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For the absolute fastest results, for a little Saturday morning fun, take it right after waking up, wait 15 minutes (time to drink some coffee), and have at it. Vardenafil and tadalafil options for erectile dysfunction. Arnold, MD Associate professor of psychiatry Director, Women’s Health Research Program University of Cincinnati College of Medicine Cincinnati, OH. Two new PDE-5 inhibitors have demonstrated efficacy and tolerability in clinical trials.

Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil and tadalafil—review of the literature.

Cialis (IC351) provides prompt response and extended period of responsiveness for the treatment of men with erectile dysfunction (ED). Earliest time of onset of erections with vardenafil determined in an at-home setting. Chicago, IL: American Urological Association annual meeting, 2003.

Minimal time to successful intercourse after sildenafil citrate: results of a randomized, double-blind, placebo-controlled trial.

The efficacy and tolerability of vardenafil, a new selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial.

Vardenafil for treatment of men with erectile dysfunction: efficacy and safety in a randomized, double-blind, placebo-controlled trial. Vardenafil, a highly selective PDE5 inhibitor, improves erectile function in patients with diabetes mellitus. Efficacy and tolerability of vardenafil in men with erectile dysfunction following radical prostatectomy.

Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. Effects of tadalafil on erectile dysfunction in men with diabetes.

Efficacy and tolerability of tadalafil, a novel phosphodiesterase 5 inhibitor, in treatment of erectile dysfunction.

Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Sildenafil has revolutionized management of erectile dysfunction (ED) over the past 5 years. The FDA recently approved two additional medications, vardenafil and tadalafil, for treating ED. Like sildenafil, vardenafil and tadalafil are selective inhibitors of the phosphodiesterase (PDE) isoenzyme PDE-5, which is predominantly responsible for degrading cyclic guanosine monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum.

During sexual stimulation, nitric oxide is released from cavernous nerves and endothelial cells and activates the


guanylate cyclase, resulting in increased cGMP synthesis.

The cGMP triggers relaxation of smooth


, allowing increased blood flow into the penis and expansion of sinusoidal spaces; this prevents venous blood outflow and results in erection.

The PDE-5 inhibitors can potentiate erections by enhancing and prolonging the smooth musclerelaxant effects of the nitric oxide-cGMP cascade in the corpus cavernosum.

1 PDE-5 inhibitors have no effect without sexual stimulation. Sildenafil 100 mg Vardenafil 20 mg Tadalafil 20 mg Maximum concentration 450 ng/mL 20.9 ng/mL 378


Time to maximum concentration 1.0 hour 0.7 hours 2.0 hours Half-life 4 hours 3.9 hours 17.5 hours Source: References 2 and 3.

Although the three PDE-5 inhibitors have similar mechanisms of action, their selectivity differs for PDE-5 compared with the PDE-6 and PDE-11 isoenzymes. Sildenafil and vardenafil have lower selectivity than tadalafil for PDE-5 over PDE-6, which plays a role in phototransduction, the process by which light impulses are converted into nerve impulses in the retina.

Thus, tadalafil is less likely than the other agents to cause visual disturbances such as abnormal color vision, increased brightness of light, or mild haziness.

Tadalafil shows lower selectivity than sildenafil or vardenafil for PDE-5 over PDE-11, meaning that tadalafil inhibits PDE-11 at clinical doses. PDE-11 is found in various tissues, but its physiologic significance and consequences of its inhibition are unknown.

Vardenafil, tadalafil, and sildenafil have different pharmacokinetic characteristics ( Table 1 ).

A lower starting dosage is required with vardenafil than with sildenafil because of the former agent’s greater in vitro and in vivo potency, but whether this results in greater clinical efficacy or tolerability is unknown.

Vardenafil and sildenafil reach maximum plasma concentration within 30 minutes to 2 hours (median 1 hour for sildenafil and 0.7 hour for vardenafil).

By contrast, tadalafil reaches maximum concentration within 30 minutes to 6 hours (median 2 hours). However, studies of time to onset of erection indicate that about one-third of patients using the maximum recommended doses of any of these agents will experience onset within 14 to 16 minutes.

Absorption rates for sildenafil and vardenafil are reduced when they are taken with a high-fat meal. High-fat foods do not affect tadalafil’s absorption rate.

Drug brand name: Levitra Class: Phosphodiesterase-5 inhibitor FDA-approved indication: Erectile dysfunction Approval date: August 19, 2003 Manufacturer: Bayer Corp.

(distributed by GlaxoSmithKline) Dosing forms: 2.5 mg, 5 mg, 10 mg, 20 mg Dosing recommendations: Start at 10 mg about 1 hour before sexual activity. Maximum recommended dose is 20 mg; maximum dosing frequency is once per day. Consider 5-mg starting dose


patients age 65 and older. Because of its 17.5-hour half-life, tadalafil has a longer period of activity than the other PDE-5 inhibitors.

