In a previous post, I spoke about how ED can be a very frightening situation for any man and how understanding the underlying causes is important in deciding what will work best to fix the situation.
In this post I will be reviewing the first line medications for ED – oral Phosphodiesterase 5 Inhibitors (PDEi). There are currently 4 in the market – Viagra (Sildenafil), Levitra (Vardenafil), Cialis (Tadalafil) and Spedra (Avanafil). Spedra goes by the name Stendra in the US.
ED is a distinct symptom from PE (Premature Ejaculation). Please click here for my article on PE.
Phosphodiesterase 5 Inhibitors (PDEi) are the most established class of ED medication. The most wellknown example is Sildenafil or Viagra. PDE are a family of enzymes found throughout the body, the subtype 5 is primarily found within penile tissue. Because this enzyme is involved in breaking down components required for an erection, inhibition of the enzyme has been proven to prolong erections. Think of it as these medicines remove the brakes on erections.
Viagra, Levitra, Cialis or Spedra? Which one is right for me?
Not all PDE5i are created equal, each have their own unique characteristics. Below is a brief run down on the 4 first line ED medications. Do note that the dosing regimen will depend on your doctors’ assessment. Also note that these are very “textbook” guidelines. At the end of the day, the fact remains that we are all unique. So it is unsurprising that the same medicine will have slightly different effects on different people.
Among my patients, all 4 brands have their fair share of fans. Sometimes, it takes a bit of trial and error before patients find the one that is right for them. In fact, many patients take a different PDE5i depending on their particular needs as a particular point in time.
Combining PDE5is is not a good idea unless specifically recommended by your Doctor. Even then, please do not exceed the dose recommended by your Doctor.
With that in mind let’s take a closer look at each of the 4 options – Viagra, Levitra, Cialis and Spedra.
Viagra - Sildenafil
Sildenafil (Viagra) – The “grand dame” of ED medications, Sildenafil was the first oral medication for ED. Launched in 1998, this famous blue pill has been the butt of many jokes. But also on a more serious note, it has been illegally counterfeited and copied many times. Sometimes leading to severe health consequences.
Good:
- Produces good rigidity
- Onset as fast as 30 minutes if taken on an empty stomach
- Available evidence that it works well on patients with Diabetes
Bad:
- Absorption can be poor when taken with a heavy oily meal
- Common side effects are similar across all PDE5i and these include facial flushing, headache, acid reflux and muscle aches
- Viagra has a higher risk of causing blue vision compared to the other PDE5i medication
Levitra - Vardenafil
Vardenafil (Levitra) – The lesser known sibling within the ED medication family, probably because it is so similar to Viagra in duration of action and interaction with food and alcohol. Levitra was launched to great fanfare in Singapore in 2006. Even engaging local football legend Fandi Ahmad and his wife Wendy Jacobs for their awareness campaign.
Good:
- Fast onset in as quick as 15 minutes for some patients when taken on an empty stomach
- Available evidence that it works well on patients with Diabetes
Bad:
- Absorption can be poor when taken with a heavy oily meal
- Common side effects are similar across all PDE5i and these include facial flushing, headache, acid reflux and muscle aches
Cialis - Tadalafil
Tadalafil (Cialis) – Cialis is quickly becoming one of the most popular treatments for ED. It was launched about the same time as Levitra. Its unique molecule makes it the longest lasting with a duration of action of up to 36 hours. This also allows it to be taken on a scheduled basis rather than only on-demand like the other medications. Cialis is also the only PDE5i that is indicated to treat symptoms arising from an enlarged prostate in addition to its beneficial effect on ED.
Good:
- Longest duration of all the ED medications at 36 hours
- Absorption is not affected by food or alcohol
- Can be used to treat symptoms caused by an enlarged prostate
- Can be taken regularly instead of on-demand improving spontaneity
Bad:
- Common side effects are similar across all PDE5i and these include facial flushing, headache, acid reflux and muscle aches
- Muscles aches are the commonest side effect
Spedra - Avanafil
Avanafil (Spedra/Stendra) – Newest ED medication on the market – launched in 2012. For a long time after the first 3 ED medications were launched, there were no new players entering the market. Then along came Avanafil. Launched with much fanfare as the “2nd Generation PDE5i”. Its main claim to fame is that it is the fasting acting – 15 minutes. It is also the shortest acting.
Good:
- Avanafil is the shortest acting ED medication with a duration of 4 to 6 hours.
- Fastest onset of 15 minutes.
- Absorption is not affected by food or alcohol
Bad:
- Common side effects are similar across all PDE5i and these include facial flushing, headache, acid reflux and muscle aches
- Short duration of action means timing when to take the pill can be tricky
So how do you decide which is the correct medication for you?
It is best to discuss this with your Doctor. Personally I take several factors into consideration before recommending a particular medicine. Factors such as age, concomitant illnesses like Diabetes or an enlarged prostate, the needs and lifestyle of the patient, whether or not other ED treatments are necessary etc.
Also, do not be afraid to try various brands to figure out which one works the best for you. As a general rule, do not take more than one tablet every 24 hours. Ask your Doctor about how to switch between different ED medicines.
Also bear in mind that treating ED is not just about getting the erections back. Frequently there is an underlying problem such as unhealthy blood vessels, scar tissue in the penis, low Testosterone levels, low HGH levels etc.
All these issues have to be taken care of. If not, you will find yourself needing ever increasing doses of ED medicines until one day even the maximum dose fails to work.
The last thing to bear in mind and to discuss with your Doctor is whether or not these tablets are all that you need. Or would you also benefit from other ED treatments such as PRP (Platelet-Rich Plasma) injections or Li-ESWT (Low-Intensity Electro Shock Wave Therapy). We discuss the other treatment modalities for ED in our next post.
Remember ED is not PE although they can be biologically related. Please click here for my article on PE.
Have you tried any these medicines? Let us know your experience in the comments section below.