Navigating the Maze of Erectile Dysfunction Drugs: Understanding the Options
Erectile dysfunction (ED) affects nearly half of men aged 40 to 70 to some degree, though only about 10% report a complete inability to have erections. For many, ED drugs can produce an erection sufficient to start intercourse in about 70% of otherwise healthy men. But does it matter which of the four primary ED drugs you take?
Exploring the Differences in ED Drugs
Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston, emphasizes the importance of finding the right ED drug. "For new patients, I have them try different ones to see what works best," says Dr. Liou. The differences between the drugs can be subtle but significant.
Sildenafil (Viagra) is often the first drug doctors prescribe. It's been available the longest, and its side effects, as well as the medications and foods it interacts with, are well understood. However, one major challenge in finding the best ED drug might be health insurance rules rather than biochemistry. Insurers commonly limit the number of pills you can obtain per month, and after reaching your limit, the out-of-pocket cost for a single pill can be quite high. "The main obstacle in my practice is the cost," Dr. Liou says. Working with your doctor to get the necessary medication at an affordable price is essential.
Available ED Drugs
In addition to Viagra, the other ED drugs available in the United States include:
Avanafil (Stendra)
Tadalafil (Cialis)
Vardenafil (Levitra)
These medications improve blood supply to the penis. In combination with sexual stimulation, they can produce an erection sufficient to initiate and complete intercourse. There is also a fast-dissolving form of Levitra called Staxyn, which you place under your tongue.
Cialis: Daily Use Option
Cialis is unique among ED drugs as it is FDA-approved for daily use in doses of 2.5 or 5 milligrams. This allows for spontaneous erections and may also help relieve urinary problems, such as difficulty starting urination, that result from an enlarged prostate.
Cost Considerations
The cost of ED drugs varies widely depending on pharmacy prices, prescription co-pays, and your health plan coverage. Even if covered by private insurance, you may be limited to four doses per month. To manage costs, consider the following:
Shop Around: Pharmacy prices can vary. Tools like GoodRx can help compare prices.
Pill Splitting: Ask your doctor about getting higher-dose pills that you can split.
Manufacturer Discounts: Look into discount programs offered by drug manufacturers.
Effectiveness of ED Drugs
ED drugs help achieve an erection sufficient for intercourse in about 70% of men. However, results can vary based on individual conditions. Men with nerve or artery damage from prostate surgery, diabetes, or cardiovascular disease might not respond as strongly to these drugs. "There are some men in whom none of these drugs work," Dr. Liou notes.
Onset of Action
The time it takes for these drugs to work ranges from 15 to 60 minutes. Viagra and Levitra must be taken on an empty stomach for optimal absorption, while Cialis and Stendra do not have this food interaction. This difference in onset time can influence how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being "on demand" erectile drugs, requiring less planning compared to others.
Proper Usage of ED Pills
Dr. Liou highlights that some men who claim ED drugs don’t work for them may not be using them correctly. "The biggest misconception is that these drugs are an on/off switch for erections," he explains. Sexual stimulation is necessary for these drugs to be effective. "During that time, you need to be with your partner and have foreplay," says Dr. Liou. "Don't take it, do the taxes or the dishes, and then meet at the bedroom thinking you'll be ready to go. It's not like that."
Duration of Effect
The duration of action for ED drugs varies:
Viagra and Levitra: Last about 4 hours.
Cialis: Can last up to 36 hours at higher doses.
Stendra: Effective for up to 6 hours.
This variation means that while each dose should provide a full cycle of intercourse, repeat cycles might not be guaranteed. For frequent sexual activity, Cialis might be the best option.
Side Effects
Common side effects of ED drugs include:
Headache
Flushing
Upset stomach
Nasal congestion
Vision problems
Diarrhea
Dizziness
Rash
A prolonged erection lasting more than four hours, known as priapism, requires immediate medical attention to prevent permanent damage.
Interactions with Other Medications
None of the ED drugs should be taken with nitrates (commonly prescribed for chest pain) as this combination can cause a dangerous drop in blood pressure. Similarly, alpha blockers for urinary symptoms can lower blood pressure, so they should be taken at least four hours apart from ED drugs. Doctors may adjust the ED drug dose or recommend alpha blockers like tamsulosin (Flomax), which has a lesser impact on blood pressure.
Heart Health and Erectile Dysfunction
ED can often be an early indicator of cardiovascular disease, such as atherosclerosis (clogged arteries). "It can predate a diagnosis of cardiovascular disease by at least a few years," Dr. Liou explains. While there isn’t strong proof that a healthier lifestyle can reverse ED, adopting healthier habits certainly doesn't hurt.
Conclusion
Understanding the differences between ED drugs is crucial for effective treatment. While Viagra, Cialis, Levitra, and Stendra all serve the same primary purpose, their variations in onset time, duration, and interaction with food and other medications mean that the best choice can vary from person to person. Consulting with a healthcare provider, considering cost factors, and understanding how to use these medications properly are essential steps toward the effective management of erectile dysfunction.
