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When Stendra (avanafil) was introduced to the field of erectile dysfunction (ED) drugs in 2012, it was the first ED medication to hit the market in more than a decade. It also brought the number of ED drug options up to five, a fact that has triggered more and more men to wonder, which ED drug is best?

The answer is, it depends. According to Dr. Laurence Levine, a professor in the department of urology at Rush University Medical Center in Chicago, “There is no drug that is the best.” Each man’s individual body chemistry “may make one drug better than another. There are certain advantages and disadvantages to all of these drugs.” The drug options, in addition to Stendra, include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxyn–the fast-dissolving form).

What are oral ED drugs?

The current five oral ED drugs all belong to the same drug class; that is, phosphodiesterase type 5 inhibitors, or PDE-5. Generally they work by blocking one or more of the five different types of the enzyme phosphodiesterase, which in turn prevents the inactivation of certain chemical messengers. This inhibiting action then improves blood supply to the penis. When ED drugs are used along with sexual stimulation, they can produce an erection that is sufficient to initiate and complete sexual intercourse.

    Research has shown that these PDE-5 inhibitors are similar when it comes to efficacy and safety, but there are some differences regarding time to action, the impact of diet on how well they are absorbed, how long they last, and some minor side effects.

These factors play a significant role in helping men decide which ED drug is best for their needs and lifestyle. Men also may take into consideration their and their partners’ preferences, such as how spontaneous they are when it comes to sexual activity, and cost.

For example, in 2011 a meta-analysis compared use of three ED drugs–sildenafil, tadalafil, and vardenafil—among more than 7,700 men. The investigators found that men consistently preferred tadalafil (Cialis) (52-65%) over the other two (12-20% for vardenafil; 8-30% for sildenafil). Although all three drugs were shown to be safe and effective, tadalafil offered men a 36-hour window of opportunity for getting an erection, while the other two provided a much shorter time period.
How do the ED drugs compare?

Men who suffer with erectile dysfunction can compare the general characteristics of each of the five available ED drugs. These facts, along with their personal preferences and lifestyle habits, can help when choosing which ED drug is best for them.

Stendra

    Begins to work within as little as 15 minutes of ingestion, although it may take longer for some men
    Can be taken with or without food with no impact on response
    Men can achieve successful erections for more than six hours after taking the pill
    Most common side effects are flushing, headache, nasal congestion, and runny nose. Symptoms such as back pain, diarrhea, dizziness, hypertension, influenza, muscle aches, and upper respiratory infections are less common.

Cialis

    Begins to work within 30 to 45 minutes after ingestion, although there have been reports that it can be effective within 15 minutes
    Men can achieve successful erections for up to 36 hours after taking the pill
    Can be taken with or without food with no impact on response
    Most common side effects are headache and indigestion. Less often men experience back pain, dizziness, facial flushing, muscle aches, and nasal congestion

Levitra and Staxyn

    Begins to work within 25 minutes, but it may take longer if you take it with a fatty meal
    Men can achieve successful erections for 4 to 5 hours after taking the pill
    Most common side effects are headache and facial flushing. Less common side effects include blue-tinged vision, dizziness, indigestion, nasal congestion, and nausea

Viagra

    Begins to work within 30 to 45 minutes of ingestion
    Taking Viagra with food can delay response time
    Men can achieve successful erections for 2 to 3 hours, although the effects may last up to 5 hours at a higher dose (e.g., 100 mg vs 25 or 50 mg)
    Most common side effects are abnormal vision (blue-tinged vision, blurriness), back pain, dizziness, flushing, headache, muscle pain, nausea, rash, stuffy or runny nose, and upset stomach. Rare effects include irregular heartbeat and stroke.

Cost of ED drugs

One other factor should be considered when choosing the best ED drug for you: cost. Insurers often limit the number of ED pills you can get per month (typically four), after which you will need to pay out-of-pocket. The cost per pill can be $15 to $20. Work with your doctor to obtain the ED pill you want at a price you can afford.

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