Why You Don’t Need to Take Cialis in the Morning and Viagra at Night
Can You Take Cialis in the Morning and Viagra at Night?
By definition, erectile dysfunction (ED) is a continuing inability to get and maintain an erection firm enough for sexual intercourse.
Several medications are effective treatments for ED, including Cialis and Viagra. To minimize the chance of experiencing adverse effects, follow the advice of the drug manufacturers and your healthcare provider. Mixing Cialis and Viagra is not recommended.¹ Here’s why.
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What are Cialis and Viagra?
Cialis (tadalafil) and Viagra (sildenafil) are the two most common phosphodiesterase inhibitor (PDE5 inhibitor) medications in the world.²
Both drugs have been approved by the US Food and Drug Administration (US FDA) as safe and effective treatments for ED.³ ⁴
How do they work?
Neither Cialis or Viagra directly causes an erection, and these medications are not a cure for ED.⁵
Rather, they treat the symptoms of ED by increasing blood flow to the penis. You also need to be sexually aroused for Cialis and Viagra to work.⁶
Phosphodiesterase is an enzyme in the body that prevents erections from occurring. It breaks down a molecule called cyclic GMP which relaxes the muscles in the blood vessels and helps to increase blood flow to the penis, so an erection can happen.
PDE5 inhibitors — including Cialis and Viagra — block the phosphodiesterase enzyme from having this effect on cyclic GMP.
This process allows an erection to take place.
Can you take Cialis and Viagra at the same time?
Unless your doctor directs you to do so, it’s not recommended to take Cialis and Viagra on the same day. (Cialis stays in your body for approximately 36 hours).⁷
Cialis and Viagra are mainly taken on an as-needed basis when having difficulty achieving an erection.
Typical instruction is to take either Cialis or Viagra around 30 minutes before having sex.,⁸ ⁹
If you follow all the guidelines for taking either Viagra or Cialis, and you continue to experience ED, speak to a healthcare professional instead of taking the two drugs in the same day. A doctor can screen you for underlying health issues and present you with different treatment options and (possibly) medication adjustments.
What might happen if you take them at the same time?
In most instances, taking Viagra and Cialis together would have similar effects to taking a double dose of either medication, which could be dangerous and ineffective.
Similarly, it’s not safe to take Cialis in the morning and then take Viagra the same night because Cialis lasts up to 36 hours in the body.¹⁰
In other words, if you were to take Cialis in the morning, it would still be in your system when you take Viagra later that day.
Wait at least 36 hours before taking Viagra, another dose of Cialis, or any other PDE5 inhibitor.
Likewise, if you take Viagra at night, you shouldn’t take Cialis or any other PDE5 inhibitor the next morning.
Although Viagra is generally only effective for a few hours, it can still linger in your system, so wait at least 24 hours.
Although you should not take Cialis and Viagra simultaneously or within 36 hours, it may be okay to alternate outside this timeframe.
Still, it’s best to seek guidance from your prescribing doctor before you do.
What are the side effects of taking them together?
Taking Cialis and Viagra together doesn’t offer a combined beneficial effect on ED.
Although Cialis and Viagra aren’t known to interact dangerously (they are both the same type of medication), you will be increasing the overall risk of side effects.
You will end up with more than the recommended amount of PDE5 inhibitor in your system.
So, you might experience symptoms much like after taking too much Viagra or Cialis. These side effects may include (but are not necessarily limited to):
Low blood pressure
PDE5 inhibitors can reduce your blood pressure. However, if you take two inhibitors, your blood could drop to dangerously low levels. You might feel this as being dizzy, lightheaded, or nauseous.¹¹
Prolonged and potentially painful erection
Priapism is a prolonged erection that lasts more than four hours. Priapism can lead to permanent ED and damage to the penis, so it should be treated as a medical emergency.
How do you know if you’re taking too much?
You will likely experience the above side effects of dangerously low blood pressure or a prolonged painful erection if you take too much Cialis or Viagra.
Cialis and Viagra are designed to be taken as needed.
However, Cialis has a low-dose option, so your doctor may prescribe it as needed or taken daily. ¹²
Why You Don’t Need to Take Cialis in the Morning and Viagra at Night
You shouldn’t take Cialis (tadalafil) and Viagra (sildenafil citrate) together to help with treating erectile dysfunction (ED).
