Ask Dr. Monti: What’s the Difference Between Viagra, Levitra and Cialis?

Daniel Monti

Question: What’s the difference between Viagra, Levitra and Cialis? And are they really safe to use?

Answer: All three drugs work by inhibiting an enzyme, phosphodiesterase type 5 (PDE-5), which is concentrated in the penile erectile tissue and interferes with a man’s ability to have an erection.

None of these drugs produces an instant erection; they take about a half an hour to become effective. Viagra and Levitra last up to 4 hours. Cialis comes in two forms: one for daily use, and a higher dose that can work for up to 36 hours, which means that it stays in your system longer.

ED drugs can make an erection physically possible for men who may not be able to have one otherwise. However, that these drugs are not aphrodisiacs. They don’t rev up sex drive or make a man want to have sex. A man must be sexually aroused for these drugs to work in the first place. If a man is low in testosterone, is depressed, or has little interest in sex, these pills may not do a thing. Many of my patients report that these drugs have been life-changing, but they do not work for every one. About a third of men who try an ED drug don’t have a satisfactory result. A minority may find the side effects, including headache, blurry vision, and upset stomach, intolerable.

These drugs are not to be used by men taking any form of nitrates for chest pain, or alpha-blockers for high blood pressure. When taken with those drugs, ED drugs (PDE-5 inhibitors) can cause a sudden and dangerous drop in blood pressure. With all ED drugs, there is also a small risk of priapism, a prolonged erection in which blood fails to drain from the penis. This can be quite painful, requiring a visit to the emergency room.

There is a comprehensive section on ED and its treatment, in my book, The Great Life Makeover.

ASK DR. MONTI: E-mail Dr. Monti your question here, and he could answer it an upcoming blog post! Dr. Monti is Director of the Myrna Brind Center of Integrative Medicine at Thomas Jefferson University Hospital and the author of “The Great Life Makeover”. Read more about him here.

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