Erectile Dysfunction (ED) and Treatment Options

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sex. If you are experiencing ED symptoms, many treatment options are available to you, including lifestyle modifications, psychotherapy, vacuum erection devices, and oral ED medications.

Two of the best-known and most commonly prescribed ED treatments are Viagra and Cialis. Keep in mind that the causes of ED can be physiological or psychological. ED drugs such as Viagra and Cialis are only effective in treating physiological ED.

If you are experiencing erection problems, you should consult a healthcare provider for ED treatments. They will evaluate you and determine if you are a good candidate for oral ED drugs. At this point, you might be asked to decide between Viagra or Cialis. While the U.S. Food and Drug Administration (FDA) approved both Cialis and Viagra for the treatment of erectile dysfunction, a common question is which one is more potent—Cialis or Viagra?

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Key Differences Between Viagra vs Cialis

Both Viagra and Cialis are contraindicated with nitroglycerin. Please let your doctor know if you are taking nitroglycerin for chest pain.
	Viagra	Cialis
What is it used for?	To treat ED	-To treat ED -To treat benign prostatic hyperplasia (BPH) -To treat ED and BPH if the person has both conditions
How should I take it?	-To be used as needed, the typical dose is 50 mg to be taken 1 hour prior to sexual activity, but your doctor can adjust this dose between 25 mg to 100 mg based on your response. -You should only take 1 tablet of Viagra within a 24-hour period.	-As needed for ED: you can take Cialis 10 mg about 2 hours prior to sexual activity - this dose can be adjusted by your doctor based on your response. -Once daily dosing for ED: 2.5 mg to 5 mg once daily. -Once daily dosing for BPH: 5 mg once daily. -Once daily dosing for ED and BPH: 5 mg once daily.
Can I take it with food?	It is best to take Viagra on an empty stomach. Especially, try to avoid a high-fat meal, as it decreases the effectiveness of Viagra	Cialis can be taken with or without food
How long is the effect of the drug?	About 4 to 8 hours	Up to 36 hours
Pros	-Having been around for a very long time. -Very fast-acting. -Shorter duration of action which is ideal for those who take it occasionally.	-Option of the once-daily lower dose that allows spontaneity of sexual activity. -Can also alleviate BPH symptoms for those who have BPH. -Can take it with or without food.
Cons	-Have to be taken on an empty stomach.	-For the as-needed dosing, it is slower to achieve an effect; you will need to take it at least 2 hours before sexual activity.

What is the Difference Between Cialis and Viagra?

Viagra Ingredients and Uses

Viagra is the brand name of the generic medication sildenafil (active ingredient). It is made by Pfizer and was approved in 1998 to treat erectile dysfunction.
The only FDA-approved indication for the brand name Viagra is erectile dysfunction.
Sildenafil citrate, the active ingredient in Viagra, is also present in a medication called Revatio, which is used to treat pulmonary arterial hypertension or PAH.

Cialis Ingredients and Uses

Cialis is the brand name of the generic medication tadalafil (active ingredient). It was made by Eli Lilly and was approved by the FDA as an ED treatment in 2003.
Cialis is also used to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland in men. In men with BPH, Cialis can improve urinary symptoms such as difficulty starting a urine stream. The FDA also approved Cialis to treat men who have erectile dysfunction and enlarged prostate at the same time.
Tadalafil is also sold under the brand name Adcirca for the treatment of pulmonary arterial hypertension (PAH).

Onset and Duration of Action

Onset of Action: Viagra starts working within 30 to 60 minutes. Cialis takes 2 hours to start working.
Duration of Action: The effects of Viagra last for 4 to 8 hours. The effects of Cialis last for up to 36 hours.

How Each Medication Works

Both Viagra and Cialis are PDE5 inhibitors and work by increasing blood supply to the penis, but they are not the same drug. Here’s how PDE-5 inhibitors like Viagra and Cialis work:

When a man is sexually stimulated, a cascade of chemical events occurs that leads to an erection. Nerve impulses cause the release of neurotransmitters in the erectile tissue of the penis called the corpora cavernosa. This leads to the production of nitric oxide, which stimulates the formation of a substance called cyclic guanosine monophosphate (cGMP) in the smooth muscle of the penis. cGMP causes vasodilation (widening of blood vessels), which increases blood flow to the penis. This causes the penis to become engorged with blood and results in an erection.

