Sildenafil Or Tadalafil?

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Trying to decide between Sildenafil or Tadalafil?

Sildenafill and Tadalafil are two effective and popular treatment options for erectile dysfunction. They belong to a family of drugs known as Phosphodiesterase type 5 inhibitors and just as in all families, Sildenafil and Tadalafil do share similarities but also have distinguishing features that make each unique.

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Sildenafil was the first drug to be discovered in this family. It was released in 1998 by Pfizer; a leading biopharmaceutical company; under the brand name of Viagra and although it has been two decades since it’s original launch, it is still a mainstay in the treatment of erectile dysfunction. That’s success by any standards. Its prominence is attributable to the fact that sildenafil revolutionised the treatment of erectile dysfunction. Up to that point, there was nothing that could be taken orally and treatment options included penile injections and vacuum pumps. It is no wonder that this little blue tablet practically flew off the shelves.

Sildenafil though was almost the drug that never was. In 1989, Pfizer researchers were working on Sildenafil under the name UK92480. It was being studied as a  possible treatment for high blood pressure and angina. It was classed as a low priority project and the trials were disappointing. Pfizer was almost at the point of abandoning the trials. In an article published by Bloomberg, David Brown; at the time a drug developer for Pfizer; was quoted as saying “It was so close to failure that people weren’t coming to meetings. I mean, you know how people sort of smell failure and disappear? It was that close.” A few days afterwards, a chance comment by a trial participant about an unusual side effect; namely the increased frequency in penile erections; led to the big breakthrough for Sildenafil. The rest made history through the release of Viagra in 1998. For the first years following its discovery. Sildenafil was the only drug of it’s kind on the market. Other drugs in this category followed suit including Tadalafil which was released by Lilly ICOS in 2003.

 

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How do Sildenafil and Tadalafil work?

During sexual stimulation, the brain sends a signal to nerve cells to release nitric oxide into the spongy tissue of the penis or corpus cavernosum. Nitric oxide is significant because it is the primary neurotransmitter involved in mediating erections. Nitric oxide binds to the enzyme guanylate cyclase and results in the increase in a signalling molecule: cyclic guanosine monophosphate or cGMP. cGMP is involved in for smooth muscle relaxation and allows the inflow of blood to the corpus cavernosum in the penis. In other words, cGMP is significant in facilitating erections. Phosphodiesterase 5 is an enzyme that breaks down cGMP. This is where drugs like sildenafil and tadalafil come in. They are in a category of drugs called Phosphodiesterase type 5 inhibitors (PDE-5 inhibitors). As their name suggests, they inhibit the action of the enzyme phosphodiesterase type 5 and result in more cGMP being around.

Sildenafil and Tadalafil do not initiate erections but are designed to be used with sexual stimulation and work with the body to allow for increased blood flow to the penis.

Although Sildenafil and Tadalafil are in the same family, there are a few key differences between them.

 

How do you take it?

Sildenafil- The recommended dose is 50 mg approximately an hour prior to the anticipated sexual activity. This dose can be tailored to your response and tolerability. Doses can range from 25mg to 100mg.

Tadalafil- The recommended starting dose is 10mg prior to the anticipated sexual activity. This dose can be tailored according to your response and tolerability. Doses can range from 2.5mg to 20 mg. If you anticipate frequent use of tadalafil (at least twice weekly), Tadalafil offers the possibility of a once-daily regimen with the lowest doses for example 2.5 mg or 5 mg daily. The higher doses of 10mg and 20 mg are intended for use prior to anticipated sexual activity and are not recommended for continuous daily use.

Both Sildenafil and Tadalafil should not be taken more than once a day.

 

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How long does it take to start working?

Sildenafil can start to work in  25 minutes and the time taken for it to reach maximum concentration in the body can range from 30 to 120 minutes but the average time is 60 minutes.

Tadalafil is reported to have the possibility of it starting to be effective in just 15 minutes although data suggests that the time to reach the optimal level is longer when compared to sildenafil. It takes 120 minutes for Tadanafil to reach peak levels in the body.

 

How long do the effects last? 

This is one of the key attributes that differentiate Tadalafil from Sildenafil. Tadalafil can work for up to 36 hours. Sildenafil can work for anywhere between 4 to 12 hours.

Tadalafil stays in the body longer and that’s what gives it a longer window of opportunity to be effective.  For some, this will be a key advantage. However, it is also worth considering that having the drug around in the body for longer also gives a longer opportunity for side effects to occur or last. Sildenafil has a shorter duration of action in the body but it also means that the drug gets out of the system faster.

 

How does food affect it?

Sildenafil is best taken on an empty stomach as the presence of food in the stomach can reduce absorption and affect how well it works. Tadalafil is unaffected by food.

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Any other considerations?

Both sildenafil and tadanafil are available as generic versions. The European Medicines Agency defines generic medicines as a medicine that is developed to be the same as a medicine that has already been authorised. This means that generic medicines contain the same active ingredient as the branded alternative. A key consideration for sildenafil is that generic sildenafil tablets can cost less than Tadalafil making it a more cost effective treatment option.

Sildenafil also has history on it’s side. It was the first drug in this category to be released and because of that, it has a longer safety profile record. One last thing to consider about Sildenafil. In 2018, Pfizer successfully launched Viagra Connect now enabling it to be procured from pharmacies without a prescription.

Whether you are thinking about Sildenafil or Tadanafil, make a choice by having an appropriate consultation with your doctor or pharmacist. They can help you take that step closer in making a decision that’s right for you.

 

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References:

  1. https://www.bloomberg.com/news/features/2017-12-11/the-little-blue-pill-an-oral-history-of-viagra
  2. Corbin JD1, Francis SHWebb DJ Phosphodiesterase type 5 as a pharmacologic target in erectile dysfunction.Urology. 2002 Sep;60(2 Suppl 2):4-11
  3. Connelly D. Three decades of Viagra.The Pharmaceutical Journal, May, Vol 298, No 7901, online | DOI: 10.1211/PJ.2017.20202847l
  4. Eli Lilly and Company Limited. Cialis® (tadalafil). Summary of product characteristics. March 2017.  Electronic medicines Compendium (eMC) [online] Available at: https://www.medicines.org.uk/emc/product/7431/smpc Accessed 15 July 2018
  5. Pfizer Limited. Viagra®  (sildenafil). Summary of product characteristics June 2016 Available at https://www.medicines.org.uk/emc/product/1072/smpc#DOCREVISION Accessed 15 July 2018
  6. Coward RM, Carson CC Tadalafil in the treatment of erectile dysfunction Ther Clin Risk Manag. 2008 Dec; 4(6): 1315–1330
  7. European Medicines Agency Glossary [online] Available at http://www.ema.europa.eu/ema/index.jsp?curl=pages/document_library/landing/glossary.jsp&mid=WC0b01ac058097a277 Accessed 15 July 2018

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