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 to treat physiological ED.  

Please continue reading to learn more about how these drugs are used to treat erectile dysfunction. Also, find out the key differences between Cialis and Viagra and which one is a better fit for you.
 

What erectile dysfunction 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, including tadalafil (Cialis), avanafil (Stendra), and 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 difference between Cialis and Viagra?

While both Viagra and Cialis are PDE5 inhibitors and work by increasing blood supply to the penis, they are not the same drug.

Viagra is the brand name of the generic medication sildenafil. It is made by Pfizer and was approved in 1998 to treat erectile dysfunction. The only FDA-approved indication for 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 is the brand name of the generic medication tadalafil. It is 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. Interestingly, the FDA also approved Cialis to treat men who have erectile dysfunction and enlarged prostate at the same time.

Is tadalafil stronger than Viagra?

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. Many people want fast relief of their symptoms and wonder which ED drug is more potent—Cialis or Viagra? 

The truth is that both medications are equally effective in treating erectile dysfunction. A meta-analysis that pooled the results of several extensive studies found that both Viagra and Cialis were equally safe and effective. Compared to no treatment or placebo, both Viagra and Cialis can produce a sufficient erection for intercourse in 70% of men in these studies. Also, because they are in the same drug class, the common side effects of Cialis were comparable to the side effects of Viagra. 

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.

Cialis or Viagra: Which one is right for me?

When deciding between Viagra and Cialis ED medications, you should keep in mind that Viagra is taken about 1 hour before sexual activity. 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. 

Like Viagra, Cialis is indicated to be taken as needed before sexual activity.  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 erectile dysfunction. The once-daily regimen of Cialis is to be taken around the same time every day without regard to the timing of sexual activity. 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.

Viagra is known for its fast-acting effect. Taking Viagra an hour before sex on an empty stomach is recommended. 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. 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.

At this point, you may be wondering if it means that Cialis would cause an erection that lasts 36 hours; the answer is no, so there are no worries! What happens is that you can possibly achieve one or more erections during that 36-hour window with the help of Cialis. An erection that lasts more than 4 hours is a medical emergency, which we will discuss below in this article, 

In summary, many people 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 with Cialis. On the other hand, some people prefer Viagra for its shorter action, which is ideal for those who use an ED drug occasionally.

If you have erectile dysfunction, it’s important to 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. 

Cialis vs. Viagra: Does Viagra give you a stronger erection than Cialis?

As discussed above, both Cialis and Viagra are generally considered equally effective. The key difference is what these drugs are used for, how often they can be taken, and how long they stay in your system. So to answer the above question, no, Viagra would not necessarily give a stronger erection than Cialis, and vice versa. However, Cialis will last longer and can help achieve one or more erections for up to 36 hours. This is considerably longer than Viagra, which is typically effective for 4-6 hours.

Please note that 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, even if you don’t experience 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 of the penile tissue that is responsible for getting an erection. Please get professional medical advice, diagnosis, and treatment if this occurs. 

Which is more powerful: Cialis or Viagra?

The reported effectiveness of both Cialis (tadalafil) and Viagra (sildenafil) is similar. Both drugs are equally powerful. Some people prefer Cialis vs. 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. 

What is the strongest ED medication?

Each of the four PDE5 inhibitors ED drugs—Viagra, Cialis, Stendra, Levitra​​—has its pros and cons. 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. However, based on your medical history, as well as personal preferences, your doctor will discuss with you other drug treatments besides Viagra, such as Cialis, Stendra, or Levitra. Keeping an open mind is the best way to approach the treatment for erectile dysfunction. 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. 

While both have similar drug interactions and common side effects, Cialis and Viagra can affect each individual differently. 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 can sometimes direct the choice between Cialis and Viagra.

Both Cialis and Viagra are contraindicated with nitroglycerin. Nitroglycerin is the generic of Nitrostat, Retiv, 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. This drug interaction can cause fatal hypotension (low blood pressure). Talk to your doctor or pharmacist if you have any questions about this. 

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. By doing so, your doctor can confidently decide the best ED therapy that works for you with minimal tolerable side effects without causing you any unexpected financial burden.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603624/

2. https://pubmed.ncbi.nlm.nih.gov/18614424/

3. https://www.health.harvard.edu/mens-health/which-drug-for-erectile-dysfunction