PDE-5 inhibitors like Cialis and Viagra block the action of an enzyme called phosphodiesterase-5 (PDE-5) in the smooth muscle of the blood vessels. This enzyme breaks down cGMP. By blocking PDE-5, these drugs prevent degradation of cGMP and accumulation of cGMP in the vascular smooth muscle. This leads to dilatation (widening) of the blood vessels in the penis and an erection.

Find out how much Viagra you can take safely.

Comparison of Effectiveness: Cialis versus Viagra

Is Tadalafil (Cialis) Stronger Than Sildenafil (Viagra)?

No, tadalafil is not stronger than sildenafil. Both medications are equally effective in treating erectile dysfunction. A meta-analysis of pooled results from several studies found that both Viagra and Cialis are equally safe and effective. Compared to no treatment or placebo, both Viagra and Cialis produce a sufficient erection for satisfactory sexual intercourse in 70% of men.

So, how do you choose between Cialis and Viagra ED treatments? It comes down to the key differences between the two drugs. Cialis vs. Viagra differs in how you take the medicine and how long the effects of the drug last. Your doctor may also prefer one over the other based on your medical history.

User Experience: Do Most Men Prefer Viagra or Cialis?

Studies and surveys on prescription patterns reveal that more men prefer Cialis (tadalafil) over Viagra (sildenafil), including men who have tried both drugs for the treatment of erectile dysfunction.

As mentioned above, both Cialis and Viagra are generally considered equally effective. The key differences between Cialis and Viagra are how often they can be taken and how long they stay in your system.

Does Viagra Give You a Stronger or Longer Lasting Erection Than Cialis?

No, Viagra will not necessarily give a stronger erection than Cialis, or vice versa. However, Cialis will last longer and can help you achieve one or more erections for up to 36 hours after taking a dose. This is a considerably longer duration of action than Viagra, which is typically effective for 4-8 hours.

Warning: While Viagra or Cialis can provide penile hardness for several hours, this does not mean that you should have a constant erection during this time. A prolonged erection lasting more than 4 hours is a medical emergency (with or without pain or discomfort). This condition is called priapism, in which blood becomes trapped in the penis and cannot drain out. It needs to be treated immediately to prevent scarring and permanent damage to the penile tissue that is responsible for giving you an erection. Please get immediate medical advice, diagnosis, and treatment if this occurs.

Efficacy in Different Age Groups

A preference for Cialis over Viagra is reported among men under 40 years old. This may be explained by the longer duration of effect of Cialis (36 hours) compared to Viagra (4 to 8 hours). Doctors may prescribe Viagra over Cialis to older men based on more extensive experience with this drug.

Side Effects and Safety Profile

Common Side Effects of Cialis and Viagra

Both Cialis and Viagra belong to the same drug class (PDE-5 inhibitors) and have many common side effects.

Potential side effects of tadalafil (Cialis) include headache, back pain, indigestion, muscle aches, nasal congestion, flushing, and sore throat.

Possible side effects of sildenafil (Viagra) include headache, flushing, indigestion, nasal congestion, back pain, muscle aches, dizziness, and nausea.

Comparison of Side Effects: Which is Milder?

Taking Cialis and Viagra can cause similar side effects, but your response to each medication can vary. You may find, for instance, that Viagra causes headaches, flushing, chest pain, or low blood pressure, while Cialis does not. Or that Cialis causes nasal congestion, muscle pain, back pain, or high blood pressure while Viagra does not. Therefore, side effects may direct the choice between Cialis and Viagra for you, depending on which medicine you tolerate better.

Who Should Not Take Cialis or Viagra?

Check with your healthcare provider before taking Viagra, Cialis, or other PDE-5 inhibitors for erectile dysfunction if you are also taking the following medications:

Nitrate medicines: Both Cialis and Viagra are contraindicated with nitroglycerin. Nitroglycerin is the generic of Nitrostat, Retiv, and Nitro-Time. It is used to treat and prevent angina (chest pain). You should not use Cialis, Viagra, or any PDE5 inhibitor if you use nitroglycerin for chest pain. Drug interactions between alpha blockers and PDE-5 inhibitors can cause fatal hypotension (low blood pressure). Other nitrate medications include isosorbide dinitrate (Bidil) and isosorbide mononitrate (Monoket). Talk to your doctor or pharmacist for professional medical advice if you have any questions about this.
Alpha-blockers for an enlarged prostate or male pattern baldness, for example, finasteride (Propecia, Proscar), dutasteride (Avodart, Jalyn), and terazosin (Hytrin).
CYP3A4 blockers such as antifungal agents itraconazole (Sporanox) and ketoconazole (Ketozole, Extina) and HIV medicines like ritonavir (Norvir) and indinavir (Crixivan).

