Our guide to prescription Viagra, Cialis, Levitra, or should you buy alternative meds to treat erection problems in men?
We will provide an introduction to the best sexual medicine or pills for erectile dysfunction. This information has been taken from a recent review of the medical literature and attempts to be as comprehensive as possible. This material is independently produced, and the mention of any ED drug or medical product does not imply its endorsement for sexual health.
- READ MORE: VigFX Review
If you are prescribed an ED medication referred to in this article for erection problems, reading this post does not substitute for reading the package insert that comes with your prescription medication. Hopefully, you would have already come across some of the sexual enhancement products and have some understanding of erectile dysfunction already.
What Are The Treatment Options?
ED can be treated at any age. Many treatment options exist. The best treatment varies depending on an individual’s situation,1 and your doctor will use all the information at hand to choose the best treatment for you.
Treatment options include lifestyle changes, adjusting medications, psychotherapy such as counseling, and behavior modification. erectile dysfunction medication or male enhancement pills, topical medications such as creams and gels, vacuum devices, injection of drugs into the penis, and surgery including penile implants or prosthesis.2
But, this article will focus on oral ED medication or pills for ED. We have other sections that review different treatment options in more detail.
All patients should strive to introduce lifestyle changes that may improve the quality of their erections and all other aspects of their sexual function. These include smoking cessation and embarking upon an exercise program that emphasizes cardiovascular conditioning, improving dietary habits, and weight loss.3 Finally, couples should take the time to focus on their relationship and make changes where necessary.
Erectile Dysfunction Pills
Beyond lifestyle changes, oral medications have become the mainstay of initial treatment for ED. Three erectile dysfunction drugs now dominate the market for ED treatment. Sildenafil Viagra, Vardenafil or Levitra and Tadalafil (Generic Cialis).4 All three of these fall within a class of prescription drug called a pde5 inhibitor. As they block an enzyme in the penis called Phosphodiesterase-5 to improve blood flow in the blood vessels supplying the erectile tissue and thus improving erectile function.5
The treatment for ED can be either IV or oral medication, surgery, or implants.6 A list of some of the drugs for erectile dysfunction is also available. The list is endless but here are a few,
- Sildenafil Citrate
- Low testosterone level replacement
- Alprostadil self-injection
- Alprostadil urethral suppository and more
How Do They Work?
By blocking PDE – 5, these drugs enhance the standard erection response allowing more blood to flow into the penis during sexual stimulation.7 It is essential to understand that taking a sex pill will not affect one’s sex drive or libido and they do not by themselves produce harder erections.
They only enhance the standard response, you will still need sexual desire and mental and physical stimulation to achieve an erection for sexual intercourse.
How Well Do They Work?
These ED meds have become widely recognized and prescribed for a good reason, as a general rule they are a very effective erectile dysfunction treatment. Exactly how useful, depends on both the underlying cause of the problem and how the user defines success.
Overall, for all types of ED – about 70 to 75% of men will achieve erections sufficient for intercourse with the use of PDE-5 inhibitors.8
An important point to understand is that these medications do not reverse the underlying cause of male sexual dysfunction. Men with ED must continue to work on lifestyle changes, control chronic medical conditions, etc. to prevent ongoing worsening of their ED Symptoms.
How To Take Them?
This table highlights some of the key features of how to efficiently take these medications.
Sildenafil Or Viagra Connect
It should be consumed about 30 to 60 minutes before anticipated sexual activity. Its effects may last for up to 24 hours.9
This does not mean that an erection will be sustained for this entire time, rather, it may still be in the system during this period to help enhance the standard erection response. A second dose should not be taken within these 24 hours. The effectiveness of Viagra is hindered by fatty food and alcohol consumption.10
Viagra is typically prescribed at 100 mg doses. However, 50 mg tablets are also available, and your healthcare provider may choose dosages ranging from 25 to 200 mg depending on the situation.
Vardenafil Or Levitra
It should be taken 25 to 60 minutes before sexual activity. Its effects may last for up to 4 to 5 hours. A second dose should not be taken within 24 hours of this previous treatment being administered.11
Levitra is not affected by food or alcohol. However, excessive drinking will jeopardize any man’s sexual performance and ability to have an erection regardless.
Levitra is usually prescribed at a 20 mg dose although, five and 10 mg tablets are also available.
Tadalafil Or Cialis Daily
It should be taken 30 to 60 minutes before anticipated sex. Its effects may last for up to 36 hours. A second dose should not be taken within 36 hours of the previous dose. Cialis also isn’t affected by food or moderate amounts of alcohol.12
Cialis is typically prescribed at 20 mg, and 10 mg tablets are also available. Your doctor will choose the dose that is best for you if you are not achieving the effect you desire you should talk to your doctor about adjusting the dose. You should not do so yourself without first discussing it.
What Are The Side Effects?
This is where it gets interesting. The most common side effects of a PDE 5 inhibitor are headaches, flushing, heartburn, or indigestion nasal congestion and allergic reactions such as skin rash are common.13
These medications can cause visual impairments, and you should not operate a motor vehicle if you experience these effects until they subside. Levitra is the least likely to cause these changes,14 and Cialis can commonly cause flu-like symptoms, back pain, or muscle aches.15
I tried Viagra and Cialis myself and regretted it tremendously. I didn’t know at the time that such adverse effects could happen when taking these medications.