It’s also typically recommended that you take one or the other shortly before sex, but not daily or on a regular schedule. These ED medications only work if you’re already aroused.
Taking both Cialis and Viagra can also increase your risk of side effects, such as low blood pressure.
And if you feel like you need to take a second ED medication because the first one isn’t helping, you may need to see your doctor so they can check for any underlying issues that may be causing your ED.
Let’s look into why taking both Cialis and Viagra won’t make a big difference in how easily you can get an erection, when you should seek treatment for ED, and what other home remedies for ED you can try.
Cialis and Viagra are both phosphodiesterase type 5 (PDE5) inhibitors. PDE5 is an important enzyme involved in erections that’s one of the biggest culprits behind ED.
- When your penis nerves are stimulated, you get an erection. When this happens, muscles that surround two cylinder-shaped pieces of tissue in your penis, called the corpora cavernosa, relax and fill with blood.
- When you have ED, nerves aren’t communicating between your brain and your penis to help make this process happen, so blood doesn’t flow properly into your penis.
- Viagra and Cialis block PDE5 and help relax your blood vessel walls. This makes it easier for blood to flow into your penis tissues and give you an erection.
Since Cialis and Viagra are both PDE5 inhibitors and both are used to treat the symptoms of erectile dysfunction, it is not necessary or recommended to take both at the same time.
If you want to maximize the benefits of taking a PDE5 inhibitor, it’s better to evaluate which drug better suits your lifestyle rather than double up on medications. Doubling up increases your risk of severe side effects from exceeding the recommended dosage.
For example, Cialis has a longer 24-hour window of effectiveness than Viagra, but to see the results, you need to take it daily. You only need to take Viagra as needed, but it’s only effective for a few hours.
If someone is having sex infrequently or has trouble remembering to take their medications daily, Viagra may be the better option. They should see results after just one dose and won’t see a drop in effectiveness from missing daily doses.
However, someone having more frequent or spontaneous sex — where it would be difficult to take a pill early enough before a sexual encounter — may find Cialis is the better option.
Keeping in mind how Cialis and Viagra work, here’s why it’s not necessary to take them together:
- Both Cialis and Viagra work on the same mechanism of arousal and erection. Taking both is basically the equivalent of increasing your overall dose of PDE5 inhibitor. Increasing your dose of any medication without approval from your doctor can be dangerous. Your body may not respond the same way to a higher dose of medication.
- You need to be sexually aroused for PDE5 inhibitors to work. Cialis and Viagra don’t cause erections on their own. They simply help your natural erection processes work more easily. Taking them every day won’t help if you’re not aroused.
- Cialis is designed to last much longer than Viagra. Viagra typically lasts about 4 hours after you take it. Cialis can last up to 36 hours after you take it. If you’re already taking Cialis, Viagra may not have any additional effects because Cialis is still functioning in your body.
The dosage of each medication makes it unnecessary to take them together, too.
Cialis is usually given in a low dose form of 2.5 milligrams (mg), which makes it safe to take every day on its own. The low dose also makes it less likely that you’ll experience side effects.
Viagra is given in much higher doses — the lowest available dose is 25 mg. It also needs to be taken 30 minutes or more before sex because the ingredients work much more quickly at such high concentrations.
Cialis and Viagra don’t have any dangerous interactions with each other because they’re the same type of medication.
But increasing your dose of a PDE5 inhibitor can increase your risk of side effects that are associated with these kinds of ED medications.
Here are some of the more common side effects of Viagra and Cialis:
See your doctor if you notice any of these side effects, especially if they last for a few hours after the medication has worn off or if they linger for more than a day afterward.
Cialis can cause your blood pressure to drop dangerously low when taken together with nitroglycerin (Nitrostat). Don’t use Cialis if you’re already taking nitroglycerin for blood pressure.
Seek emergency medical treatment if you notice any of the following side effects:
- sudden chest pains during or after sex
- an erection that lasts 4 hours or more (priapism)
- trouble seeing or hearing
- skin reactions like hives or eye swelling
- unexplained seizures
If PDE5 inhibitors aren’t working for you, there are some other ED treatments your doctor might recommend:
- therapy or counseling for anxiety, depression, stress, or other mental health conditions that can cause ED
- other ED medications, such as avanafil (Stendra)
- alprostadil urethral suppositories, which are inserted directly into your urethra , if low T levels are causing ED , which can help induce an erection by sucking and trapping blood in the penis
- insertion of an implant
Your doctor may also recommend one of the following experimental treatments:
Here are some other treatments you can try to help make your ED medication more effective or as alternatives to medication:
- Limit alcohol. Drinking less alcohol can improve blood flow.
