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Is Viagra, Cialis or Levitra Best for You?

Older men who have less frequent sex and who are happy with the responses using Viagra should certainly continue Viagra. Some patients who do not get optimal responses to Cialis may find that Viagra is more to their liking. In general, all three drugs work and the patients should talk to their doctors about finding the one that works best for them and their sexual lifestyle.

Three drugs now and others in various stages of clinical trials has not only further expanded the treatment options for ED, but in many ways has caused new confusion among physicians and patients. Add this to other medications and vacuum therapy and it's easy to see why patients and potential patients have questions.

For all practical purposes, these oral drugs are a first line of medical treatment. In certain circumstances in which the males are healthy, young, and laboratory blood tests and such are normal one should look for the physical cause of their erectile dysfunction before instituting treatment since the disease process may be more serious than the symptoms, i.e., the ED itself. In some cases, treatment of the primary disease may in fact resolve the sexual dysfunction. However, most men have other physical causes for ED as found in their health history and lab tests, making PDE-5 inhibitors a first line of choice. Selecting the appropriate drug is sometimes extremely difficult to do without proper information on each drug and a careful discussion about the sexual history of the patient and his partner.

Let us discuss the pros and cons of each of these three drugs and the sexual circumstances that may indicate the use of one drug over another. Viagra was the first and is probably the most famous of the three PDE-5 inhibitors used to treat erectile dysfunction. It had been researched for over a dozen years before becoming available to the American public. It works in about 70% of all men with all types of erectile dysfunction, although approximately 25% of them do not feel that the responses are optimal.

When initially doing the studies on Viagra, the endpoint of efficacy was improvement in sexual function; however, all patients in the Viagra studies had ED, whereas studies for the other two drugs were based on patients who had success with Viagra.Viagra's major drawbacks include decreased absorption due to food intake. You should take the pill on an empty stomach as absorption takes approximately 30 minutes. The drug takes about one hour for maximum effect, but loses 50% of its maximal concentration every four hours. Sexual stimulation is necessary to achieve erection. Of the three drugs, the maximal concentration for Viagra appears to be the therapeutic concentration. Side effects include mild headaches, facial flushing, stomach upset and unusual ocular disturbances including a bright vision and a blue-green halo around the vision.

Levitra was the second oral PDE-5 inhibitor for erectile dysfunction to be FDA approved. In vitro, it is six to 10 more times more potent than Viagra, however, 15% of the drug is nonprotein-bound and bioactive. Studies on Levitra have excluded patients who did not have success with Viagra, therefore the efficacies are somewhat shifted toward the positive. In general, the thought is that Levitra is more potent and efficient than Viagra as demonstrated by the hard-to-treat groups of patients. Diabetics and post-radical-nerve-sparing-prostatectomy patients appear to have a higher incidence of success than for Viagra. In addition, the efficacy is based on sexual satisfaction or successful penetration rather than improvement, which were the endpoints for Viagra. Levitra reaches its peak concentration at 40 minutes, is only affected by a very high fat diet.

Most patients can eat and take the drug without affecting its absorption and maximal concentration. The half-life of Levitra is five hours; however, the therapeutic levels appear not to be the maximal concentration and therefore multiple half-lives may occur with efficacy of the drug. In Europe, Levitra is considered a 24-hour drug whereas in the United States the package insert states, "No duration of action for Levitra" although the majority of physicians consider it to be a drug that has efficacy longer than Viagra.

Overall the slight chemical change noted in Levitra appears to give it more potency, efficacy, longer duration, and probably more rapid onset. Levitra has shown that 25% of patients had optimal responses within 16 minutes of the oral intake of the pill. In recent studies, Viagra has also shown longer duration of action than four hours even though the package insert shows four hours of duration. However, if duration is the goal, Cialis appears to be the winner. Cialis has been approved for duration of 36 hours, yet, there are studies showing high efficacy out to 100 hours. It is not affected by any food whatsoever and in fact can be taken with pure fat.

The typical McDonald's double cheeseburger with French fries and malted milkshake would certainly inhibit the effect of Levitra, but a steak with potatoes, a glass of wine, salad, and dessert would probably not. Neither of these would affect the absorption of Cialis. Cialis is protein-bound that causes a serum peak concentration of two hours and a half-life anywhere between 16 and 22 hours depending on the age of the patient. The older the patient, the longer the half-life. Because of the long duration of action, the lack of absorption effects, and efficacy at least as good as Viagra, if not better. The paradigm of taking these PDE-5s may in fact change as people gain more and more experience with Cialis.

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