Wednesday, 2 September 2009

Viagra vs Levitra and Cialis

As many peyronie's disease sufferers have erectile dysfunction, use of phosphodiesterase type 5 inhibitors such as Viagra are common. Even where ED is not present there is an argument for use of PDE5 inhibitors alongside a more comprehensive oral treatment regime. We see this in early stage PD treatments such as the PAV cocktail (Pentoxifylline, L-Arginine and Viagra).

Over the years the number of erectile dysfunction options has expanded from Viagra, to new additions Levitra and Cialis. For a compairson, check out the below chart:



There's really not much to seperate any of them in any real sense and patients tend to stick with whatever treatment they start with. Viagra has a good track record behind it, but as Cialis has such a long half life (resulting in its "weekender" reputation) that would probably be the best option to start with. If the drug works against PD via multpiple mechanisms it's surely best to have it in your system for as long as possible. If reducing ED is the primary benefit, then still it helps to be able to gain a full erection on demand, rather than specifically have to prepare for it.

The Erectile Dysfunction Observational Study (EDOS) is a 6-months observational prospective multicentric study enrolling men with erectile dysfunction (ED) who asked, to be started on a treatment or to change a previous treatment. Aims of the study were to analyse the pattern of treatment and compare the efficacy of treatments used. Patients were enrolled during a normal hospital visit and were prescribed a treatment for ED. They were asked at baseline and after 3 and 6 months, to answer a set of questions from the International Index of Erectile Function, Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and Short Form of the Psychological and Interpersonal Relationships Scale questionnaires (SF-PAIRS). Clinicians were free to prescribe any therapy for ED available in the market, and to change therapy at any time during the study. Out of 1 338 patients, available for analysis at 6 months, 624 (47%) changed their treatment during the study and 714 (53%) continued with the drug prescribed at baseline. Patients assuming tadalafil had a significantly higher probability of maintaining the same treatment compared to sildenafil or vardenafil. There was no clinically significant difference in terms of efficacy, patient satisfaction, self-confidence and spontaneity between the different inhibitors of PDE5. The 'time concerns' domain score of SF-PAIRS, was statistically better in patients assuming tadalafil. In conclusion sildenafil, vardenafil and tadalafil show similar efficacy in the clinical practice. However, patients receiving tadalafil display a lower risk to discontinue or change the treatment.Asian Journal of Andrology advance online publication. 24 Augest 2009; doi: 10.1038/aja.2009.48. - http://www.ncbi.nlm.nih.gov/pubmed/19701217?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


(For reference: Tadalafil = Cialis, Sildenafil = Viagra , Vardenafil = Levitra)

The above study echoes the thought that there's not much between the various options, though it does state that "patients receiving tadalafil display a lower risk to discontinue or change the treatment", so again this is probably a good starting point. Should it not work for you, then you always have Viagra and Levitra to turn to. Also, remember that cutting pills in half or quarters may be a good way to find a dose that is most appropriate for you.

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