- Quit smoking. Smoking can inhibit blood flow.
- Maintain a healthy weight. Exercise and a healthy diet will keep your weight down and improve your blood flow.
- Get a good night’s sleep. This will reduce stress damage to tissues that can make ED worse.
Don’t buy Cialis or Viagra without a prescription. Only your doctor can perform the examinations necessary to make sure these medications and their dosage are safe for you.
If you’re experiencing symptoms of ED on a regular basis over a period of several weeks, talk with your doctor to rule out the possibility of more severe underlying issues. Your doctor will be able to begin diagnosing your symptoms and help you find an effective treatment.
For people who are already taking Cialis or Viagra, consider seeing your doctor if you aren’t seeing the desired results from your medication or you are noticing a dip in its effectiveness. Your doctor will be able to discuss alternative treatment options or decide if you should change your dosage.
In addition, if you are experiencing severe or sudden side effects from either Cialis or Viagra, it’s important to reach out to your doctor.
As with most medications, some side effects are expected, but more severe side effects, like issues with your vision, hearing loss, and erections lasting over 4 hours should be reported to your doctor. These uncommon side effects may indicate that you have accidentally taken too much of the drug or it is having a negative reaction to another medication you are taking.
How long does it take for Viagra to work?
One of the biggest benefits of Viagra is how fast it starts working. On average, it can begin working in about 30 to 60 minutes, but it can take up to 2 hours to take effect in some people. Unlike Cialis, Viagra can work after taking just one pill and doesn’t require daily usage. It is worth noting that Viagra is only effective for a few hours and can become less reliable after 2 to 5 hours.
How long does Cialis last?
Cialis can work for an estimated 36 hours . However, Cialis does require a daily dose to be fully effective and relies on a certain level of the drug to have built up in your system. In other words, when a dose is being taken regularly every 24 hours, the effects of the drug can last as long as you are able to keep maintaining daily usage.
How does Cialis work?
Cialis works as a PDE5 inhibitor that works to block the PDE5 enzyme that restricts blood flow to the penis. Cialis is a low dose pill that requires you to take it daily so it can build up in your system and maintain its effectiveness. When used correctly, you should always be ready for sex and wouldn’t need to rely on taking a drug like Viagra a few hours in advance of having sex.
Don’t take Cialis and Viagra together. Not only will combining them not improve ED symptoms, but it can also be dangerous.
Talk with your doctor about any concerns you have about your ED and its causes. In some cases, incorporating both medication and lifestyle changes is the best way to help improve ED symptoms.
Viagra vs. Cialis vs. Levitra vs. Stendra: Which Is Best?
Viagra, Cialis, Levitra, and Stendra are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names:
About 30 million American men occasionally have a problem with getting or keeping an erection, according to the Urology Care Foundation. When ED becomes a problem, many turn to these oral ED medications. They often help address the issue.
The medications work in similar ways. However, they also have some key differences, such as when you take them, how long they work, and what their side effects are.
Viagra, Cialis, Levitra, and Stendra are all in a class of medications called phosphodiesterase type 5 (PDE5) inhibitors. These drugs work by blocking the PDE5 enzyme.
They also boost a chemical in your body called nitric oxide. This action encourages the muscles in your penis to relax. Relaxed muscles allow blood to flow freely, so you can get an erection when you’re aroused. It also helps you maintain the erection long enough to have sex.
Unlike Viagra and the other PDE5 inhibitors, Cialis is also approved to treat enlarged prostate.
Both Viagra and Cialis can be taken 30 minutes before sexual activity. However, Cialis lasts much longer and is noteworthy for the amount of time it remains in your body. You may feel the effects of the drug up to 36 hours after you take it.
The fact that it comes in a low dose of 2.5 milligrams (mg) also means that you can take Cialis every day. A daily dose will ensure that the drug’s always in your system.
