Approximately 30 million men have problems getting or maintaining an erection, according to the Urology Care Foundation. This inability to perform sexually is known as erectile dysfunction (ED) and can be a cause of turbulence and stress for men.
When ED attacks, many men will have a discussion with their doctor about the use of an oral ED drug. Treating ED with an oral medication did not come to the scene until 1983, when a physiologist was able to demonstrate the effect of fentoalmine on the induction of an erection.
This paved the way for further development of oral agents, being the first Viagra, introduced in 1989.
Since then, Viagra has joined other ED drugs Cialis and Levitra. How does a man decide what is right for him? What are their similarities or do they have big differences?
How do ED drugs work?
Viagra, Cialis and Levitra are used to treat ED. They are also known by their generic names of sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).
Each of them works similarly and is in a class of drugs called PDE-5 inhibitors. They work by blocking an enzyme called phosphodiesterase type 5 while increasing a chemical in your body called nitric oxide.
This helps the penis muscles to relax, allowing the blood flow into the penis to help achieve and maintain an erection when you wake up.
Each of the medications does not cause an instant erection – it takes about 30 minutes to be effective. These medications can make a physically possible erection for men who may not be able to have one otherwise, but are not aphrodisiacs. In other words, they do not stimulate a man’s sex drive or cause him to wake up. That still has to be done the old way – a man must be sexually aroused for the drugs to work.
Men who are depressed, have low levels of testosterone or have little interest in sex may not have any reaction to ED medications. In addition, ED drugs do not work for every man, since about one-third of men who attempt ED do not have a satisfactory outcome.
Who should not use ED medications?
Certain men are not considered to be good candidates for ED medications. A man who is taking any form of nitrates for chest pain, or alpha-blockers of high blood pressure, should not prescribe an ED drug as it can cause a sudden and dangerous drop in blood pressure.
Men who take nitroglycerin or a similar medication for chest pain should also not use ED drugs as it can cause low blood pressure.
Each ED drug may also cause a small risk of priapism, which is a prolonged and painful erection of four hours or more in which blood does not drain from the penis and requires a trip to the emergency room.
A minority of men will have side effects of an ED medication including headaches, blurred vision, heat sensation, back pain, muscle aches, nasal congestion and upset stomach or heartburn.
What are the differences between drugs?
Since Viagra, Cialis and Levitra work similarly, there are subtle differences between them.
Levitra works a little more Viagra but both take effect in about 30 minutes. The effect of Levitra should last about five hours while Viagra lasts about four hours.
Cialis comes in two forms – one for daily use and a higher dose that can work up to 36 hours, which means it stays in your system longer.
Cialis and Viagra can be taken with or without food, while Levitra should be taken on an empty stomach.
Cialis can also interact with alcohol by causing low blood pressure when you get up from a sitting or lying position resulting in dizziness or headache.
Viagra and Levitra do not seem to cause low blood pressure when taken with alcohol, but alcohol can inhibit the ability to get an erection.
Similarities between drugs
Viagra, Cialis and Levitra have many more similarities between them than the differences. All of them are used only to treat ED, they all come in one oral tablet, each taken 30-60 minutes before sex or once a day, they should be stored at room temperature and most pharmacies carry them, with Each drug costs about the same.
Most health insurance companies do not cover the cost unless you have certain medical conditions.
When used correctly, each of these ED drugs have helped men with ED and with good results. If one drug does not work, then another can be tried. Sometimes it also takes some patience to get the right dose for each man.
The decision to use an ED drug should be thoroughly discussed with your doctor. They can guide a man in whom the drug ED is the most suitable to achieve the results you want with the least amount of side effects.
Men should always remind their doctor of any over-the-counter or prescription medications or herbal or dietary supplements they are using. All health conditions should also be discussed in depth.
Dr. Samadi is board certified urologic oncologist, trained in open and traditional laparoscopic surgery and is an expert in robotic prostate surgery. He is president of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for Fox News Channel Medical Team A. Follow Dr. Samadi on Twitter, Instagram, Pintrest, SamadiMD.com and Facebook