No need to dig deeper: the Most Detailed comparison of Viagra (Sildenafil) and Cialis (Tadalafil)
The Root of all problems – Eectile Dysfunction
Currently, the term ‘erectile dysfunction’ (the one that replaced a less accurate ‘impotence’) stands for an inability to achieve and/or maintain an erection sufficient to conduct a full sexual intercourse. With the emergence of PDE-5 inhibitors referring to the phenomenon that doesn’t mean a complete absence of erection as ‘impotence’ has lost its actuality; so erectile dysfunction means that the problems with sexual life may have temporary or recurring nature and includes such manifestations as premature ejaculation, sexual fatigue, prolonged sexual recovery time and etc. Considering the problems with erection from erectile dysfunction standpoint it is meaningful only if the sufficient erection is not achieved in more than 25% of copulations.
Erectile dysfunction affects 150 million men worldwide (although the global researches have not been conducted; the actual amount is considered to be way higher) and 20 million men in the US. A range of studies in men revealed the prevalence of erectile dysfunction in 27 – 39% of males in Europe (the statistics includs the United Kingdom).
IMSM research focusing on studying the aging process in men revealed 52% of 40 – 70 years old men suffer from erectile dysfunction. It was shown that 58% of 40 – 50 years old males take no measures to combat the issue, considering the loss of erectile function to be a normal process.
Erectile dysfunction types
Depending on the nature of the problem, erectile dysfunction is referred to one of the following types:
Psychological (or psychogenic) – as a rule, this ED type is manifested quite unexpectedly. The main reason for its occurrence is stress, caused by a variety of reasons: from complex relationship between the partners to excessive loads at work. In case of psychological ED the morning erection of the penis and the ability to remain in a tense state during an intercourse are preserved.
Organic – this ED type emerges gradually, weakening of erection as time passes. This indicates the presence of concomitant diseases requiring treatment. Receiving drugs that affect the potency can also be the cause for appearance of problems of organic nature. In this case morning and nocturnal erections are lost, there is a sudden loss of rigidity, although an ability to ejaculate may be preserved.
Mixed – according to the recent statistics, erectile dysfunction is caused by psychological factors in 20% of cases, while in the rest 80% it indicates the presence of serious diseases, against which it develops (e.g., hypertension or diabetes). Therefore, it is essential to diagnose the changes in the body affecting erection.
Vascular causes fall into the largest groups having a dominant value in the structure of the organic causes of erectile disorders. So according to the National Institutes of Health in 75% of cases erectile dysfunction is diagnosed on the background of a vascular pathology. The most widely spread cause are arterial hypertension, heart failure, coronary heart disease (CHD), diabetic angiopathy in diabetes, hyperlipidemia (increased fats in the blood), smoking, post-operative complications (such as prostatectomy).
Erectile dysfunction is also oftentimes observed against the background of chronic prostatitis. Partially it is explained by general exhaustion and largely psychological factors as prostatitis is likely to contribute to the development of depression. Physiologically, erection issues in the event of chronic prostatitis are caused by inflammatory process that affects nerve bundles, passing through the prostate gland.
There’s also a number of drugs having a negative impact on sexual health. Thus, a number of hormonal drugs may block the functioning of anti-androgens, sex hormones; some preparations may trigger an increased production of female sex hormones which leads to erectile dysfunction as a result of hormonal mechanisms violations. Such drugs are included in complex treatment of serious conditions, such as prostate cancer – the most widely spread.
Comparing Viagra and Cialis by Canadian Health&Care Pharmacy
The most effective non-invasive treatment of ED implies the use of phosphodiesterase type 5 (PDE-5) inhibitors: sildenafil citrate and tadalafil, the active substances of Viagra and Cialis accordingly. These preparations represent the first-line treatment drugs group and are appointed in about 70% of erectile dysfunction cases. The mechanism of action of both components is identical: these drugs do not have a direct relaxing effect on the cavernous body of the penis, but during naturally caused sexual arousal they increase the relaxing effect of nitric oxide by inhibiting the PDE-5 and increasing concentration cGMP concentration.
