There are three main oral drugs categories for erectile dysfunction treatment: vardenafil (Levitra and Staxyn), sildenafil (Viagra) and tadalafil (Cialis) as well as their generic versions. Avanafil (Spedra) is the latest addition to this category. All these drugs belong to the group of PDE-5  (phosphodiesterase-5) inhibitors and have the same action mechanism, which is to increase the flow of blood into the penis so that when a man is sexually stimulated, he will achieve an erection.

It is highly advisable that before taking any oral medication for erectile dysfunction, you consult a doctor, who will judge whether oral medication is appropriate, which is the best drug for you, the dosage and for how long you need to do the treatment.

Beyond that, since all drugs have the same action mechanism, their main features are the same. However, they do exhibit some important differences which the patient should consider before making a decision.

Common negative features

Unfortunately for 30% of patients, these drugs are not effective and all PDE-5’s require sexual stimulation and sexual desire in order to induce an erection

Similar side-effects, including headaches, flushing, transient visual disturbances and dyspepsia have been noted by some patients and these are determined by the individual circumstances.

Patients should avoid these in combination with any form of nitrate therapy (pill, spray, paste, or patch) as the combination of the 2 drugs has been shown to lower the blood pressure to dangerous levels.

Men with a significant cardiac disease are at higher risk of problems. Patients who have had:

• A heart attack within the last 3 months
• Poorly controlled high blood pressure
• Poorly controlled angina (cardiac chest pain)
• A stroke within the last 3 months
• Severe congestive heart failure
• Heart valve disease

Distinct features

The main differences between PDE-5 inhibitors are the following:

Dosage

Incorrect dosage is one of the main reasons why some of the drugs do not work for certain patients. Consequently, taking the correct dosage will not only make the treatment more effective but can also save you money.

It is generally advised that you begin with the lowest dosage available and if this dosage does not work on more than two occasions, the dosage can be doubled until the maximum prescribed level is reached. You will discuss this procedure with your doctor. Beyond that, if results are still not satisfactory then other treatment options need to be considered.

Levitra is available in 10 and 20 mg oral tablets, as well as in 10mg orally disintegrating tablet. Viagra is available in 25, 50 and 100 mg oral tablets. Cialis is available in 10 and 20 mg oral tablets. Finally, Spedra is available at  50, 100 and 200mg oral tablets. All the above must be taken on demand i.e. before sexual activity. In this respect, Viagra and Spedra offer more standard dosage options allowing experimentation until the correct level has been found. To note, the price between the different drugs varies and the difference can be considered.

When to take the medication

The majority of the oral treatments are taken on demand i.e. before sexual activity. However, there are subtle differences in drug action duration and how quickly it works. It should be clarified that drug action duration does not mean that PDE-5 induced erections will last over a large period of time. It means that if there is sexual stimulation during the drug action period then the medication will help to achieve an erection. After successful sexual intercourse, it is expected that a natural loss of erection will occur.

Levitra works a little longer than Viagra. They both take effect in after 30 minutes. With Levitra, the effects last for about 5 hours. With Viagra, the effects last approximately 4 hours.

Cialis works faster (within 15 minutes) and the effects last much longer – up to 36 hours in some cases. Spedra can start working in 15 minutes and last up to 6 hours.

Cialis is also available in a 5mg tablet for daily use, regardless whether sexual intercourse will follow. This is especially useful for men who do not usually plan their sexual activity or have infrequent intercourse. Moreover, 5mg daily Cialis intake has shown to benefit patients suffering from benign prostate hyperplasia (BPH), which is the most common disease-causing urinary difficulty in men above 50 years old.

Interaction With Food and Alcohol

Food consumption affects the action of sildenafil (Viagra) and vardenafil (Levitra) in the oral tablet form. The vardenafil disintegrating tablet and Tadafil (Cialis) is not affected by food intake.  Thus, the classical sildenafil and vardenafil forms should be taken with an empty stomach, for if food intake has preceded –especially fatty meal- the drug action is delayed. Alcohol consumption does not affect the action of PDE-5 drugs but can increase the potential for symptomatic hypotension and is better to be avoided.

I am suffering from Erectile Dysfunction, what should I do next?

We advise you to book a consultation with our highly experienced doctors. The first step towards an accurate diagnosis is an investigation of possible causes by our specialists.

After this, our doctors will aim to do two things:

• design a treatment plan that will allow you to immediately achieve a strong erection to continue normal sexual activities.
• design a treatment plan to address the underlying causes of your ED, this means that each treatment we offer in our clinic is highly personalised.