Weighing the benefits and risks of Levitra versus Sildenafil requires some basic knowledge of each. A comparison can be made by examining how they can be used, the time it takes for them to work, the length of time they work, the restrictions on how they can be taken, the contraindications to their use, and their side effects.
Viagra, which is Sildenafil, has been approved “for the treatment of erectile dysfunction (ED), including ED patients with diabetes mellitus or following radical prostatectomy.” (PDR) Viagra is available in doses of 25 mg, 50 mg, and 100 mg. However, generic Sildenafil comes only in one size, 20 mg. The FDA approved Sildenafil in the low 20 mg dose for pulmonary hypertension, but since it is the same medication as in Viagra, and only a fraction of the cost, many patients work with their healthcare providers to use sildenafil “off-label” for erectile dysfunction (ED). Many find the cost of the brand sildenafil (Viagra) so high they cannot start the medication nor continue its use.
Most physicians who prescribe Viagra (Sildenafil) start patients on the 50 mg dose and either raise or lower the dose as warranted. One of the benefits of using sildenafil in the 20 mg dose is that you and your healthcare provider can raise or lower the dose more carefully.
A physician might write a prescription for a patient to take 2 of the 20 mg tablets of sildenafil (a 40 mg dose) one hour before sexual activity. Based on effectiveness and tolerance, the physician and patient may find it is appropriate to increase the dose to 60 mg (3 tablets), 80 mg (4 tablets), or the maximum 100 mg (5 tablets). On the other hand, a patient may find that a 20 mg dose (1 tablet) gives the effect he wants and avoids an annoying side effect. Such fine shifts are not possible with brand sildenafil (Viagra). A physician can only jump from 50 mg to 100 mg if an increase is needed, or drop from 50 mg to 25 mg if a decrease is warranted. These are big jumps in dosages by comparison.
Sildenafil tablets are to be taken as a single dose. If prescribed a 60 mg dose, for example, you would be required to take 3 of the 20 mg tablets by mouth with water about one hour before you anticipate you will engage in sexual activity.
Sildenafil and Levitra both have relatively rapid onsets. They can be effective in as little as 1 hour, though for some patients these medicines can work more rapidly.
Sildenafil and Levitra will be out of the body in approximately 6 to 8 hours. Levitra works about as quickly as Sildenafil and lasts about as long. However, it can be taken with food (unless it is an exceedingly fatty meal), which is an excellent option with obvious real world usefulness. The effect of Sildenafil or Levitra may not be needed beyond 6 or 8 hours and any side effects they cause will fade rapidly as a medication leaves the bloodstream.
The differences people experience in terms of the effects or side effects can make one drug preferred over the others, depending on a person’s circumstance. Sometimes, a peculiar side effect might prevent a person from taking Sildenafil but not Levitra. Some men might not be able to take Levitra because they are on a medication that might lead to a cardiac arrhythmia, as discussed below. Many physicians avoid Levitra because of that risk.
How might choices be made? Consider two men.
They both might be able to predict when sexual activity will occur. A drug that works rapidly and leaves their system quickly thereafter would be perfect, as with either Sildenafil or Levitra. If dining is part of the evening’s plan, Levitra may be a more practical choice, as it is unaffected by food. If he is on a medication that can cause a heart abnormality call QT syndrome, Levitra cannot be used, and he may decide to take Sildenafil well before his meal.
Yet, one issue is rarely the sole factor men consider when taking a medication for erectile dysfunction. It is the interplay between a man’s social circumstances (and that of their partner), his need for a rapid onset of medication activity versus a prolonged duration of action, the individual reaction to the drug in terms of side effects, a person’s prior medical history, the other medications they take, and the very personal definition of what it means to achieve an erection satisfactory for sexual activity.
Remember, since these medications all affect phosphodiesterases, and there are many slightly different types of phosphodiesterases doing various work throughout the body, side effects occur and can vary between meds. To one degree or another, they all may cause headaches (10%-16%), nasal stuffiness (1%-10%), flushing (5%-12%), dizziness (~3%), and upset stomach (4%-12%). [Drugs 2005;65:1621-1650] Yet, side effects can differ.
Levitra is almost identical to Sildenafil in onset of action and the duration of its effect. It has been shown to be more potent and more selective than Viagra at inhibiting phosphodiesterase 5 biochemically; yet, that doesn’t seem to translate into being more effective in treating Erectile Dysfunction (ED). However, it does give Levitra one advantage over Viagra. Though uncommon, Viagra can cause men to see a bluish tint. That is because Viagra not only affects phosphodiesterase 5 but also phosphodiesterase 6, which has a role in regulating the retina. Levitra has very little impact on phosphodiesterase 6 and significantly decreases the possibility of that side effect.
There is a good deal of trial and error in finding the right medicine, the most effective dose, and the plan that results in the fewest side effects. Sometimes, a side effect is worth the benefit, sometimes not. On occasion, a man will be on medications that require a dose adjustment. Even a simple antibiotic like erythromycin can alter how the body handles either medication, and the dose must be adjusted. Grapefruit juice can do so as well. Some medications lower blood pressure and each of these medications, Sildenafil or Levitra, can add to that blood pressure lowering effect and be quite dangerous. Nitrates, nitrites, and nitroglycerin can all be dangerous when combined with medications that treat erectile dysfunction.
The key is to get educated and to share all your information with each of your healthcare providers. Only by doing so can a safe, effective, and personalized treatment plan be crafted with your goals achieved and your safety preserved.