Viagra vs. Cialis. Which is one is better.

1) What is the difference between Cialis and Viagra ?

2) What medication should I take, Cialis or Viagra ?

3) Which ED medication is best for me ?

4) Can testosterone help my erectile dysfunction ?

As a practicing urologist and specialist in testosterone replacement therapy for Low-T and erectile dysfunction (ED) treatments, I commonly get asked by men with ED the following questions during a visit:

1) What is the difference between Cialis and Viagra?

2) What medication should I take, Cialis or Viagra?

3) Which ED medication is best for me?

4) Can testosterone help my erectile dysfunction?

I will address each question, but first let’s discuss a little about ED meds and the first line treatment for ED.

The first line of treatment for men with ED is oral medication. Oral ED medications such as Viagra, Cialis, Levitra, Stendra & Stayxn are all phosphodiesterase type 5 inhibitors (PDE5i). They all act on the same physiological pathway in the human body. PDE5 is an enzyme in the penis (corpora cavernosa tissue) that prevents an erection from occurring. All oral ED medication work to inhibit this enzyme and are therefore called PDE5 inhibitors.

The difference between all the ED medications is their specificity for the PDE5 enzyme. There are many PDE enzymes in the body. The level of specificity for the PDE5 enzyme is different for all ED meds. Other aspects of ED medications that are different include bioavailability (how long it last in the body for use), ability to be taken with or without food and side effect profile. Let’s address these topics as they relate to Viagra and Cialis.

1) “What is the difference between Cialis and Viagra?”

There are very several important differences between Cialis and Viagra that patients should be aware, because choosing the right medication will ultimately lead to the best result.

Viagra, also known as Sildenafil (the active ingredient), was the first ED medication to enter the market. It was a groundbreaking achievement in the field of medicine that men could improve their erectile function with just a tablet. Viagra was actually discovered on accident, as researches at Pfizer were originally investigating the drug for the treatment of angina (chest pain). They noticed that men were having improved erectile function during their follow up visits during the clinical trials. As thus, they changed the trial to investigate the drug for erectile dysfunction purposes and so began the birth of Viagra. On March 27,1998 Pfizer received FDA approval for Viagra for the treatment of ED at 50mg and 100mg dosages. Viagra has since been used by over 20 million men in over 110 countries and is one the best studied pharmacological substances available.

Viagra is best used when taken 1 hour prior to sexual activity and will last in the body for 4-5 hours. Viagra reaches peak levels in the body approximately 30min – 2 hours after oral ingestion. Viagra must be taken on empty stomach, as food will impair its absorption. Side effects of Viagra include: blurry vision and dizziness among others.

In comparison, Cialis (also known as Tadalafil) is a second-generation ED medication. Cialis is different than Viagra in the following ways.

First, and most noteworthy, is Cialis can be taken with food. Food does not impair the absorption of Cialis. This is important to note because in clinical studies the majority of sexual activity occurs after dinner between the hours of 9pm-1am. Cialis makes it easier for men to be more spontaneous and not have to worry about food intake with medication usage.

Second, Cialis has a duration of action of 36 hours, compared to Viagra of only 4-5 hours. Many men find this longer duration of action more appealing because the ability to get multiple erections becomes easier to sustain within than 36-hour window. This does not mean you will an erection lasting 36 hours, but rather the window period of 36 hours makes it much easier to obtain, achieve and sustain an erection much longer than Viagra.

Third, Cialis has a lower side effect profile than Viagra. Main side effects of Cialis include congestion and slight back pain among others.

Fourth, Cialis can be taken daily. The FDA approved Cialis for erectile dysfunctional and BPH (Benign Prostatic Hyperplasia). A low dose 5mg Cialis, can be taken daily to provide men more spontaneity with their sexual activity and not have to worry about taking medication before sex. This sense of freedom makes Cialis more attractive for men as an ED tablet compared to Viagra. The daily Cialis will also improve symptoms of an enlarged prostate such as waking up at night to urinate, straining to urinate, or frequency and urgency of urination.