Pharmacological action comparison
Both medications are rapidly absorbed from the gastrointestinal tract. Simultaneous reception of fatty foods reduces and delays sildenafil absorption, while the rate and extent of absorption of tadalafil does not depend on food intakes. When taking Viagra alcohol consumption must be excluded, while in Cialis small doses of alcohol are allowed.
Most fundamentally PDE-5 inhibitors are distinguished by such parameters as the time to reach maximum concentration and half-life.
Tadalafil outperforms Viagra speed exceeds the maximum concentration in the blood an average of 4 hours (the duration of the effect up to 9 times longer in comparison with sildenafil). In practice this means that tadalafil enables faster readiness for conducting sexual intercourse than sildenafil. Thus, in a clinical trial which included 732 men with ED, tadalafil marked effect already 16 minutes after ingestion of 20 mg respectively. During the first 25 minutes after tadalafil intake every second men with erectile dysfunction diagnosis has managed to achieve erection sufficient to conduct sexual intercourse.
Sildenafil half-life equals 4 hours; the same indicator in tadalafil is 17.5 hours. However, the clinical effect of tadalafil lasts for 36 hours in 59.2% of patients. With tadalafil a person can choose the most appropriate moment for intimacy during almost 1.5 days, which for some men is a more preferable option (the absence of the need to take medication at certain times). At the same time, a long half-life of tadalafil may cause more frequent cases of muscular aches due to a more rapid deposit of blood in the muscles. Furthermore, the risk of drug interactions increases in patients receiving concomitant drug therapy (in particular with organic nitrates) for diseases of internal organs.
Direct comparative studies of the efficacy and safety of PDE5 inhibitors have not been conducted, and the results of studies of individual drugs rather difficult to compare given the differences in the patient population, inclusion criteria and statistical analysis methods. Nevertheless, according to product registration in Europe, the percentage of successful intercourse attempts at 50-100 mg sildenafil therapy was 66%, tadalafil 20 mg 75%. Clinical efficacy may partly depend on the actions of other drugs, so it is not reasonable to draw a direct parallel between the active ingredients and their efficacy.
Side effects
The majority of adverse reactions when using PDE-5 inhibitors is associated with their main mechanism of action blocking PDE-5. Apart from cavernous tissue, the preparation builds in smooth muscles of vessels of lungs, kidney, gastric cardia, and platelets. The distribution of PDE-5 in the body varies individually, so all the drugs in this group are characterized by a similar set of adverse reactions, primarily associated with the blockade of the enzyme in various organs. These include headache, flushing, indigestion and stuffy nose. Against the background of tadalafil, sildenafil causes flushes more frequently, but at the same time it is less likely to cause dyspepsia (epigastric discomfort), and myalgia.
Contraindications
PDE5 inhibitors should be used with caution or not used at all in those whose sexual activity is associated with a potential risk of complications within 90 days after myocardial infarction, unstable angina or angina occurring during sexual intercourse, heart failure class II and higher which has developed over the past 6 months, uncontrolled cardiac arrhythmias, hypotension or uncontrolled hypertension, and for 6 months after stroke. In addition, this group of drugs with caution in patients with a predisposition to priapism, or in patients with anatomical deformations of the penis.
Choosing an optimal preparation: Canadian Viagra or Canadian Cialis?
Both drugs are characterized as highly effective and safe means for ED treatment, having the same indications and largely the same contraindications. However, they have certain differences in efficacy and tolerability, the severity of which may vary in different patients.
In the absence of comparative studies of sildenafil and tadalafil, making a choice can be a challenging task. In general, sildenafil is a drug for regular sexual intercourses, while tadalafil is a more suitable option for those preferring more intense sexual relations. It is strongly recommended that the drug selection should be made within a consultation with a physician. The professional point of view may, for example, take into account the higher risk of violations of color in sildenafil driver means it could not be the best choice for vehicle drivers, or a higher atherogenic index in some cases may mean the excessive loads on heart should be avoided (sildenafil could be an option here).
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canadian-healthcare.com – Canadan Health Care Pharmacy Team