Viagra vs. Cialis: Differences, similarities, and which is better?
Do you know the difference between sildenafil and tadalafil or viagra and Cialis?
Well, today, that’s what we’re going to talk about.
I’m Dr. Chrystal Green, and I’m here to talk about all things sexual education, bladder health, and much much more.
So before we get into the actual treatment with these medications for erectile dysfunction, it’s important for you to understand how an erection happens, so the first component of an erection is arousal you see something you smell something, you hear something, or you feel something that gets you aroused that causes your body to release something called nitric oxide.
Nitric oxide is like the ignition for erections, so to get an erection, you need arousal. It would help if you had nitric oxide, so once you get that and that arousal, your body starts releasing several chemical messengers.
One of these is called cGMP or Cyclic guanosine monophosphate and as these messengers are released, the muscles or the smooth muscles in the penis relax. This allows blood to flow in, and at the same time, the veins of the penis get blocked off so that blood flow stays in the penis, causing a firm erection and then what stops the erection, well there are three major things first that nitric oxide or the stimulus for arousal goes away second is that chemical messenger cgmp starts to degrade or break down and lastly your body has a nervous response to ejaculation so when ejaculation happens your nervous system revs up and causes those smooth muscles to now contract to force the blood out of the penis and into the rest of the body which then causes your penis to become flaccid so all of these medications for erectile dysfunction they work by blocking the breakdown of that chemical messenger cgmp and they do so by blocking an enzyme called phosphodiesterase so before I get into the difference between sildenafil and tadalafil or viagra and cialis I want you to know there are some side effects that are common with all of these medications includes headaches flushing, nasal congestion, heartburn and sometimes vision changes also there is one medication that if you’re taking you absolutely cannot take these medications, and that’s called a nitrate medication or a medication with nitrate in it something called nitroglycerin is very commonly prescribed to people who have chest pain or angina is the medical term for it, and what that is is it’s usually a pill that’s given to you to take and put underneath your tongue if you have chest pain that won’t go away, so if you’re on that medication you cannot take any of these medications for erectile dysfunction the reason being is if you take both of these at the same time, your blood pressure can drop so low that you may have a risk of death or dying also, there are certain medications that can cause the drug to drug interactions. If you have kidney or liver problems, you might have to change the dosing of the medication you’re receiving, so you want to get these under the care of a physician.
You may find some over-the-counter supplements even though they’re not supposed to have these medications in them that do have them, and those are dangerous because you need to make sure that you’re not getting too much or too little of the medication.
There’s also a couple of infrequent but very side effects with these medications. One of these is called priapism, and priapism is an erection that lasts longer than four hours, which is not a good thing.
When you have an erection that lasts longer than four hours, it starts causing damage to the tissues in the penis that can cause irreversible damage if not treated right away.
We only see it if someone overdoses on these medications, take too many pills, and have this problem.
The other rare side effect that is potentially dangerous is hearing loss. I have never seen that in my career, but it has been reported as a scarce but severe side effect.
The success rate for both of these medications is about 60 to 80 percent, so if you’re looking as far as efficacy, they’re both about the same and why am I talking specifically about viagra and Cialis or sildenafil and tadalafil well, because at least in the United States there are the cheapest options for erectile dysfunction. Because they are equally effective, I tend to prescribe these both most often as far as sildenafil is concerned. The origin story of how they came up with sildenafil is interesting. So it was initially made as a treatment for high blood pressure, so they did these clinical trials on patients to see if it
would improve their blood pressure, and what they found was that it didn’t do anything for blood pressure. Still, people started reporting firmer erections. So that’s how viagra was born, so specifically talking about sildenafil, it is the oldest medication available for erectile dysfunction, so it has the longest data on its efficacy and its use, so when you take viagra, you need to take it about 30 minutes to an hour before intercourse. On an empty stomach, if you have a lot of high-fat foods before taking viagra, it reduces the efficacy of the medication so.
Ideally, you want to take out an empty stomach, or if you had a very light meal, it lasts in the bloodstream for about four hours.
It’s available in different dosing starting from 25 milligrams up to 200 milligrams, and it’s only offered in what we call on-demand dosing and so what that means is you can only take it at the time before intercourse.
You can’t take a daily dose every single day. It won’t work like that. The side effects that are unique to viagra are that sometimes people who take viagra get what we call blue-green discoloration or changes in their
color vision if that happens, you have to stop the vigor right away and talk to your doctor. The other side effect we sometimes see in viagra and not in tadalafil is nose bleeds. Although it is in a small percentage of people, tadalafil is a more selective phosphodiesterase inhibitor meaning it more selectively inhibits the enzymes responsible for erections. It was released in 2003, so we don’t have as much data on tadalafil as we do on sildenafil, it needs to be taken about 30 minutes to an hour before intercourse, but you can take it on an empty stomach also it lasts in your bloodstream for up to 36 hours. Hence, if you want to have multiple episodes of intercourse on the weekend well, this is an excellent medication option for you. It’s also available in a low dose that you can take every single day, and some people like that because they like the spontaneity associated with taking one pill every single day and then being able to have intercourse whenever you want the on-demand dosing is available from 2,5 milligrams to 80 milligrams. You might notice that that’s less than the sildenafil dosing. It doesn’t mean that it’s less effective; it’s also different. The other exciting thing about the low dose daily tadalafil is that it also is helpful for men with benign prostatic hyperplasia or BPH.
I made before to learn more about that but what it does is it helps men who have symptoms urinary symptoms associated with BPH, specifically having difficulty emptying your bladder, straining waking up at night to urinate, maybe having some urgency has to go gotta go or urinary frequency so if you find yourself having urinary symptoms that are related to BPH and erectile dysfunction well you might be able to get away with just taking one medication that can help both problems and lastly, there are some data to suggest that men who have complete erectile dysfunction who have no erections at all may benefit better from tadalafil than other medications. Hence, which one is better for you? Well, I’m going to share some data that I found comparing sildenafil and tadalafil head to head. I looked at a meta-analysis.
They do a systematic review which means they look at the particular data from all of the studies combine it, and that makes for a much more substantial study so you can look at those outcomes and say, well, this is what 10 or 15 or 20 studies said, so this must be more valid than just one study by itself this particular meta-analysis and systematic review looked at sildenafil versus tadalafil and looked at any study that compared them head to head. They used a specific validated questionnaire to compare the erectile dysfunction outcomes.
They couldn’t just say they were your erections better. They had to use a questionnaire looked at and validated to show clinically meaningful differences in erectile dysfunction outcomes on medication. In this particular review, they include 16 studies with over 5 000 patients, so what they found was that efficacy, as i mentioned earlier was about the same in both groups, but in this, they also looked at how the partner felt their erections were as well as the patient’s treatment satisfaction and adherence or sticking to the medication or using it regularly with either sildenafil or tadalafil people in these studies who took tadalafil tended to have better self-esteem in their relationships and were more satisfied with their treatments and in nine studies they looked at preference they asked them what do you prefer in nine of these studies they found that the men and their partners both preferred to tadalafil over sildenafil so what they found was that persistence and side effects were similar in both groups the only difference in side effects were that sildenafil patients were more likely to have vision changes whereas tadallafil patients were more likely to have muscle aches, so what do I recommend well, if you have urinary symptoms with bph well then I recommend taking one daily dose of tadalafill every single day if you are willing to take an on-demand medication, try either one and if one doesn’t work, go ahead and switch to the other one, but always make sure you’re doing this under the supervision of a physician.
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