A review of a decade of articles concerning three of the PDE-5 (phosphodiesterase type 5) treatment options for erectile dysfunction—sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)—reveals that men consistently prefer one medication over the other two choices. Despite research showing no significant differences in the three drugs’ safety and efficacy, men have a preference for Cialis (tadalafil) as the best ED drug for men.
Research indicates that these three PDE-5 inhibitors have no significant differences regarding safety and efficacy. The medications do differ, however, in their half-life (how long it takes for the drug to lose 50% of its potency) and the impact of diet on absorption.
Both sildenafil (Viagra) and vardenafil (Levitra) have a half-life of about 4 hours, therefore providing men with an estimated 8 hours during which erection should be possible. Tadalafil (Cialis), however, has a half-life of 17.5 hours, offering a 35 to 36 hour window. Men can take tadalafil with any type of food, while high-fat meals can reduce both the extent and rate of absorption of sildenafil and vardenafil.
The reviewers looking at the best ED drug for men selected studies from peer-reviewed publications published since 2000 and chose nine that met their criteria. Altogether the data were gathered from two randomized, double-blind trials, one observational and three open-label studies that compared tadalafil with sildenafil; and one randomized trial, one open-label and one observational study that evaluated all three PDE-5 inhibitors. The studies included more than 7,700 participants.
Overall, the reviewers found that 52 to 65 percent of men preferred tadalafil (Cialis) as the best ED drug for men compared with 12 to 20 percent who liked vardenafil (Levitra) and 8 to 30 percent who chose sildenafil. Men preferred tadalafil mostly because it provided them with a longer window of opportunity—36 hours—and thus greater freedom in their sex life. The reviewers also found that among patients who had a chance to try tadalafil, 66 to 90 percent decided to continue taking tadalafil or switch to it.
Men who suffer with erectile dysfunction have several safe and effective treatment options, and factors important to them and their partners can influence the treatment they choose. Men’s preference when choosing treatment depends on three things: personal characteristics (e.g., age, how long they have had erectile dysfunction, and the state of their sexual relations), their partners’ characteristics (e.g., age, menopausal status, level of interest in sexual activity), and the treatment’s features, such as quality of erection, consistency of results, how long it takes for an erection to occur, side effects, convenience, cost, and how the treatment is administered.
The authors of the review note that features such as convenience, simplicity, and naturalness of results are characteristics men value when choosing a treatment for erectile dysfunction. These features could “have contributed to more tadalafil patients being satisfied with their treatment, thereby resulting in less patients switching from tadalafil.” They also emphasized that physicians should consider a patient’s needs and perception and that “the real objective should be the ‘normalization’ of patient’s sexual life when looking at the best ED drug for men.”
Read more in our Erectile Dysfunction Health Center.
Morales AM et al. Patients’ preference in the treatment of erectile dysfunction: a critical review of the literature. Intl J Impotence Res 2011; 23:1-8