Sildenafil vs Tadalafil vs Vardenafil: Which ED Medication Is Right for You?
The three major ED medications—sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)—all work similarly but have key differences in how fast they act, how long they last, and their side effects. Here's everything you need to make an informed choice.
Quick Summary
Sildenafil (Viagra)
The original. Fast-acting, 4-6 hours. Best for occasional planned use.
Tadalafil (Cialis)
"The weekend pill." Lasts up to 36 hours. Best for spontaneity.
Vardenafil (Levitra)
Most potent. 4-6 hours. Best for those who had vision issues with Viagra.
Complete Comparison
| Factor | Sildenafil | Tadalafil | Vardenafil |
|---|---|---|---|
| Brand Name | Viagra | Cialis | Levitra |
| FDA Approved | 1998 | 2003 | 2003 |
| Time to Work | 30-60 min | 30 min - 2 hrs | 15-60 min |
| Duration | 4-6 hours | Up to 36 hours | 4-6 hours |
| Standard Dose | 50mg | 10mg | 10mg |
| Max Dose | 100mg | 20mg | 20mg |
| Daily Option | No | Yes (2.5-5mg) | No |
| Food Interaction | Reduced by fat | Not affected | Reduced by fat |
| Visual Side Effects | Blue tint (3%) | Rare | Rare |
| Back Pain | Rare | More common | Rare |
| Generic Price | $2-6/dose | $2-8/dose | $4-10/dose |
| Effectiveness | ~70-84% | ~70-80% | ~71-85% |
How They All Work
All three medications belong to the same drug class: PDE5 inhibitors. They work identically at the molecular level:
- 1. Sexual stimulation triggers nitric oxide release
- 2. Nitric oxide activates cGMP (causes erection)
- 3. PDE5 enzyme breaks down cGMP (ends erection)
- 4. PDE5 inhibitors block this breakdown
- 5. More cGMP = stronger, longer-lasting erections
Key point: None of these medications create desire or cause spontaneous erections. Sexual stimulation is still required.
Sildenafil (Viagra) — The Original
Approved in 1998, sildenafil was the first oral ED medication. It remains the most recognized and widely used.
Best For:
- • Occasional, planned sexual activity
- • Men who want effects to wear off predictably
- • Budget-conscious users (cheapest generic)
- • First-time ED medication users
Not Ideal If:
- • You eat before sex (fatty meals reduce effect)
- • You want spontaneity
- • You're prone to vision disturbances
Clinical trials show 77-84% of men report improved erections with sildenafil. It's particularly well-studied in diabetics, cardiac patients, and men with psychogenic ED.
Tadalafil (Cialis) — The Weekend Pill
Tadalafil's standout feature is its 36-hour duration—take it Friday evening and it's still working Sunday morning.
Best For:
- • Complete spontaneity
- • Frequent sexual activity
- • Dating/dinner scenarios (food doesn't matter)
- • Men who also have BPH symptoms
- • Daily use option available
Not Ideal If:
- • You prefer shorter-acting medication
- • You're prone to back pain
- • You need nitrates (longer clearance time)
Studies show men often prefer tadalafil over sildenafil when given both options—likely due to the flexibility of the longer window. A 2024 analysis also found tadalafil users had lower rates of cardiovascular events.
Vardenafil (Levitra) — The Potent Alternative
Vardenafil is biochemically the most potent PDE5 inhibitor, meaning lower doses are needed. It's also more selective, causing fewer visual side effects.
Best For:
- • Men who had vision issues with sildenafil
- • Potentially faster onset (as quick as 15 min)
- • Older men (85% success in 65+ in studies)
- • Available as dissolving tablet
Not Ideal If:
- • Budget is a concern (often pricier)
- • You eat fatty foods before sex
- • Brand-name Levitra discontinued (generic only)
Vardenafil doesn't inhibit PDE6 (the enzyme linked to vision changes), making it a good choice for men who experienced the "blue tint" with Viagra. Studies show 71-85% effectiveness across age groups.
Side Effects Compared
All three share common side effects from vasodilation:
| Side Effect | Sildenafil | Tadalafil | Vardenafil |
|---|---|---|---|
| Headache | Common (~16%) | Common (~15%) | Common |
| Flushing | Common | Common | Common |
| Nasal congestion | Common | Common | Common |
| Indigestion | Common | Common | Common |
| Vision changes | 3% (blue tint) | Rare | Rare |
| Back/muscle pain | Rare | More common | Rare |
| Side effect duration | 4-6 hours | Longer (up to 36 hrs) | 4-6 hours |
⚠️ Important Safety Warning
All three medications are contraindicated with nitrates (nitroglycerin) and recreational "poppers." This combination can cause dangerous drops in blood pressure. Seek immediate medical help for erections lasting more than 4 hours or sudden vision/hearing loss.
Which Should You Choose?
Choose Sildenafil If:
- ✓ You want the most affordable option
- ✓ You have occasional, predictable sexual activity
- ✓ You can plan around meal timing
- ✓ You're new to ED medications (most studied)
Choose Tadalafil If:
- ✓ You want maximum spontaneity
- ✓ You have sex frequently
- ✓ You often eat before sex
- ✓ You also have enlarged prostate (BPH)
- ✓ You want a daily option
Choose Vardenafil If:
- ✓ You experienced vision issues with sildenafil
- ✓ You want possibly faster onset
- ✓ You prefer a dissolving tablet option
- ✓ Sildenafil didn't work well for you
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What About Avanafil (Stendra)?
There's actually a fourth PDE5 inhibitor worth mentioning: avanafil (Stendra). It's the newest (approved 2012) and fastest-acting—working in as little as 15 minutes. Duration is 6-12 hours.
However, avanafil is typically more expensive and less commonly prescribed. Most men start with one of the "big three" above.
Key Takeaways
- 1. All three are equally effective (~70-85% success rates)
- 2. Biggest difference: duration — Tadalafil lasts 36 hours vs 4-6 for others
- 3. Food matters for sildenafil and vardenafil, not tadalafil
- 4. Only tadalafil has a daily option
- 5. Vardenafil is best for men with vision issues from Viagra
- 6. Sildenafil is usually cheapest
- 7. Try different ones to find what works best for you
- 8. All require prescription in the US
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. All ED medications are prescription drugs with potential side effects and drug interactions. Do not take with nitrates. Consult with a qualified healthcare provider before starting any ED treatment.