Humanity has been thinking about the ideal drug for the treatment of potency problems for almost as long as it existed. However, only at the end of the 20th century, medicine was able to find a remedy that was able to effectively and safely improve potency. That drug was Viagra. In an FDA approval application filed by the American pharmaceutical company Pfizer, the scientists who synthesized Sildenafil described it as an ideal drug for the treatment of erectile dysfunction, which is effective, safe, fast onset and long lasting. Over the past three decades, medicine has made significant progress in understanding the peripheral physiology of erection, which has led to such advances in the pharmacological treatment of erectile dysfunction as the creation of PDE-5 inhibitors. The pioneer among drugs in this category, which opened a kind of new era in the treatment of erectile dysfunction – the era of effective oral treatment, was Viagra.
To date, the two most popular drugs used in the treatment of erectile dysfunction are Cialis and Viagra. The active ingredients of these drugs, respectively, are Tadalafil and Sildenafil. Both of them belong to the same pharmacological group of PDE-5 inhibitors, so their mechanism of action is practically the same. PDE-5 (phosphodiesterase type 5) is an enzyme that inhibits the expansion of the blood vessels of the penis, and therefore weakens the erection. Both Cialis and Viagra inhibit this enzyme, that is, it prevents its production in the cavernous bodies of the penis, which contributes to the onset of a longer and stronger erection.
Viagra meets the basic requirements for the treatment of erectile dysfunction, namely, efficiency up to 90%, reliability, ease of use, non-invasiveness and a relatively low number of side effects. However, certain pharmacokinetics of Viagra, such as half-life period, association with food and alcohol intake, lead to the need for planned intercourse, decreased romance and loss of spontaneity of sexual activity. A fairly short period of action (an average of 5 hours) limits a man in the time and frequency of attempts to have sexual intercourse. In addition, approximately 10% of patients, for unexplained reasons, have no effect after taking Viagra.
For these reasons, a certain part of men suffering from erectile dysfunction symptoms are not too happy with Viagra treatment. Some even stop using it, mainly due to side effects such as severe headache, flushing of the skin of the face, and tachycardia. The presence of a public demand for a drug that is more gentle on the body to restore potency led to the creation of such a drug as Cialis from the pharmaceutical company Eli Lilly, also an American enterprise.
Today Cialis is preferred by many men, in terms of popularity it is almost equal to Viagra. Its action does not depend on the intake of various kinds of food. So, even abundant fatty foods practically do not affect the absorption of Tadalafil into the blood. It can be combined with a moderate amount of alcohol. The duration of action of Cialis (up to 36 hours) allows men to be more calm about planning sexual intercourse and maintain spontaneity and romance of sexual relations. In this regard, there is no or significantly reduced psychological component and dependence on the pill. The connection “took a pill – had sexual intercourse, if not – nothing will work out” is destroyed. This allows a man to overcome the increased unstable psycho-emotional background, which is present in violations of potency of any etiology.
However, in some patients taking Tadalafil, side effects in the form of headache, heartburn or back pain are observed for as long as the drug works, that is, 36 hours or more (up to three days), which significantly limits the use of the drug.
One of the new options for treating patients with ED is the regular use of PDE-5 inhibitors (read more). So far, only one drug has been registered for daily use – Cialis at a dosage of 5 mg. All researchers note as an advantage of this method the absolute spontaneity of sexual intercourse and the absence of physical and mental dependence on taking the pill. The maximum naturalness of the relationship is combined with the ability to be active not only for a man, but also for his sexual partner without fear of being rejected because of “unpreparedness”. The relationship of the sexual partner to the treatment of ED is one of the interesting and not very well studied aspects of the treatment of this category of patients.
In a study comparing the clinical efficacy of Sildenafil and Tadalafil, partner preference was also examined in 12% of cases. Patients were randomized into two groups receiving either Sildenafil or Tadalafil for 12 weeks. In the next 12 weeks they received a different drug. During both phases of treatment, the men and their partners completed sex diaries. In addition, women were also interviewed at the beginning of treatment, in the middle and at the end. The main parameter assessed was recent interviews with women, during which they answered which drug they preferred and why. A total of 79.2% of the women rated their partners taking Tadalafil as their preferred treatment, and 15.6% chose Sildenafil. (https://pubmed.ncbi.nlm.nih.gov/16925764/)