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Viagra and Cialis are medications for treating erectile dysfunction (ED), or difficulty maintaining an erection.  Around half of men over forty have some form of ED, although only about 10% of those have serious problems and an additional 25% have moderate difficulty.

It is a problem because it can make sexual intercourse awkward or difficult and cause significant self-esteem and quality of life issues.

How does Viagra vs Cialis compare?

Medication class

Both Viagra and Cialis are phosphodiesterase type 5 (PDE5) inhibitors.  What that means is as follows.  When you experience sexual arousal and are a man, the activity of the chemical NO induces blood to flow into your penis.  This causes an erection and build up of cGMP.

Your body, however, has a natural mechanism for getting rid of the cGMP, which lets the blood leave your penis.  The PDE5 inhibitors go and stop your body from getting rid of it, which maintains the erection.

That said, while Viagra and Cialis are both PDE5 inhibitors, they differ in their exact activity.  They inhibit other PDE receptors, for instance, to different degree, which explains some of their side effects.

Efficacy

Both medications have similar rates of effectiveness.  One study, for instance, showed that up to 80% of those using Viagra said it improved the quality of their erections, while another study showed the same results for Cialis.

Preference – Cialis vs Viagra

Most of the studies to date have shown that people prefer Cialis to Viagra.  One study, for instance, which gave participants both over a period of time, then had them choose which one to keep using, had 70% choose Cialis.

Critics of these results have pointed out, however, that the studies may have had flaws that helped them get the results in favor of Cialis.  And, while most studies favor Cialis, critics argue that people are more likely to change their prescription from Cialis than from Viagra.

Remember, both medications have similar efficacy rates.

Dosing

Viagra takes effect in less than an hour and lasts about 4 hours.

Cialis can take up to two hours to take effect but has some effect for up to 36 hours.

Importantly, taking Viagra with a meal heavy in fatty foods can delay its onset of action by up to an hour and cause up to a 30% difference in how much drug works.  By contrast, Cialis has not been shown to be affected by what you eat.

Side Effects

Both have similar rates of side effects which are related to the medication’s basic activity.  This includes headache, flushing and nasal congestion.  Only 1-2% of people report side effects as a reason for stopping use, which is among the lowest rate of most medications.

Since Viagra has activity that effects the eye, roughly 5% of those who use it will have some sort of visual disturbance.  This can include things being tinted the color blue.

And the chemical activity of Cialis, while not causing as much visual issues, causes back pain in about 6% of those who use it.

Problem Areas

Both medications have similar drug interactions and should not be used in certain people, especially those with a recent heart attack, chest pain, serious hypo- or –hypertension and liver issues.

See manufacturer’s insert for full list of contraindications.