Since the appearance of Viagra (sildenafil) in 1998, three other drugs for erectile dysfunction have emerged. Each of them has distinctive characteristics that allow you to customize its use.
Sildenafil (Viagra) was the first drug for erectile dysfunction (impotence), but for a few years, it has not been the only one. Three others from the same family have been added to this treatment: tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra). All are part of the group of phosphodiesterase 5 inhibitors, but each one offers distinctive characteristics, and, together, they allow a more individualized treatment, depending on the type of sexual intercourse or the preferences of each patient.
All of these medications are administered orally and act in the same way and for the same purpose: to trigger the physiological mechanisms essential for erections. By blocking the action of the enzyme phosphodiesterase type 5 (PDE5) in the body, they promote a better action of nitric oxide, which is a crucial substance for relaxing penile muscles, with the consequent increase in blood flow that allows achieving an erection in response to sexual stimulation.
Differences between different drugs for erection.
The main difference between the four members of the family of phosphodiesterase 5 inhibitors is their half-life, that is, the time it takes for half of a given dose to be eliminated from the bloodstream. This measure is used to determine the time during which the effects of the drug are maintained in the body, which in the case of erectile dysfunction allows defining the period of time in which sexual relations with quality erections can be maintained. These are the main distinguishing features of each of the available drugs:
Sildenafil (Viagra)
With him began the revolution in the treatment of erectile dysfunction. It is most effective when taken on an empty stomach one hour before sexual intercourse and its half-life is about 4-5 hours.
Tadalafil (Cialis)
It can be taken with or without food and is effective for up to 36 hours. You can take a small daily dose, or a larger one, as needed.
Vardenafil (Levitra)
It has a half-life of 4-5 hours and is most effective when taken one hour before sexual intercourse. It can be administered with food, but high-fat foods may reduce its absorption.
Avanafil (Spedra)
This drug can be taken only 30 minutes before sexual intercourse, depending on the dose. It has a maximum duration in the body of 6 hours.
How to choose the best drug for each patient?
The choice will depend on the characteristics of each man and the preferences that he expresses to his doctor, who is the one who has the last word because they are prescription drugs.
Sildenafil, avanafil, and vardenafil are short-lived inhibitors, generally less than 8 hours.” they are much more designed for taking on demand, that is, before having sexual intercourse”.
On the other hand, tadalafil is a long-lived medication “which also has two dosages: one daily, which is usually 5 milligrams, and another 20 milligrams.” It has been called the “weekend pill” because it can be taken on Friday or Saturday for unplanned sex for up to 36 hours.
The daily administration would therefore be intended for those men who do not want to have to plan their sexual relations. However, as the doctor points out, “it has been wrongly associated with the number of sexual relations”, ruling it out in those who have sporadic sexual contact.
The urologist believes that the administration of tadalafil to someone who, for example, has three sexual relations a month cannot be ruled out. “Perhaps that patient decides to have few meetings, but that they are very satisfactory and not have to schedule them” and this motivation is enough to opt for daily treatment.
On the other hand, this continued treatment can lead the patient to “increase the number of sexual relations because he gains confidence and has much less anticipatory anxiety”. This would show, once again, that the criterion of the number of sexual encounters is not enough to make the choice of the most appropriate drug for each case.
In many cases of erectile dysfunction, there is a clear psychological component in which anticipatory anxiety, that is, the fear that an erection will not occur at the right time, plays a very important role. In this patient profile, taking it daily prevents the generation of a self-observation phenomenon just after taking the medication that makes you pay more attention to whether or not you are going to have an erection.
If what matters is that the patient follows the treatment correctly and does not forget to consume it, it may be that taking it on demand is more practical because they do not have to be aware of the daily administration routine. It is very frequent that adherence to daily treatment is low, which leads to many patients not achieving the desired effects and becoming discouraged. “For these cases, a medication such as sildenafil, taken on demand, usually works very well and ensures success in a significant percentage of people,” says the urologist.