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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.
Learn more about ED and premature ejaculation in our dedicated hub.
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.
The following table compares these two ED medications:
People can purchase Cialis and Viagra from telehealth providers if they have a valid prescription. The following are two options people may consider.
Lemonaid Health offers a range of ED medication, including generic Viagra and Cialis, and generic daily Cialis.
To use this service, a person must answer an online questionnaire. Then, the medical team reviews the person’s health history and may ask follow-up questions before creating a treatment plan.
Lemonaid Health states that it offers ED medication starting from $2 per pill. The company recommends generic daily Cialis for people who have sex more than five times a week.
The company offers free delivery. Lemonaid Health states that people will have to pay for prescription out of pocket if they opt for delivery. If a person’s health insurance covers the cost of the medication, they can instead ask the company to send the prescription to a local pharmacy.
Read our review of Lemonaid Health here.
Levitra and Viagra have the following similarities and differences:
These medications are also available to purchase online with a valid prescription from reputable telehealth providers.
Blink Health offers telemedicine appointments and states it can help people find a lower prescription cost.
The company claims that it offers ED medication for up to 50% less than other health websites.
The first doctor’s visit and month of medication costs $10, with monthly refills starting from $17.
It states that the most common medications the healthcare professionals on this platform prescribe are generic Viagra and Cialis.
Blink Health states that vardenafil, the generic form of Levitra, starts at $622.12 for 30 tablets of 20 mg.
Hims is a telehealth company that focuses on male health. The platform offers several ED medications, including Viagra.
Hims offers generic Viagra starting at $3 per pill, and branded Viagra starting at $139 per pill.
To start with Hims, people must fill in an online questionnaire. The service will connect people to a licensed medical professional who will prescribe treatment if necessary.
The company offers free and discreet delivery.
Read our review of Hims here.
The following table provides an at-a-glance comparison between these two medications.
Stendra and Viagra are available from several telehealth providers, including the following:
Blink Health states that it can help people find the lowest price for their ED medication.
While the service offers ED treatment direct from the website for as little as $17 per month, it does not state whether it prescribes Stendra through its ED treatment plan.
Instead, Blink Health can send a prescription for Stendra to local participating pharmacies.
A bottle of six 200 mg Stendra tablets costs $414.33 through this platform.
Roman offers generic Viagra and generic Cialis.
To start treatment with this company, a person must first fill out an online questionnaire. Roman will connect people with a healthcare professional who will prescribe treatment if necessary.
Generic Viagra is available starting from $4 per dose.
Rooman offers free and discreet two-day shipping.
Read our review of Roman here.
The following table compares Levitra and Cialis:
Roman offers generic and branded Cialis and daily Cialis.
People will have to fill in an online questionnaire and connect with a healthcare professional through the service to receive a prescription.
Generic Cialis starts at $8 per dose. Branded Cialis starts at $20 per dose.
Roman offers free and discreet 2-day shipping.
The price of ED medication can vary widely depending on which medication a person chooses and whether they choose the generic or branded version of the drug.
Costs will also vary depending on whether a person’s insurance wil cover the price of the medication. People should always contact their insurance provider to see which medication it covers. Some companies may not offer coverage for branded medication.
Websites such as Optum Perks find and compare prices of medication and may offer discounts and coupons. People may find their medication at a cheaper price using a comparison site.
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:
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.
If a person experiences vision loss, priapism, or sudden hearing loss while using any of these medications, it is important to contact emergency services for immediate medical attention.
Each of the medications in this article can interact negatively with other drugs. It is important to tell a healthcare professional about any other medication a person uses to reduce the risk of negative interactions.
Viagra may interact with the following drugs:
People should not use Cialis with the following drugs:
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:
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:
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.
While these drugs can help manage ED, a doctor may recommend trying making lifestyle changes before taking medication.
Actions that may help improve ED include:
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.
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.
They do not. They improve blood flow to the penis during an erection, but they do not change the size of the penis.
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.
Tadalafil and sildenafil, the active ingredients in Cialis and Viagra respectively, have similar effectiveness and studies show that both medications improve a person’s sexual confidence.
However, both people who take the medication and their partners prefer tadalafil over sildenafil as the effects last longer.
Cialis has a longer mechanism of action than Viagra, but it will not help people achieve harder erections than they would if they take Viagra.
The manufacturers of Cialis recommend taking the medication around 30 minutes before sexual activity.
20 mg of Cialis is the maximum dose for this medication. 100 mg of Viagra is the maximum dose a healthcare professional will prescribe.
People should not exchange one medication for the other without contacting a healthcare professional.
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, 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 February 13, 2023
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