If you take Cialis, there’s a chance of limb pain. This side effect is not associated with any other oral ED drugs.
| Similarities | Differences |
|---|---|
| They’re both PDE5 inhibitors. | Cialis lasts up to 36 hours in the body, while Viagra lasts 4–6 hours in the body. |
| Both are taken 30 minutes before sex. | Cialis can cause limb pain, while Viagra can cause vision change, rash, and dizziness. |
| Side effects include flushing, back pain, headaches, muscle pain, and upset stomach. |
Pros of Cialis
Cons of Cialis
Pros of Viagra
Cons of Viagra
Viagra can take 30 to 60 minutes to work in the body, while Levitra takes 60 minutes. The effects of both drugs last for about 4 hours.
Levitra does have fewer common side effects than Viagra, and it’s not associated with rash or muscle aches. Vision color changes are considered side effects of both Viagra and Levitra.
| Similarities | Differences |
|---|---|
| They’re both PDE5 inhibitors. | Viagra can be taken 30 minutes before sex, while Levitra should be taken 1 hour before. |
| Side effects include stuffy or runny nose, headaches, vision changes, dizziness, flushing, and back pain. | Levitra may increase creatine kinase levels, a sign of possible muscle injury, but is not associated with rash or muscle aches that may occur with Viagra. |
Pros of Levitra
Cons of Levitra
Pros of Viagra
Cons of Viagra
Stendra is the newest drug on the market. No generic version is available for sale yet.
A hallmark of Stendra is its fast-acting nature. You can take the 100-mg and 200-mg doses as shortly as 15 minutes before sexual activity.
As a second-generation medication, Stendra also seems to have milder side effects than Viagra and the other PDE5 inhibitors that came before it. Side effects commonly caused by Viagra — but not Stendra — include vision changes, nausea, and muscle aches.
The only common side effect caused by Stendra — but not Viagra — is a sore throat.
| Similarities | Differences |
|---|---|
| They’re both PDE5 inhibitors. | Stendra can be taken 15 minutes before sex, while Viagra should be taken at least 30 minutes beforehand. |
| Side effects include stuffy or runny nose, headaches, flushing, and back pain. | Viagra can cause side effects including nausea, muscle aches, vision changes, and rashes. |
Pros of Stendra
Cons of Stendra
Pros of Viagra
Cons of Viagra
As mentioned earlier, Cialis can be used as a daily medication to treat enlarged prostate, unlike Levitra, which is strictly used as a treatment for erectile dysfunction.
Cialis is also faster acting than Levitra. You can take it 30 minutes before sexual activity, while you should take Levitra at least 1 hour in advance.
Cialis and Levitra both have similar side effects, but some side effects unique to Cialis include muscle aches and pain in the limbs.
| Similarities | Differences |
|---|---|
| They’re both PDE5 inhibitors. | Cialis can be taken 30 minutes before sex, while Levitra should be taken at least 60 minutes beforehand. |
| Side effects include stuffy or runny nose, headaches, flushing, upset stomach, indigestion, and back pain. | Cialis can cause muscle aches and pain in the limbs, while Levitra does not. |
Pros of Levitra
Cons of Levitra
Pros of Cialis
Cons of Cialis
Here are the basic features of each of these drugs:
| Viagra | Cialis | Levitra | Stendra | |
|---|---|---|---|---|
| What’s the generic name? | sildenafil | tadalafil | vardenafil | avanafil |
| Is a generic version available? | yes | yes | yes | no |
| What form does it come in? | oral tablet | oral tablet | oral tablet | oral tablet |
| What strengths does it come in? | 25 mg, 50 mg, 100 mg | 2.5 mg, 5 mg, 10 mg, 20 mg | 5 mg, 10 mg, 20 mg | 50 mg, 100 mg, 200 mg |
| What’s the typical dosage? | 50 mg | 10 mg as needed or 2.5 mg daily | 10 mg (5 mg if you’re 65 years or older) | 100 mg |
| When do I take it? | 30–60 minutes before sex | 30 minutes before sex | 60 minutes before sex | 15 minutes before sex for 100 mg and 200 mg, 30 minutes before sex for 50 mg |
| How long does it work? | 4 hours | up to 36 hours | 4–5 hours | 6 hours |
| How do I store it? | around room temperature, between 68–77°F (20–25°C) | at 77°F (25°C) | at 77°F (25°C) | around room temperature, between 68–77°F (20–25°C) |
These medications are available in a variety of doses, ranging from 2.5 mg to 200 mg. You can take all of them with or without food. However, taking Viagra, Levitra, or Stendra after eating a high fat meal does slow the rate of absorption.