Also, tell your doctor if you have medical conditions such as hypotension (low blood pressure), hypertension (high blood pressure), severe liver disease, severe kidney disease requiring dialysis, heart disease, blood vessel or circulation problems, recent heart attack or stroke, heart rhythm disorders, inherited eye conditions affecting the retina.

Learn more: What Are Tadalafil Effects On Kidneys?

Cost Comparison: Cialis vs Viagra

Availability of Generic Versions

The generic forms of both drugs are available. Generic Viagra (sildenafil) and generic Cialis (tadalafil) cost significantly less than the brand name versions and are equally effective and safe.

Which is Cheaper: Viagra or Cialis?

Generally speaking, if you are paying out-of-pocket, the cost of Viagra ($85 to $115 per dose) is higher than the cost of Cialis ($15 to $85 per dose).

Average Pricing

The price of Cialis and Viagra depends on many factors, including the dosage, generic versus brand names, where you purchase the medicine, your health insurance status, and prescription drug coverage under your health plan.

You can save money on Cialis and Viagra by using a free BuzzRx discount coupon for your ED medication. Here’s what you can expect to pay with a BuzzRx prescription savings card:

Sildenafil (generic) 50 mg (10 tablets): $10 to $30
Viagra (brand) 50 mg (10 tablets): $900
Tadalafil (generic) 10 mg (10 tablets): $10 to $30
Cialis (brand) 10 mg (10 tablets): $575

Insurance Coverage

The cost of Viagra or Cialis ED treatment may also depend on your health insurance. Many insurers limit the quantity of ED medication that men with ED can obtain every month. Once you hit this limit, you must pay out-of-pocket for Cialis and Viagra, and the cost of these drugs can be prohibitive.

Therefore, you should have an open conversation with your doctor to address all of your questions and concerns. You and your doctor can together decide the best ED therapy that works for you with minimal side effects and the least amount of financial burden.

Which is Right For Me: Viagra or Cialis?

When deciding between Viagra and Cialis ED medications, you should keep in mind that Viagra is taken about 1 hour before sex. The drug reaches peak levels 30 minutes to 2 hours after you take Viagra. The effects typically last around 5 hours (this can range between 4 to 8 hours depending on the dose and the individual). Some people can experience more than one erection during the time a Viagra tablet is effective. Taking Viagra on a full stomach, especially after a high-fat meal, can make it less effective due to reduced absorption.

In contrast, Cialis starts working in about 2 hours. Its effects last for up to 36 hours. Food does not have any effect on how well Cialis works. You can also take a lower daily-dose of Cialis, which allows more spontaneous sexual activity.

For Faster Effects

Viagra is known for its fast-acting effect and may be preferred over Cialis if you want a medicine that works quickly. Taking Viagra an hour before sex on an empty stomach is recommended for this drug to work best.

However, if you are using Cialis as needed, make sure to give yourself plenty of time since Cialis takes about 2 hours to reach its peak effect.

For Longer Duration of Action

Cialis may be preferred over Viagra if you want an ED drug that lasts longer. Once Cialis is in your system, the effects last up to 36 hours—this is a lot longer than Viagra, which is around 4 to 8 hours.

Note: Cialis does not cause an erection that lasts 36 hours. You can achieve one or more erections during that 36-hour window after you take a dose of Cialis. As mentioned, any erection that lasts more than 4 hours (with or without pain) is a medical emergency.

For Frequent Use

Like Viagra, Cialis can be taken as needed before sex. However, one notable difference is that the FDA also approves Cialis for routine once-daily dosing (at a dose of 2.5 mg to 5 mg) for men with erection problems. The once-daily regimen of Cialis is to be taken around the same time every day without regard to the timing of sexual activity. This allows for more spontaneity for men who require frequent use of ED medicines.

