Viagra

Wondering about drugs to treat erection dysfunction? Find out how Viagra, Levitra and Cialis compare with each other.
By Mayo Clinic staff
Viagra, Levitra and Cialis are often the first treatment tried for erectile dysfunction – the inability to achieve or sustain an adequate erection for sexual” activity. For most men with erectile problems, they work well and have few side effects. All three medications improve erectile function in the same basic way, but the effects of tadalafil (Cialis) last longer. This and a few other minor differences among these medications may make one a better choice over another for some men.
Viagra, Levitra and Cialis: How they work
Viagra, Levitra and Cialis increase levels of nitric oxide, a chemical produced by your body during sexual stimulation that causes blood vessels in the penis to relax and open. This allows you to achieve and maintain an erection. These medications don’t automatically trigger an erection; sexual arousal is needed to start the whole process.
Which is best for you?
Viagra, Levitra and Cialis each have a slightly different chemical make up. These minor differences affect the way they work, such as how quickly they take effect and wear off; how they interact with other medications; and side effects. Your doctor will consider these factors when deciding if one of these medications is a good choice for you. Your doctor will also consider any other health problems you have and whether any of your current medications could cause problems when taken with Viagra, Levitra or Cialis.
Not safe for everyone
Although these Erection medications can help many people, not all men can safely take them. Viagra, Levitra and Cialis may not be a good choice if you have:
” Heart problems, including a recent heart attack, heart pain (angina) during sex, heart failure, heart rhythm problems (arrhythmias)
” High or low blood pressure (hypertension or hypotension) that isn’t controlled
” A history of stroke within the last six months
” Relatives with retina disorders, including retinitis pigmentosa
” Sickle cell anemia, leukemia or other health conditions that can cause an erection that won’t subside (priapism)
Interactions with other medications
Tell your doctor about all medications you take, including herbal remedies. A number of other drugs, including certain antibiotics, anti-seizure medications, blood thinners and anti-arrhythmic heart medications can affect how well Viagra, Levitra or Cialis work and cause other side effects.
A few medications should never be taken with Viagra, Levitra or Cialis, or should be used with caution:
Never take Viagra, Levitra or Cialis if you take nitrate drugs to treat chest pain due to heart problems (angina). Like Viagra, Levitra and Cialis, nitrates dilate blood vessels. Their combined effects can cause dangerous low blood pressure and loss of consciousness. Medications that contain nitrates include:
” Nitroglycerin (Nitro-Bid, Minitran, others)
” Isosorbide dinitrate (Dilatrate-SR, Isordil, others)
” Isosorbide mononitrate (Imdur, Monoket, others)
” Recreational drugs such as amyl nitrite or nitrite (“poppers”)
Talk to your doctor if you take alpha blockers, medications often used to treat an enlarged prostate. Alpha blockers can cause dangerously low blood pressure when combined with drugs for erectile dysfunction. Examples of alpha blockers include: tamsulosin (Flomax), terazosin (Hytrin) and doxazosin (Cardura).
” Don’t use Viagra, Levitra or Cialis within four hours of taking an alpha blocker.
” If you do use an alpha blocker, never take sildenafil (Viagra) in doses above 25 milligrams.
” There’s one exception to the rule about not taking alpha blockers with medications for erectile dysfunction: Tadalafil (Cialis) has been approved for use with the alpha blocker tamulosin (Flomax).
Erectile dysfunction medications for other health problems
Viagra, Levitra and Cialis all belong to a type of medications called phosphodiesterase-5 (PDE-5) inhibitors, which improve erectile function by affecting blood pressure. Experts are investigating whether these drugs may be useful to treat certain heart or blood flow problems. Revatio, the same medication as sildenafil (Viagra) was recently approved by the Food and Drug Administration as a treatment for pulmonary hypertension, a rare condition affecting blood flow to the lungs.
Common side effects
Viagra, Levitra and Cialis don’t usually cause severe side effects. Some men have reported headache, flushing, indigestion, and a stuffy or runny nose after taking Viagra, Cialis or Levitra. Men taking Levitra have also reported back pain and muscle aches. In some men, Viagra caused temporary vision changes, such as “blue” vision.

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Viagra may cause vision loss

Ophthalmologists at the University of Minnesota say that a condition that causes permanent vision loss has been diagnosed in a small group of men who have taken the Erectile dysfunction drug Viagra ( Sildenafil ).

The condition, nonarteritic ischemic optic neuropathy ( NAION ), described as “stroke of the eye,” occurs when blood flow is cut off to the optic nerve, which injures the nerve and results in permanent vision loss.

The study has been published in the Journal of Neuro-Ophthalmology.

Seven patients, aged between 50 and 69 years, had typical features of NAION within 36 hours after ingestion of Viagra for erectile dysfunction. Seven similar cases have been previously reported.

” For years, we’ve known that some men who take Viagra will experience temporary color changes in their vision and see things as blue or green, ” said Howard Pomeranz, at the University of Minnesota Medical School. ” NAION is a much more serious condition because it can lead to permanent vision loss.”

All of the patients had at least one arteriosclerotic risk factor, including hypertension, diabetes, hypercholesterolemia, or hyperlipidemia. All of the patients also had a low cup to disk ratio, which is a way doctors measure the small circular indentation where the optic nerve connects to the eyeball. The low cup to disk ratio means that the blood vessels and nerves are tightly bundled together into the small space in the back of the eye.

“Viagra regulates a chemical in the body to constrict the arteries. This constriction may cut off the blood flow to the optic nerve, especially in people with a low cup to disk ratio, where the blood vessels and nerves are tightly bundled provoking NAION,” says Pomeranz.

The onset of NAION within hours after ingestion of Viagra in 14 patients supports an association between the use of the drug and NAION. Based on the fact that 14 cases of NAION have now been reported soon after the use of Viagra, the researchers believe that ophthalmologists should ask all men with NAION about the use of Viagra, and recommend that patients with a history of NAION in one eye be cautioned that Viagra may increase the risk of NAION in the fellow eye.