Most of them stay in your bloodstream for about 4 to 5 hours. Cialis is the exception, as it remains in your bloodstream for up to 36 hours. The length of time a drug stays in your system may be important if you’re taking other medications.
Do not take any of these medications more than once in a 24-hour period.
The side effects of these medications are mostly similar, and they’re usually mild. Tell your doctor if you have any side effects that linger and do not go away on their own.
Below are the most common side effects, according to their manufacturers:
| Side effect | Viagra | Cialis | Levitra | Stendra |
|---|---|---|---|---|
| stuffy or runny nose | x | x | x | x |
| headache | x | x | x | x |
| dizziness | x | x | ||
| upset stomach | x | x | x | |
| nausea | x | |||
| indigestion | x | x | x | |
| vision changes | x | x | ||
| rash | x | |||
| flushing | x | x | x | x |
| back pain | x | x | x | x |
| pain in the limbs | x | |||
| muscle aches | x | x | ||
| sore throat | x |
Priapism warning
If you have an erection that lasts longer than 4 hours, contact your doctor right away. This condition, known as priapism, is a risk associated with all of these ED drugs.
To get any ED medication, you’ll need a prescription. You can get a prescription through your primary care doctor or online through telehealth companies.
Unless prescribed by a doctor, online ED medications are not FDA-approved. They may contain ineffective or harmful ingredients.
Usually, you’ll go to the pharmacy to pick up your Viagra, Cialis, Levitra, or Stendra prescription. If you have health insurance, keep in mind that most insurance companies will not cover the cost of your prescription. But if you have certain medical conditions, your insurance plan may pay for the drug with prior authorization.
The exact price you pay for any drug will depend on your insurance plan, if you have one, and your pharmacy.
If you’re on a tighter budget, it’s also worth considering generic versions of ED medications like Viagra, Cialis, and Levitra. They can be just as effective at treating ED and are available at a fraction of the cost.
If your insurance company covers brand-name ED medications, they’re very likely to cover generics, too, which will bring down the price even further.
If your insurance plan doesn’t cover ED medication or you don’t have insurance, you can still get FDA-approved medication through a reputable source — but the price will be higher.
Online ED treatment companies, like Roman, Hims, and Lemonaid, all offer ED medication (brand name and generic) even without insurance.
Because these medications require a doctor’s prescription, you’ll need to meet with a doctor first. Most of these online providers allow you to meet with a licensed doctor in your state virtually.
These prices can vary based on your state, subscription package discounts, and whether you have the prescription mailed to you or filled through a pharmacy.
Here’s a quick look at what you can generally expect to pay, as of September 2022, through these services:
Viagra, Cialis, Levitra and Spedra – How Are They Different?
Viagra, Cialis, Levitra and Spedra are some of the most common drugs used right across the world to treat male impotence, or as it is better known, erectile dysfunction. Erectile dysfunction is nothing to feel embarrassed about as the occurrence of male impotence has been increasing over the last few years, and erectile dysfunction is thought to affect half of all men over 40 to some degree. They belong to a class of drugs known as PDE 5 inhibitors. It can be caused by both physical and emotional factors. As obesity levels continue to rise, so too does problems with sexual performance. As health care improves and people are living longer, erectile dysfunction is getting more and more common. In the busy world that we live in, getting stressed out is inevitable at times, which is another cause of erectile dysfunction.
Help is at hand, with a variety of treatments available in order to prevent erectile dysfunction. Many men find success with counselling, but a variety of oral drugs can help produce an erection in response to sexual stimulation. The four orally administered drugs available in the UK, Cialis, Viagra, Levitra and Spedra have revolutionised the treatment of erectile dysfunction since 1997.