What About My Heart?
There is a misconception and fear among some men that PDE-5 inhibitors cause heart attacks and this is certainly not a common side effect.
We will aim to clarify the relationship between these medications and heart problems.
Firstly, PDE-5 inhibitors do not cause heart attacks. The more important question to answer first regarding heart safety and using ED drugs is whether or not your heart is fit enough to allow you to engage in the sexual activity regardless of how you achieve an erection.16
If you have any questions about your exercise tolerance or your suitability to take an erectile dysfunction drug, seek medical advice.
There is also a myth that men with high blood pressure should not take ED pills, and this is also not entirely the case. It is true however that certain blood pressure medications may need to be considered when prescribing PDE-5 inhibitors. Especially a class of drugs called alpha blockers.17 Again, talk to your doctor if you do take medication for high blood pressure.
The most important thing to understand about PDE-5 inhibitors and heart safety is that when combined with drugs called nitrates they can cause low blood pressure which can lead to dizziness, fainting, or even heart attacks or strokes.18
Nitrates are contained in drugs used to treat cardiac chest pain called angina.19 These include nitroglycerine tablets, nitro spray, or nitro patches. They are also an active ingredient of the recreational drug Amyl nitrate also known as “poppers.”
If you have any questions about nitrates and if you are unsure if you are using one, talk to your doctor.
Having said that, it follows that if you have ischemic heart disease meaning a history of heart attacks or chest pain called angina and all carry nitroglycerin or other nitrates with you, you must not take PDE-5 inhibitors.20
Similarly, if you develop chest pain and have recently taken PDE-5 inhibitors later do not take nitrates and notify emergency medical services that you have taken such a pill.
As mentioned earlier, PDE-5 inhibitors combined with the class of drugs called alpha-blockers can also lead to a drop in blood pressure. These medications are also used to treat prostate symptoms in men. Ask your doctor about this if you are taking medicines for your prostate.
It is also recommended that you talk to your doctor if you take any of the following drugs;
- Amiodarone, Sotalol, Quinidine or Procainamide (heart rhythm medications)
- Erythromycin (antibiotic)
- Indinavir, Ritonavir (HIV drugs)
- Ketoconazole, Itraconazole (antifungal drugs)
- Rifampin (tuberculosis drug)
Furthermore, before taking a PDE-5 inhibitor speak with your doctor if you have any of the following conditions;
- Kidney dialysis
- Liver failure
- Blood disorders (such as lymphoma or leukemia)
- Stomach ulcers
- Cardiovascular disease
- Vascular disease
- Previous prolonged erections lasting more than four hours (priapism)
- Deformation of the penis such as curvature called Peyronie’s disease
- Retinitis pigmentosa (a rare eye condition)
- Pulmonary hypertension
Will I Go Blind?
Another myth that has caused some men to fear the use of PDE-5 inhibitors is that they might go blind if they take them. Erectile dysfunction medicine can indeed be associated with some mild and temporary visual impairments such as blue tinting to the vision. However, they do not cause blindness.
There have been a few case reports published with very few high-risk patients consuming PDE-5 inhibitors experiencing rare occasions of a particular type of blindness called nonarteritic anterior ischemic optic neuropathy.21
These men, however, have medical conditions that put them at high risk of this disease and their blindness was not likely related to the use of PDE-5 inhibitors. If you are not satisfied with the results you achieve using a PDE-5 inhibitor. Firstly do not despair, keep trying and focus on just relaxing and enjoying the experience.
If you’re still unsatisfied, you should seek alternative treatments.
Natural Versus A Synthetic ED Pill
As you have read that there are many adverse side effects associated with using Viagra, Levitra, and Cialis. These pills are artificial and completely unnatural, and that’s why they can have such devastating consequences and severe drug interaction with other medications you may be using.
Herbal supplements such as VigRX Plus, Male Extra, ExtenZe, and ProSolution Plus Pills do not have such negative consequences.
- READ MORE: VigRx Plus Review
- READ MORE: Prosolution Plus Review
It’s as though the pharmaceutical companies had studied the effects of natural herbs and mimicked them synthetically to create their prescription male enhancement pills to line their pockets with money.
A natural male enhancement supplement is the better option, and you do not need a prescription due to the nature of how safe they are. There is also much scientific proof to prove the efficacy of the herbs and natural ingredients contained in sexual enhancement supplements such as VigRX Plus, Male Extra, ExtenZe, and ProSolution Plus Pills.
- READ MORE: Extenze Review
- READ MORE: Male Extra Review
Use A Penis Pump…
Penis pumps or vacuum devices have also been FDA approved to be used as a treatment option for patients suffering from erectile dysfunction. Even doctors have begun to prescribe them,23 and in some countries, they are covered by health insurance.
The two recommended penis pumps are both water-based as opposed to using air as a medium (water is much safer than air as a medium not to mention more efficient).