Most patients can complete sexual intercourse up to 36 hours after taking tadalafil, which potentially allows spontaneous sexual activity. Sildenafil and vardenafil each are effective for about 4 hours. All three PDE-5 inhibitors are eliminated by hepatic metabolism, mainly by the CYP 3A4 hepatic enzyme.

Therefore, concomitant use with CYP 3A4 inhibitors—such as ketoconazole, ritonavir, grapefruit juice, or erythromycin —results in increased plasma levels of these agents, and the use of CYP 3A4 inducers such as rifampin reduces plasma levels of the concomitant agent.

Drug brand name: Cialis Class: Phosphodiesterase-5 inhibitor FDA-approved indication: Erectile dysfunction Approval date: November 21, 2003 Manufacturer: Eli Lilly and Co. Dosing forms: 5 mg, 10 mg, 20 mg Dosing buy viagra professional online recommendations: Start at 10 mg before anticipated sexual activity.

Maximum recommended dose is 20 mg; maximum dosing frequency is once per day.

In a placebo-controlled, 12-week trial, 7 601 men with mildly to severely impaired erectile function received placebo or 5, 10, or 20 mg of vardenafil.

Subjects receiving vardenafil at any dose saw significantly greater improvement in erectile function than did the placebo group. Percentage of successful intercourse ranged between 71% and 74% for the three vardenafil doses. For the 20-mg dose, 80% of patients experienced improved erections compared with 30% of those taking placebo.

In another trial of 805 men with best online ed meds mild to severe ED, 8 vardenafil in 5-mg, 10-mg, and 20-mg doses demonstrated efficacy versus placebo.

Eighty-five percent of men using vardenafil, 20 mg, reported improved erections at 26 weeks compared with 28% in the placebo group. Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction.

1 The University of Queensland, School of Biomedical Sciences, Australia.

Comparison of clinical trials with sildenafil, vardenafil



in erectile dysfunction. Search in PubMed Search in NLM Catalog Add to Search. 1 The University of Queensland, School of Biomedical Sciences, Australia. Erectile


order viagra pills online (ED) affects up to 50% of men, between 40 and 70 years of age.

In the first major trial of sildenafil in ED, at 24 weeks, improved erections were reported by best online ed meds 77 and 84% of men taking sildenafil 50 and 100mg, respectively.

Subsequently, sildenafil has been reported to be effective in men with ED associated with diabetes and prostate cancer, and in psychogenic ED.

Sildenafil is safe in men with coronary artery disease, provided it is not used with the nitrates (a contraindication).

The most commonly reported adverse effects with sildenafil are headache, flushing and dyspepsia. Vardenafil is more potent and more selective than sildenafil at inhibiting phosphodiesterase-5. Vardenafil is similarly effective to sildenafil in the treatment of ED. The only advantage that vardenafil has over sildenafil is that it does not inhibit phosphodiesterase-6 to alter colour perception, a rare side effect which sometimes occurs with sildenafil.

Tadalafil has a longer duration of action than


and vardenafil. Tadalafil is similarly effective as sildenafil in the treatment of ED.

In comparison studies, tadalafil is preferred to sildenafil (50/100mg) by men with ED, possibly because of its longer duration of action.

Of the phosphodiesterase inhibitors, tadalafil may displace sildenafil as the drug of choice among men with ED. Levitra (vardenafil hydrochloride) and Viagra (sildenafil) are erectile dysfunction drugs that work by blocking a certain enzyme (phosphodiesterase-PDE5) used to treat erectile dysfunction (impotence).

headache, flushing (warmth or redness in your face, neck, or chest), runny or stuffy nose, stomach upset, heartburn, dizziness, back pain, or nausea.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Common side effects of Viagra include: warmth or redness in the face, neck, or chest, stuffy nose, headaches, stomach pain, upset stomach, nausea, diarrhea, memory problems, back pain, an inability to differentiate between the colors green and blue, loss of hearing, ringing in the ears, and dizziness. Levitra is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men. ED is a condition where the penis does not harden and expand when a man is sexually excited, or when he cannot keep an erection.

A man who has trouble getting or keeping an erection should see his doctor for help if the condition bothers him. Levitra may help a man with ED get and keep an erection when he is sexually excited.

Viagra is a prescription medicine used to treat erectile dysfunction (ED). You will not get an erection just by taking this medicine.

Viagra helps a man with erectile dysfunction get and keep an erection only when he is sexually excited (stimulated).

It is not known if


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Levitra may interact with other medications for erectile dysfunction, conivaptan, imatinib, isoniazid, antidepressants, antibiotics, antifungals, drugs to treat high blood pressure or a prostate disorder, heart or blood pressure medications, or HIV/AIDS medicines.

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