Viagra/Sildenafil
Viagra is the trade name of a drug called Sildenafil which is the world’s most commonly used drug to treat erectile dysfunction. It had a 45% market share in the erectile dysfunction drugs market in 2012. It is prescribed as a diamond-shaped blue pill with VGR on one side and the tablet strength in mg on the other. When a man gets an erection, the nervous system releases nitrous oxide, which stimulates the production of cyclic guanosine monophosphate. This relaxes the smooth muscle, causing increased blood flow to the penis. Viagra works by maintaining the levels of cyclic guanosine monophosphate so an erection can be maintained. Viagra works within an hour and allows an erection to be achieved following sexual stimulation up to four hours after being taken. However, it potentially has some unpleasant side effects which are thought to affect roughly 1 in 100 men who take Viagra. Some men report to experience dizziness, indigestion or headaches. Its effect can be inhibited if food is eaten, making it impractical for many people. Viagra can now be easily bought online, how safe it is though?
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Spedra
Cialis & Tadalafil (As Needed)
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- 2 Take medical consultation
- 3 Doctor issues prescription
- 4 Medication dispensed from pharmacy
Cialis/Tadalafil
Cialis & Tadalafil (Once a Day)
Cialis is the trade name of tadalafil, and works in the same way Viagra does, in order to achieve an erection. It is an almond-shaped yellow pill with a C on one side and the tablet strength in mg on the other side. Cialis however, differs from Viagra in that it takes as little as 15 minutes in order to take effect, and allows an erection to be had up to 36 hours after being taken. Cialis also has the advantage in that it can be taken with food, whereas with Viagra, the patient must have an empty stomach. This makes the drug much more practical than the others. Cialis also has a form in which daily tablets can be taken and it for these reasons that Cialis is becoming more popular. Cialis does, however, have some of the same potential side effects as Viagra does, so it is not without its flaws.
Levitra
Levitra, or as it is sometimes known by its proper name, Vardenafil is another oral treatment for erectile dysfunction, working in the same way as Viagra and Cialis. Levitra is a round orange pill with Bayer written horizontally and vertically on one side, and the tablet strength in mg on the other side. Levitra takes around half an hour to take effect, is faster than Viagra but slower than Cialis. Levitra lasts up to 10 hours after being taken, which is again, better than Viagra but not as good as Cialis. Levitra is also thought to be less likely to have side effects when taken than the other 3 drugs.
Spedra
Finally, Spedra (or avanafil as it is more properly called) is another new oral drug that works using a similar mechanism to the other 3 drugs. Spedra is an oval shaped yellow pill with the strength in mg on one side and Vivus on the other side. Spedra is the fastest out of the four drugs. It has been known to work in as little as 15 minutes, but usually takes 20-30 minutes. It lasts for 4-5 hours after being taken, which is similar to how long Viagra lasts but is quite short when compared with Cialis or Levitra. Spedra is a relatively new product, only having been approved for marketing distribution in the European Union in June 2013, so not much is known about the side effects of the drug, but it is thought to be relatively safe like Viagra, Cialis and Levitra but may cause headaches or reddening of the skin in some cases. Spedra can be taken with or without food. However, it is recommended that no food is taken because it is likely to increase the time taken to become effective. Cialis isn’t affected at all by food being taken with the tablet, so it comes out on top in that regard.
Cialis can be taken as 2.5, 5, 10, and 20mg tablets whereas Viagra is available in 25, 50 or 100mg tablets. Levitra comes as 5, 10 or 20mg tablets and Spedra usually is taken as 100mg tablets. Patients are usually told to start on a small to medium size dosage and if that isn’t effective and there are no adverse side effects, then the dosage may be increased.
However, there is not a definitive drug that is the best for everyone. As mentioned previously, Viagra is the most popular drug to treat erectile dysfunction, so it is the drug that has the most availability and most research done to ensure it is safe, making it a good choice for some men. Cialis is ideal for men who need a fast-acting drug or for men who prefer to take a daily form of medication. Viagra and Spedra are suitable for use in men who don’t want the drug to be effective in their system for an extended period of time. Levitra is best used in men who are worried about experiencing side effects with their drug.
The choice in the drug that men use to treat erectile dysfunction is largely dependent on their personal requirements. Some of the drugs will work brilliantly in some men, and the same drug may have no effect in others. Finally, always remember that erectile dysfunction medication of any kind should not be taken if you suffer from a cardiovascular disease, or if you are already on a drug that contains nitrates, as it can interfere with your heart.
The best way of preventing erectile dysfunction is to live a healthy lifestyle. Exercise improves blood circulation and relieves stress. This could potentially improve your ability to maintain an erection without the use of Cialis, Viagra, Levitra or Spedra. Quitting smoking can help also, as hardens your blood vessels, reducing blood flow to the penis.
Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected] .
Viagra, Cialis, Levitra, and Stendra: Which is better?
Four popular drugs are widely available for treating the symptoms of erectile dysfunction (ED).
The drugs are phosphodiesterase 5 (PDE5) inhibitors, and their brand and generic names, respectively, are Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), and Stendra (avanafil).
They all have approval from the Food and Drug Administration (FDA), and they have the same function. However, there are some differences between them.
Understanding these differences can help a person choose the most suitable option.
The drugs are all PDE5 inhibitors, and they all work in a similar way. They help relax the muscles and increase blood flow to the body.
This makes it easier for blood to enter the penis, and it allows people with ED to experience a lasting erection during sexual activity.
The drugs act relatively quickly, but the precise timing depends on the drug.
This table shows when to take the drug, the usual starting dose in milligrams (mg), and how long the effect is likely to last. It is of note that a doctor may adjust the dose for people with certain health conditions and those using other medications.
| Drug name | When to take it | Starting dose | How long it lasts |
|---|---|---|---|
| Viagra (sildenafil) | 30 minutes–4 hours before sex, but preferably 60 minutes before | 50 mg maximum once daily | 4–12 hours |
| Cialis (tadalafil) | daily, at the same time each day | 10 mg maximum once daily | 17.5–36 hours |
| Levitra (vardenafil) | 60 minutes before sex | 10 mg maximum once daily | 4–12 hours |
| Stendra (avanafil) | 30 minutes before sex | 100 mg maximum once daily | 3–6 hours |
Viagra, Cialis, Levitra, and Stendra are all drugs for treating the symptoms of ED.
A doctor will reach a diagnosis of ED if a person meets one of the following criteria :
- never being able to get an erection
- often being unable to get an erection
- being able to get an erection but one that does not last long enough for sexual intercourse
Aspects of physical and mental health can contribute to ED, and a doctor will discuss these and lifestyle habits with the individual before prescribing these drugs.
Doctors may not prescribe the drugs to a person who has a cardiovascular health issue, which makes sexual activity dangerous for them.
The drugs are also not suitable for use with certain medications. Below, learn more about medications that can interact with these drugs.
Viagra, Cialis, Levitra, and Stendra have many similar side effects and interactions, but there are also some variations.
Anyone considering using these drugs should speak with a doctor first. The drugs may not be suitable for everyone, as they may affect a person’s existing health conditions or interact with other drugs the person is taking.
None of these drugs are suitable for an individual whom a healthcare professional has advised to avoid sexual activity because they have cardiovascular issues or are taking nitrates for a heart condition.
Using these drugs with nitrates or alpha-blockers may lead to a sudden fall in blood pressure, resulting in dizziness, faintness, and possibly falls and injuries.
An older study in rodents suggests that the following medications may increase the concentration of PDE5 inhibitors in the body, and therefore, an individual should consult a doctor before using ED drugs with any of them:
Grapefruit juice is a CYP3A4 inhibitor and may increase the impact of these drugs.
The following table compares the possible adverse effects of the four drugs.
| Viagra | Cialis | Levitra | Stendra | |
|---|---|---|---|---|
| Side effects | • headache • nasal congestion • flushing • indigestion • nausea • dizziness • rash • vision changes • muscle aches and pains, or myalgia |
• headache • nasal congestion • flushing • indigestion • back pain • limb pain • muscle aches and pains |
• headache • nasal congestion • flushing • sinusitis • indigestion • flu-like symptoms • back pain • nausea • high levels of creatine kinase |
• headache • nasal congestion • flushing • a sore throat • back pain |
| Serious side effects (need immediate medical attention) | • vision loss • priapism, which is an erection lasting 4 hours or more |
• vision loss • priapism |
• vision loss • priapism • sudden hearing loss |
• vision loss • priapism • hearing loss |
Viagra drug interactions
- nitrates, such as nitroglycerin
- alpha-blockers
- drugs to decrease blood pressure
- CYP4 inhibitors, such as ritonavir, ketoconazole, and erythromycin
Cialis interactions and warnings
People should not use Cialis with the following drugs:
- nitrates
- alpha-blockers
- drugs to reduce blood pressure
- CYP3A4 inhibitors, such as ketoconazole and ritonavir, as they can increase the impact
- CYP3A4 inducers, such as rifampin, an antibiotic, as they may prevent Cialis from working
Levitra interactions and warnings
Individuals should not use Levitra if they have an irregular heartbeat or are using the following:
A doctor may adjust the dose if the person has liver problems or is already using one of the following:
- ritonavir, indinavir, saquinavir, or atazanavir, which are antiretroviral drugs doctors use to treat or prevent HIV
- the antifungal medications ketoconazole or itraconazole
- the antibiotics clarithromycin or erythromycin
Stendra interactions and warnings
A person should not take Stendra with nitrates or any strong CYP3A4 inhibitors, such as ketoconazole or ritonavir.
