Medications like Viagra, Cialis, Levitra, and Stendra are popular drugs for treating the symptoms of erectile dysfunction in men of all ages.
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.
ED Medication
Cialis and Viagra are PDE5 inhibitors that help to relax the muscles and increase blood flow to the penis. Other options are Levitra and Stendra.
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 all are 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 man 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.
Viagra
There are some drug-specific side effects to be aware of, however. Viagra’s side effects include headaches
stomach pain, facial flushing, congestion, nausea or diarrhea, color blindness, and blurred vision, but these side effects can be avoided if taking the right dosage and not overdosing on the drug.
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.
Cialis
Cialis’s side effects include headaches, facial flushing, low blood pressure, congestion, dizziness, and chest pain. However, they are not compulsory to appear and can happen occasionally in the case of improper drug-taking.
Interactions and warnings
People should not use Cialis 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, but these are just possible risks and not compulsory effects. Avoid overdosing on the drug to prevent side effects and risks and consult a doctor before using the drug.
Interactions and warnings
If a doctor has recommended you avoid sexual activity due to health problems, you 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 man 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. Don’t use Levitra with alpha-blockers for prostate problems and 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 effects like a headache, flushing, a stuffy or runny nose, a sore throat, back pain, vision problems, hearing problems, and priapism (a long-lasting erection). These risks are possible to be avoided if you’ve got no precautions to taking Stendra and you follow all doctor’s recommendations concerning the prescribed dosage.
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.
Don’t 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.
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 lasts for more than 4 hours. If a person experiences an erection that lasts for long, they should seek medical attention to avoid lasting damage.
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 man may not suit another. A doctor or pharmacist can help you choose a suitable option.
Cialis is the only drug of the four that has approval for use by people with benign prostatic hyperplasia (BPH) or an 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.
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.
Shock Wave Therapy
There are several ways to treat erectile dysfunction (ED) and Peyronie’s Disease (PD). Shock wave therapy could serve as a long-term treatment for underlying physical causes of ED and PD.
Aside from medication and lifestyle changes, techniques that include injections represent on-demand treatment options. Shock wave therapy could be an alternative.
Inadequate blood supply to the penis is a common underlying cause of ED, known as vasculogenic ED. Shock wave therapy may work best for people with this condition, as experts believe it increases blood supply.
Underlying causes for Peyronie’s disease, in its turn, are not certain, however, shock wave therapy works to eliminate the consequences of this disorder by breaking the plaques within the pen and bringing relief.
Keep reading to learn more about how shockwave therapy for ED and PD works, its potential risks, and its side effects.
What is shock wave therapy?
Shockwave therapy is an alternative, non-invasive treatment for ED and PD. It is a fairly recent technique that has emerged over the last decade.
Practitioners may refer to shockwave therapy for ED and PD as low-intensity extracorporeal shock wave treatment (LI-ESWT).
How does it work?
LI-ESWT for ED and PD works by applying low-intensity shock waves to the penis. A practitioner uses a handheld probe to administer these. A gel is used as an interface to conduct the shock pulses.
People do not usually need an anesthetic, but they may experience a tingling sensation in the treatment area.
A practitioner will apply a set amount of shocks per minute, for a fixed amount of time. A session may last 15–20 minutes, and people may require repeat treatments.
The energy from shock wave therapy stimulates new blood vessel growth through a process called angiogenesis. This increases penile blood flow, which may improve erectile function and break the plaques.
LI-ESWT may also improve the effectiveness of PDE5 inhibitors, which are oral drugs to treat ED.
A 2017 study looked at the effects of LI-ESWT on ED in 710 people. Each participant received five weekly 20-minute sessions. Some also had additional drug treatments for ED.
The study results showed that LI-ESWT caused a significant improvement in erection quality in people with and without additional medication.
A month after the sessions, there was a decrease in improvement. The researchers suggest that a longer treatment duration may provide better and longer-lasting results.
Risks and side effects
Side effects of shockwave therapy for ED may include:
- bruising of penile skin;
- painful erection;
- pain or difficulty during sexual intercourse, due to the above.
However, these side effects are occasional and depend on the individual reaction of a certain patient to the treatment. They may occur just temporarily during the term of the treatment.
People may wish to take the following steps before they decide to undergo shockwave therapy:
- Consult with a primary care doctor before they decide on a treatment option.
- Talking with a urologist for further information. Urologists are doctors who specialize in urinary and reproductive health.
- Finding out about the experience, knowledge, and background of the practitioner providing ED treatment.
- Checking practitioners use a recognized shockwave machine, as some devices may not deliver effective levels of energy.
- Researching the total cost of treatment beforehand, and researching the legitimacy of any high-cost therapies.
LI-ESWT is a new and non-invasive treatment for ED and PD.
Shock Wave Therapy Found Safe, Effective for Erectile Dysfunction
Low-intensity extracorporeal shock wave therapy (Li-ESWT) is safe and effective for improving mild-to-moderate vasculogenic erectile dysfunction (ED), new data suggest.
Therapeutic success is especially pronounced among young patients with a short duration of ED and no associated comorbidities.
A team of researchers has studied 425 patients with vasculogenic ED, all of whom underwent Li-ESWT with the PiezoWave2 device. They assessed ED using the Sexual Health Inventory for Men (SHIM) score.
The SHIM includes 5 questions each having 5 possible responses scored from 1 to 5. Answer scores from the 5 questions are added to arrive at a total score, with 25 the highest attainable score. Higher scores indicate better erectile function. The investigators defined successful treatment as a 6-month SHIM score of 22 to 25 (no signs of ED). Successfully treated patients were followed up for 30 months.
The cohort had a baseline SHIM score of 11.8 (range from 5 to 20). Six months following Li-ESWT, 220 patients (51.8%) reported satisfactory sexual intercourse, with a SHIM score of 22 to 25 without the use of phosphodiesterase type 5 inhibitors (PDE5i) like Viagra or Cialis.
Shorter duration of ED, younger age, lower pretreatment SHIM score, and absence of smoking, obesity, hypertension, diabetes, or hyperlipidemia were significantly associated with improved odds of Li-ESWT success, the scientists reported.
At the 30-month follow-up, 168 (76.3%) of the 220 men still reported satisfactory sexual intercourse, with a SHIM score of 22 to 25 without the use of PDE5i, according to the investigators.
All patients had 6 Li-ESWT sessions over 6 weeks. Patients received 6000 shocks at a frequency of 8 Hz at each session. Shock waves were delivered to 5 sites (dorsal surface, both sides, and both crus of the penis).
As part of first-line treatment, healthy men with mild-to-moderate ED should be educated about lifestyle modifications to improve erectile function, the authors noted. “Li-ESWT may be a treatment option in healthy patients with mild-to-moderate ED if lifestyle changes did not improve erectile function.”
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