Comparing Viagra / Sildenafil vs Cialis / Tadalafil. Which Is Best?

By: Michael Kemper, M.D.

Erectile dysfunction (ED) is not simply a medical issue; it can impose a heavy strain not only on the affected individual but also on their intimate partner. Given the widespread nature of this condition, finding effective solutions is crucial. Thankfully, there are numerous treatment options available that cater to varying stages and severities of ED. Among these, sildenafil—widely recognized under the brand name Viagra—and tadalafil, marketed as Cialis, stand out as the most commonly thought of medications. Their reputation stems not only from consistent clinical effectiveness but also from extensive marketing efforts throughout the past few decades. They have become the quintessential first-line therapeutic choices due to their practical and straightforward administration.

In subsequent discussions, we will delve deeper into the specifics of when these medications yield the best results and what options are available if they begin to lose effectiveness over time. For now, however, our focus will be on comparing these two prominent treatment modalities.

It is essential to highlight that both sildenafil and tadalafil are classified as PDE-5 inhibitors. This classification implies that they function by relaxing the smooth muscle cells located within the walls of blood vessels. In doing so, they promote vasodilation, thereby enhancing blood flow to specific areas of the body, particularly the penis. Because these medications are taken orally, they exert a systemic effect. This can lead to some individuals experiencing facial flushing or a reddening of the skin, in addition to the intended improvement in erectile function. Though these medications share common characteristics, it is vital to understand their distinctions to optimize their use and effectiveness for each individual.

**It is noteworthy that both medications are generally safe for a wide range of patients and are often interchangeable. This means that if one medication fails to produce the desired outcomes or results in side effects that are difficult to tolerate, the other can typically be considered as an alternative. Many men may even choose to alternate between these medications during the initial phases of their treatment journey to determine if either option provides superior results. For the majority of patients, both medications yield comparable effectiveness when taken as directed.

Duration of Action

This aspect represents one of the most significant points of differentiation between the two medications. Viagra / sildenafil typically acts more quickly, with effects observable within 30 minutes to an hour post-ingestion, and lasts for several hours thereafter. In contrast, Cialis / tadalafil has a more gradual onset, taking 1-2 hours to become effective, but offers a remarkable duration of action spanning up to 36 hours. This extended timeframe allows patients to achieve an erection spontaneously over a day and a half, provided that sexual stimulation is present.

It is crucial to recognize that these medications do not enhance libido or the intrinsic desire for sexual activity. If an individual lacks an interest in engaging in sexual intercourse, they will not experience an erection, regardless of which medication they opt to take. Furthermore, these medications do not induce erections spontaneously; instead, they serve to facilitate the natural erectile response that occurs in response to sexual stimulation.

With a clear understanding of these duration characteristics, healthcare providers can tailor the choice of medication based on the patient’s lifestyle. For those individuals in stable, committed relationships with predictable sexual encounters, either medication may suffice. Conversely, for those with a more spontaneous approach to sexual activity, the prolonged duration of effect associated with Cialis / tadalafil may provide a more suitable alternative.

Side Effects

Both Sildenafil and Tadalafil can produce similar side effects, primarily stemming from their blood vessel-dilating effects. Patients may report facial flushing or a feeling of warmth as a result of these vasodilatory properties. Additionally, headaches may occur due to the increased blood flow. It’s important to note that the side effects can manifest differently across individual patients. Therefore, while these medications are generally interchangeable, one may prove to be more suitable than the other based on the specific side effect profile experienced by a patient.

Common side effects associated with sildenafil / Viagra include:

• Headaches
• Nausea
• Flushes
• Congestion
• Indigestion
• Dizziness
• A temporary blue tint to vision that subsides upon discontinuation of the medication
• In rare instances, vision loss that could potentially lead to permanent blindness

Common side effects related to tadalafil / Cialis include:

• Headaches
• Congestion
• Indigestion
• Back pain
• Cough
• Upper respiratory tract infections

It is imperative to acknowledge that while most side effects are mild, their duration is closely linked to the medication's half-life. As a result, patients experiencing side effects from tadalafil are likely to encounter them over a longer duration compared to those using sildenafil.

Dosage

Upon researching these two medications, you may notice that their maximum dosages significantly differ. For sildenafil / Viagra, the upper limit is set at 100 mg, while for tadalafil / Cialis, it is capped at 20 mg. It’s essential to emphasize that this variation does not impact the overall effectiveness of either medication. Many patients may initiate treatment at the maximum dosage and subsequently experiment with lower dosages (such as half or a quarter of a tablet) to ascertain if comparable results can be achieved.

Interactions with Food

Another notable difference lies in how these medications interact with food. Viagra / sildenafil may have its efficacy diminished when taken alongside high-fat meals, making it most effective when consumed on an empty stomach. In contrast, Cialis / tadalafil is not similarly affected by food intake. This attribute often makes tadalafil the preferred choice for individuals actively engaging in dating scenarios—especially those who tend to dine out prior to intimate encounters.

A Daily Option for Enlarged Prostate

Interestingly, a low-dose regimen of tadalafil / Cialis (5 mg) can be prescribed for daily use to assist with symptoms associated with prostatic enlargement or Benign Prostatic Hyperplasia (BPH), while simultaneously enhancing erectile function. For those experiencing both of these issues, discussing this alternative with a urologist can be beneficial, as sildenafil / Viagra does not provide this dual advantage.

Peak Blood Concentration

Although both medications typically exhibit effectiveness within 30 to 60 minutes of administration, the peak blood concentration varies considerably. Sildenafil / Viagra reaches peak levels approximately an hour after administration, whereas tadalafil / Cialis peaks after about two hours. This distinction is especially significant and should be factored into planning for sexual activity.

The Bottom Line

In summary, while both Viagra and Cialis belong to the same class of medications and are recognized for their safety and efficacy, they exhibit several key differences that are worth considering. The advent of generics and the expiration of patents have greatly improved the affordability of both options, making them more accessible to patients in need. It is often beneficial for individuals to experiment with alternating between these two drugs to determine which offers the best results or minimizes side effects based on their personal circumstances. In certain cases, combining both medications may yield even better outcomes. Most importantly, if you experience any signs of erectile dysfunction, it is vital to consult with your urologist to explore all available treatment options tailored to your needs.