. The trial lasted for eight weeks, and the patients took tablets daily.

Oral administration of the extract improved all aspects of sexual function. This makes it a practical option for bettering sex life in men with sexual dysfunction. (7)

Yohimbe bark

On that note, you can obtain a Yohimbe bark extract as a dietary supplement. It can be a good way of bypassing the uncomfortable adverse events of conventional medicine. Research indicates that Yohimbe can be a reasonable therapeutic extract for managing ED. (8)

Damiana

Another natural alternative is Damiana. Folk medicine considers it an aphrodisiac. People use the leaves to take their stamina and sexual arousal to the next level.

In the past, Damiana was popular for treating urinary and bladder problems. Some users enjoy the way the herb makes the bladder feel. It can bring some relief, making it a potent herbal remedy. (9)

But, do remember that herbal medicine or supplements can’t be as potent as conventional ED medicine. There are occasions when people can benefit just by taking supplements. But, for a more severe problem, medication prescriptions can help.

To find the product that can help with your particular ED problem, consult a urologist. They specialize in treating the male reproductive organs, including any urinary, kidney, or bladder problems.

Conclusion

Does Cialis work better than Viagra? There is no “miracle” pill that will make your erectile problems a thing of the past.

In terms of potency and effect, both products can work for ED. If you don’t like planning sex or want to have it at different times a day, then you can make the most of Cialis. But, if you want to better control the erection duration, then Viagra can be a more viable alternative.

Evaluation of Safety and Effectiveness of 2 Lower Dose Combined PDE5i’s Versus Single Maximal Dose PDE5i Treatment (PDE5i)

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Clinical effectiveness is of the finest tools to evaluate treatment success and is combined of 3 elements: treatment effectivity, side effect profile and patient compliance. Since the 3 main PDE5i’s differ in their molecular structure, therapeutic profile and pharmacokinetics, it seems logical to assume that combining 2 different PDE5i’s at lower dosage each may be beneficial in comparison to a single PDE5i maximal dose therapy. The aim of this study is to compare the clinical effectiveness of combination therapy (2 lower-dose PDE5i’s) versus single maximal dose PDE5i therapy.

Condition or disease Intervention/treatment Phase
Erectile Dysfunction Drug: Sildenafil 100 mg Drug: Tadalafil 20 mg Drug: Combination half of maximal dose for sildenafil & tadalafil Phase 4

This will be a prospective, randomized, 3-arm parallel trial on 60 males with erectile dysfunction (ED) that have never been exposed to PDE5i therapy (naïve patients) will be enrolled. In each group, every patient will receive three treatment regimes (Viagra®50mg & Cialis®10mg, Viagra®100mg, Cialis®20mg), in different sequences of administration.

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Layout table for study information

Study Type : Interventional (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Prospective, Randomized, 3-arm Parallel Trial to Evaluate the Safety and Clinical Effectiveness of 2 Lower Dose Combined PDE5i’s vs. Single Maximal Dose PDE5i Treatment
Study Start Date : June 2011
Estimated Primary Completion Date : June 2012
Estimated Study Completion Date : July 2012

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