Tadalafil (CIALIS) vs Sildenafil (Viagra) – Is One Better?

Sildenafil and tadalafil are prescription tablets for erectile dysfunction, when a man cannot get or keep an erection firm enough for sex. Both belong to the same family of erection medicines and work only with sexual stimulation. The main difference is timing: sildenafil is taken close to sex and wears off within hours. Tadalafil lasts up to 36 hours, or it can be taken daily. Both are prescription-only in India, so a doctor should decide which suits you.

Both are tablets with one active ingredient: sildenafil citrate or tadalafil. Neither contains testosterone or herbal ingredients. The same molecule is sold under many brand names in India, so check the label rather than the brand.

Check the exact strength printed on your pack; it may vary between brands.

Neither tablet is a sex-drive booster or a party drug. Taking either one without a prescription is unsafe.

Think of an erection as water filling a pipe. Sexual stimulation releases nitric oxide, which relaxes the penile blood vessels and lets more blood flow in. Both medicines block PDE5, the enzyme that clears this signal away, so the effect lasts only while the signal is there.

Doctors prescribe these medicines for:

• Erectile dysfunction
• Urinary symptoms from an enlarged prostate - tadalafil only, as a small daily dose
• Erectile dysfunction with urinary symptoms - tadalafil only, when both problems are present
• Pulmonary arterial hypertension, high blood pressure in the lungs — both, at different doses and on a strict schedule

They do not increase sex drive, help with premature ejaculation, or treat the heart, hormone or nerve problems behind erectile dysfunction. If the cause is not checked, the tablets may hide a condition that needs attention.

1. Swallow the tablet whole with a glass of water. Do not split it.
2. Take sildenafil about an hour before sex; 30 minutes to 4 hours before also works.
3. For tadalafil as needed, take it at least 30 minutes before sex. For daily use, take it at the same time each day. Do not stop daily tadalafil without asking your doctor first.
4. Sildenafil works faster on a relatively empty stomach; a fatty meal delays it. Tadalafil can be taken with or without food.
5. Do not take more than one dose in 24 hours.
6. The tablet only helps when there is sexual stimulation.

Your doctor chooses the dose based on your age, health, other medicines and response. The labelled starting dose for sildenafil is 50 mg as needed (range 25 mg to 100 mg), once a day at most. Tadalafil starts at 10 mg as needed (range 5 mg to 20 mg); daily treatment starts at 2.5 mg.

Never increase the dose on your own. If one tablet did not help, a larger one is unlikely to change that. A higher dose only raises the chance of headache, flushing and a sudden fall in blood pressure.

For sildenafil, a lower 25 mg start is used in men over 65 and in those with liver or severe kidney disease. Tadalafil needs no change for age, but daily tadalafil is not recommended if kidney function is very low, and it should not be used in severe liver disease.

For sildenafil or as-needed tadalafil, a missed dose is rarely an issue. You take it only when you plan to have sex. For daily tadalafil, take it when you remember; if the next dose is almost due, skip the missed one.

Most men notice a difference within 30 to 60 minutes, though a fatty meal can delay sildenafil. If it has not helped after several tries at the correct dose, see your doctor, because the cause may need treatment.

Store the tablets at room temperature, away from sunlight, heat and moisture, and out of reach of children. Check the expiry date before use.

Most men take these tablets without trouble; side effects are usually mild and settle within hours.

Common and mild:

• Headache
• Flushing or warmth in the face
• Indigestion or heartburn
• Blocked or stuffy nose
• Back or muscle pain, more often with tadalafil
• Blurred vision or a blue tinge to colours, more often with sildenafil

Rare but serious - stop the medicine and get medical help right away:

• Sudden loss or blurring of vision
• Sudden loss of hearing, sometimes with ringing in the ears
• Chest pain, fainting or an irregular heartbeat
• An erection that is painful or lasts more than 4 hours
• Rash, swelling of the face, lips or tongue, or trouble breathing

Headache, flushing and a stuffy nose come from widened blood vessels. Back and muscle pain can happen with either, but they are a common complaint with tadalafil. Vision changes are more typical of sildenafil.

• Anyone taking nitrates for chest pain
• Anyone taking riociguat for pulmonary hypertension
• Anyone taking another ED medicine or PDE5 inhibitor
• Anyone allergic to sildenafil, tadalafil or any tablet ingredient
• Anyone whose doctor has said sex is unsafe for their heart

These tablets are not for children or teenagers with erection problems. Sildenafil is sometimes used in children with pulmonary hypertension, but only under a specialist.

Tell your doctor before taking either medicine if you have:

• Heart disease, or a recent heart attack or stroke (ask your doctor whether sex is safe for you)
• Low blood pressure or uncontrolled high blood pressure
• Liver or kidney disease (the dose may need to be lower)
• An inherited eye condition that affects your sight, or a previous sudden loss of vision
• A curved penis, sickle cell anaemia, leukaemia or myeloma (higher risk of a prolonged erection)
• A stomach ulcer or a bleeding disorder
• Upcoming surgery, including dental surgery (tell the surgeon)

Women taking these medicines for pulmonary hypertension should tell their doctor if they are pregnant, planning pregnancy or breastfeeding.

Always tell your doctor about every medicine, supplement or home remedy you are using. Keep alcohol light, because heavy drinking adds dizziness and low blood pressure.

See a doctor quickly if you have:

• Chest pain, dizziness, nausea or fainting during sex — stop and call 112
• An erection that lasts more than 4 hours — call 112 or 108 for an ambulance
• Sudden loss of vision or hearing
• Swelling of the face, lips or tongue, or trouble breathing
• No improvement after several tries, or heart disease, diabetes or high blood pressure that has not been checked

Sildenafil and tadalafil work the same way and help many men with erectile dysfunction. The choice comes down to timing: sildenafil for sex planned a few hours ahead, tadalafil for a longer window or daily use. Take either as prescribed, never with nitrates, and never more than one dose a day. Sudden vision or hearing loss and a prolonged erection need emergency care.