2) “What medication should I take, Cialis or Viagra?”

Now that we have discussed the main differences between Cialis and Viagra, which one should you choose? I tell many of my patients it really depends on lifestyle and the amount sexual activity you are having. For instance, for a man who has sex multiple times per week and does not plan sexual activity, then Cialis is a more attractive option. For a man who plans his sexual activity, such as a married couple who goes out to dinner and then plans to engage in sex, then Viagra can be a better option.

Most men, including the partners of men, prefer Cialis over Viagra. 73% of patients prefer Cialis over Viagra, and 63% of men preferred the freedom and dosing instructions Cialis provides.

Couples who are anticipating more frequent sexual activities and spontaneity prefer Cialis. With Cialis you don’t have to link sex with medication, because Cialis can be taken daily. This feature is preferred by most men and provides greater freedom and less planning.

In studies of men using Cialis, men felt less time pressure, less sense of urgency, and less planning before and during sexual intercourse when taking Cialis compared to Viagra. Men who take Cialis state they have the “ability to get an erection long after having taken Cialis” and the “ability to get an erection every time.”

Men who use Viagra score higher in sexual self-confidence domains. Men on Viagra feel the “ability to get an erection every time” and the erections are firmer.

3) “Which ED medication is best for me?”

When it comes to choosing the right erectile dysfunction medication it’s important to take into account lifestyle and frequency of sexual activity. Some men respond better to Cialis than Viagra and vice versa. If you are having sex often, Cialis is enjoyed by most men. Viagra may better for more planned sexual activity.

Also, Cialis (Tadalafil) and Viagra (Sildenafil) can be formulated to work faster, enhance stamina, sensitivity, rigidity and delay ejaculation. These are new and emerging formulations that REGNEX Health provides than enhanced Sildenafil and Tadalafil.

Currently, Cialis and Viagra are made as a film coated tablet. The film acts as a barrier to absorption and must be broken done by the gut. The gut and liver also breaks down the medication and less active ingredients are available. With oral rapid dissolving tablets, the film coating is removed and the tablets dissolve fast under the tongue. Absorption is across the mucus membrane in the mouth, bypassing the gut, and going directly into circulation. More active ingredient is available and onset for an erection to occur is much faster. A study from 2003 evaluated the velocity by which sildenafil acted when the film coated tablets were crushed. Crushed tablets were taken under the tongue and allowed to dissolve. Researches noted faster onset of activity. The benefits of oral dissolving ED tablets include:

1) Higher Bioavailability (less breakdown of the drug by the stomach or gut)

2) Discrete intake since no water is needed

3) Elimination of any swallowing issues

4) Faster time to peak concentration (Tmax)

5) Shorter duration of time of onset (faster acting) (Tonset)

A REGENX Health urologist can guide you on the best treatment and regiment for ED. Speak with a REGENX Health Urologist today and get the expert treatment and medication that is right for you.

4) “Can testosterone help my erectile dysfunction”

Yes. Men with who have low testosterone (Low-T) should be informed that testosterone replacement therapy can improve erectile dysfunction. Several studies have confirmed that ED meds are more effective when combined with testosterone replacement therapy. There are 5 randomized controlled trials that observed men who took ED meds combined with testosterone replacement had better outcomes compared to men who only took ED meds without testosterone. Patients on testosterone therapy and ED meds had higher erectile function scores and more pronounced sex drive. It’s imperative that all men with ED have their testosterone and estradiol levels checked. Optimizing therapy may include hormone replacement.

Testosterone therapy is not an effective mono-therapy for ED, but when combined with an ED med such as Viagra or Cialis, results can be enhanced.

If you have any questions about the information above or desire to speak with a REGENX Health Urologist today, please give us a call at 1.888.6.REGENX.