Viagra is a hugely successful drug, so other drug companies of course want a piece of the action. They developed different chemicals to block the PDE5 enzyme and created two new drugs: Cialis (tadalafil) and Levitra (vardenafil). (There is another drug, Staxyn, with the same active ingredient as Levitra that has recently come onto the market. It's an orally disintegrating tablet that isn't interchangeable with Levitra, but chemically is much the same.)
Because Cialis and Levitra block the PDE5 enzyme, they work exactly the same way as Viagra. They help men who have trouble maintaining an erection because of blood flow problems, and they only work when the man is sexually aroused.
Because they block PDE5 with different chemicals, however, there are some differences between the three drugs. For example:
- Cialis causes muscle aches and back pain in some patients, a side effect that isn't associated with Levitra or Viagra.
- Viagra lasts about four hours in the bloodstream, while Levitra lingers for five. Cialis stays in the bloodstream much longer (it has a 17.5-hour half life) and can therefore be effective for more than a day -- for this reason, Cialis is expected to outsell Viagra soon [source: Wilson]. Its nickname? "The Weekender."
- Cialis works faster than Levitra or Viagra -- in about 15 minutes.
- Fatty foods seem to affect how Viagra and Levitra work in the body but don't affect Cialis.
There are always new drugs in development. Here are a few future possibilities:
- Uprima (apomorphine) is available in Europe, but not the U.S. It works quickly and may affect sexual interest, but it also causes nausea and, sometimes, syncope (fainting). It acts on the central nervous system. There is also a nasal spray version in development. (Interestingly, it used to be used in aversion therapy to try to "convert" gay men to heterosexuality -- the nausea side effect came in handy.)
- Topiglan (alprostadil) would be a topical version of the drug that is even now used in injection or suppository form to fight ED. This might be very helpful for men whose other medications make it impossible for them to take oral ED drugs safely.
- Avanafil, another PDE5 inhibitor that may work faster and have fewer side effects than what's currently on the market. It is in phase III clinical trials.
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