- READ MORE: Penomet VS Bathmate
We recommend either using the BathMate Hydro Max or the Penomet pump to regain your sexual function and treat your ED naturally without the use of harmful and dangerous prescription PDE-5 inhibitors.
- Mulhall, John P., et al. “Relationship between age and erectile dysfunction diagnosis or treatment using real‐world observational data in the USA.” International journal of clinical practice 70.12 (2016): 1012-1018.
- Retzler, Kathryn. “Erectile dysfunction: A review of comprehensive treatment options for optimal outcome.” Journal of Restorative Medicine 8.1 (2019).
- Esposito, Katherine, et al. “Effects of intensive lifestyle changes on erectile dysfunction in men.” The journal of sexual medicine 6.1 (2009): 243-250.
- Tat Chan, Chakravarthi Narasimhan, Ying Xie, (2012) Treatment Effectiveness and Side Effects: A Model of Physician Learning. Management Science 59(6):1309-1325. https://doi.org/10.1287/mnsc.1120.1640
- Wright PJ. Comparison of phosphodiesterase type 5 (PDE5) inhibitors [published correction appears in Int J Clin Pract. 2006 Nov;60(11):1517]. Int J Clin Pract. 2006;60(8):967-975. doi:10.1111/j.1742-1241.2006.01049.x
- Patel, Nishant, and T. Mike Hsieh. “Urologic/clinical treatment of erectile dysfunction.” Management of Sexual Dysfunction in Men and Women. Springer, New York, NY, 2016. 53-63.
- Corbin, J. D. “Mechanisms of action of PDE5 inhibition in erectile dysfunction.” International journal of impotence research 16.1 (2004): S4-S7.
- McMahon, Chelsea N., Christopher J. Smith, and Ridwan Shabsigh. “Treating erectile dysfunction when PDE5 inhibitors fail.” Bmj 332.7541 (2006): 589-592.
- Andrianne R. Le médicament du mois. Le sildénafil (Viagra) [Drug of the month. Sildenafil (Viagra)]. Rev Med Liege. 1999;54(1):58-61.
- Lim, Peter HC, P. Moorthy, and Kenneth GF Benton. “The clinical safety of viagra.” Annals of the New York academy of sciences 962.1 (2002): 378-388.
- Kamel A, Khaouli R, Sabha M, Al Mitwally K, Fouad W, Landen H. The real-life safety and efficacy of vardenafil: an international post-marketing surveillance study of 2824 patients from the Middle East. Clin Drug Investig. 2007;27(5):339-346. doi:10.2165/00044011-200727050-00005
- Porst, Hartmut, et al. “Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial.” Urology 62.1 (2003): 121-125.
- Moncada, I., et al. “Combination therapy for erectile dysfunction involving a PDE5 inhibitor and alprostadil.” International journal of impotence research 30.5 (2018): 203-208.
- McGee HT, Egan RA, Clark WM. Visual field defect and intracerebral hemorrhage associated with use of vardenafil (Levitra). Neurology. 2005;64(6):1095-1096. doi:10.1212/01.WNL.0000154468.11834.41
- Haghro, Alireza Farshi, et al. “Efficacy of Tadalafil on Ureteral Stent Symptoms: A Randomized Controlled Trial.” Nephro-Urology Monthly 11.1 (2019).
- Doumas, M., Lazaridis, A., Katsiki, N. and Athyros, V., 2015. PDE-5 Inhibitors: Clinical Points. Current Drug Targets, 16, pp.420-426.
- Yan, Huilei, et al. “The efficacy of PDE5 inhibitors alone or in combination with alpha‐blockers for the treatment of erectile dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and meta‐analysis.” The Journal of Sexual Medicine 11.6 (2014): 1539-1545.
- Maideen, Pakkir, and Naina Mohamed. “Pharmacologically relevant drug interactions of nitrovasodilators.” International Journal of Medical Reviews 7.1 (2020): 30-31.
- Frishman, William H. “Pharmacology of the nitrates in angina pectoris.” The American Journal of Cardiology 56.17 (1985): I8-I13.
- Kloner, Robert A., et al. “Time course of the interaction between tadalafil and nitrates.” Journal of the American College of Cardiology 42.10 (2003): 1855-1860.
- Verit, A. “Non-arteritic anterior ischemic optic neuropathy, PDE-5 inhibitors, and amiodarone: May there be a sex hormone effect for the eye?.” Medical hypotheses 69.2 (2007): 470-471.
- Masuku, Nelisiwe Prenate, Jeremiah Oshiomame Unuofin, and Sogolo Lucky Lebelo. “Promising role of medicinal plants in the regulation and management of male erectile dysfunction.” Biomedicine & Pharmacotherapy 130 (2020): 110555.
- Yuan, J., et al. “Vacuum therapy in erectile dysfunction—science and clinical evidence.” International journal of impotence research 22.4 (2010): 211-219.
Shahrokh Shariat, MDProf. Shariat has published over 1400 scientific papers in peer-reviewed journals. In 2014 he received the Matula Award from the European Society of Urology (EAU), in 2017 the Gold Cystoscope Award from the American Society of Urology, probably the most important urologist award worldwide.
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