Medical Conditions

Apart from ED treatment, Cialis also alleviates the urinary symptoms of BPH, such as urinary urgency or difficulty starting urination. In 2011, the FDA approved Cialis for men who have both ED and BPH. If you have urinary symptoms related to an enlarged prostate, your doctor may prefer Cialis over Viagra.

The important thing is, if you have erectile dysfunction, you should be medically reviewed and get a doctor’s advice, diagnosis, or treatment. One of the other medications, Cialis or Viagra, or something else, might be best for your situation.

Frequently Asked Questions

Is Cialis More Powerful Than Viagra?

Cialis is not more powerful than Viagra. Both Cialis (tadalafil) and Viagra (sildenafil) have similar effectiveness, and both drugs are equally powerful. Some people prefer Cialis versus Viagra because of its longer effect (up to 36 hours). Others may prefer the once-daily dosing of Cialis as a longer-term solution for erectile dysfunction that allows more spontaneity in their sex lives. Viagra, with its fast-acting effect, is ideal for those who only use it occasionally.

Do More Men Prefer Cialis or Viagra?

Many men find Cialis gives them more flexibility and enhances their sexual confidence. This is because, unlike Viagra, Cialis allows more spontaneity in sex. In addition, due to its longer duration of action, there is less pressure to plan sexual intercourse in advance when using Cialis. On the other hand, some people prefer Viagra for its shorter action, which is ideal for those who use an ED drug occasionally.

Does Cialis Keep You Hard After Ejaculating?

No, Cialis does not keep you hard after coming; however, the effects of this medicine last for up to 36 hours after you take a dose, and you may achieve one or more erections during this timeframe.

Is 20 Mg Cialis Equal To 100mg Viagra?

No, 20 mg Cialis is not equal to 100 mg Viagra. There is no direct milligram-to-milligram comparison between the two medicines. Do not switch from Cialis to Viagra or vice versa without consulting your doctor. Notably, 20 mg Cialis and 100 mg Viagra are both the highest doses of these medications available and may be prescribed if lower doses have not worked.

Can Viagra and Cialis Treat Premature Ejaculation?

Yes, drugs like Viagra and Cialis that are used to treat erectile dysfunction may also help with premature ejaculation (semen leaving the man’s body sooner than wanted during sexual intercourse).

What ED Pills Are Available Besides Viagra and Cialis?

The best-known ED medication is Viagra (sildenafil). However, there are other erectile dysfunction medications available in the United States as well. The U.S. Food and Drug Administration (FDA) has approved the following PDE5 inhibitors:

Sildenafil (Viagra)
Tadalafil (Cialis)
Avanafil (Stendra)
Vardenafil (Levitra)

A quick-dissolving formulation of vardenafil called Staxyn is designed to be put under the tongue to release the medication faster.

All these medications belong to a class of drugs called phosphodiesterase-5 inhibitors or PDE5 inhibitors. PDE5 inhibitors work by relaxing the blood vessels and improving blood flow to the penis. Thus, in the presence of sexual stimulation, ED drugs can produce a strong erection, allowing a person to initiate and complete sexual intercourse.

What Is The Strongest ED Medication?

Each of the four PDE5 inhibitors ED drugs—Viagra, Cialis, Stendra, Levitra—has its pros and cons. Your doctor will choose between Viagra, Cialis, Stendra, or Levitra based on your medical history, lifestyle, and personal preferences:

Viagra (sildenafil) is often the first drug that doctors recommend and prescribe to patients. This is because it has been around the longest, and many practitioners feel more comfortable because of this fact. In addition to that, Viagra’s side effects and its drug/food interaction profiles are well understood.
Cialis (tadalafil) has the longest half-life and duration of action (up to 36 hours) and may be preferred for men who need a longer-lasting ED medicine.
Levitra (vardenafil) is more selective, which means a lower dose is needed with potentially fewer adverse effects.
Stendra (avanafil) has a distinct advantage over other ED medications in that it starts working within 15 minutes of taking a dose.

Keeping an open mind is the best way to approach the treatment for erection problems. Non-pharmacological treatment, such as therapy or counseling, also plays an important role since psychological factors can be one of the causes of ED.

The choice between ED medications Cialis and Viagra will depend on your lifestyle to a large extent, i.e., how much spontaneity you desire in sexual activity. It may also boil down to your other medical conditions. For example, if you have urinary symptoms from an enlarged prostate, Cialis may be a better choice.