A doctor may adjust the dose if an individual is using alpha-blockers or a moderate CYP3A4 inhibitor , such as erythromycin, amprenavir, or diltiazem.
People should take care when using Stendra with the following, as they can lead to a drop in blood pressure:
Other concerns
Individuals should also take care that their product is an approved version and follow a doctor’s guidance when purchasing any of these drugs.
In 2020, for example, the FDA advised people not to purchase an imported product sold as a supplement called U.S.A Viagra.
The FDA warned that this product contains sildenafil but is not an approved form of Viagra and could be dangerous, especially for people with certain health conditions and those taking drugs that may interact.
The cost and availability of each drug can affect a person’s decision. All four drugs are widely available across the United States, but costs vary greatly.
Generic versions of Viagra, Cialis, and Levitra have approval from the FDA. These may be cheaper than brand-name drugs.
| Brand name | Available since | Pros and cons |
|---|---|---|
| Viagra | 1998 | • possibly the best-known drug for ED • generic version available • suitable for using only when a person needs sexual stimulation • effect lasting up to 12 hours • can use with alcohol |
| Cialis | 2003 | • widely available and may be cheaper than Viagra • suitable for people with benign prostatic hyperplasia • generic version available • suitable for daily use to keep the body ready for sexual stimulation at any time • effect lasting up to 36 hours • can use with up to 5 units of alcohol |
| Levitra | 2003 | • generic version available • suitable for using only when a person needs sexual stimulation • effect lasting up to 12 hours • can use with alcohol |
| Stendra | 2012 | • adjustable dose, by a doctor, to use with certain drugs • may have fewer adverse effects • no generic version yet available • effect lasting up to 6 hours • can use with up to 3 units of alcohol |
While these drugs can help manage ED, a doctor may recommend trying making lifestyle changes before taking medication.
- , if applicable
- limiting alcohol consumption, if applicable
- increasing physical activity
- reaching or maintaining a moderate body weight
- avoiding the use of some recreational drugs
- seeking counseling to help manage anxiety and stress
It is advisable for anyone who has concerns about ED to consult a doctor, as they may be able to help. For example, they may prescribe one of these drugs.
If a person is already using one of these medications, they should contact a doctor if the drug is not helping or if they experience side effects such as vision changes. The doctor may recommend changing the dose or drug type.
Individuals should seek immediate medical attention if they experience any of the following:
Viagra, Cialis, Levitra, and Stendra can help a person get an erection, but they will not cure ED. Other possible treatments include testosterone therapy and, in some cases, surgery.
Below, we answer some of the most common questions about Viagra, Cialis, Levitra, and Stendra.
Which is better: Viagra, Cialis, Levitra, or Stendra?
The choice will depend on a person and various factors, such as whether or not the person has sex regularly, other medications they are taking, and the cost and availability of the ED drugs.
Individuals should consult a healthcare professional to help them decide.
Do these drugs make you bigger?
They do not. They improve blood flow to the penis during an erection, but they do not change the size of the penis.
Which pill lasts longer?
The effects of Cialis (tadalafil) last up to 36 hours, but this only means a person can have an erection or multiple erections within that time. It does not mean they will have an erection lasting 36 hours.
Viagra, Levitra, Cialis, and Stendra can help a person with ED get and maintain an erection.
There are many side effects and interactions to consider. However, studies show that, with the right choice and correct use, these drugs can help a person overcome ED and engage in sexual activity.
It is of note that none of these drugs will provide sexual stimulation. The person will need stimulation in order to have an erection.
The only way to decide on the best drug may be through trial and error. Working directly with a doctor can help a person track side effects and decide which drug is most suitable for them.
Last medically reviewed on March 22, 2022
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