Viagra vs. Cialis vs. Levitra vs. Stendra: Which Is Best?

Viagra, Cialis, Levitra, and Stendra are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names:

About 30 million American men occasionally have a problem with getting or keeping an erection, according to the Urology Care Foundation. When ED becomes a problem, many turn to these oral ED medications. They often help address the issue.

The medications work in similar ways. However, they also have some key differences, such as when you take them, how long they work, and what their side effects are.

Viagra, Cialis, Levitra, and Stendra are all in a class of medications called phosphodiesterase type 5 (PDE5) inhibitors. These drugs work by blocking the PDE5 enzyme.

They also boost a chemical in your body called nitric oxide. This action encourages the muscles in your penis to relax. Relaxed muscles allow blood to flow freely, so you can get an erection when you’re aroused. It also helps you maintain the erection long enough to have sex.

Unlike Viagra and the other PDE5 inhibitors, Cialis is also approved to treat enlarged prostate.

Both Viagra and Cialis can be taken 30 minutes before sexual activity. However, Cialis lasts much longer and is noteworthy for the amount of time it remains in your body. You may feel the effects of the drug up to 36 hours after you take it.

The fact that it comes in a low dose of 2.5 milligrams (mg) also means that you can take Cialis every day. A daily dose will ensure that the drug’s always in your system.

If you take Cialis, there’s a chance of limb pain. This side effect is not associated with any other oral ED drugs.

Similarities Differences
They’re both PDE5 inhibitors. Cialis lasts up to 18 hours in the body, while Viagra lasts 4–6 hours in the body.
Both are taken 30 minutes before sex. Cialis can cause indigestion and limb pain, while Viagra can cause vision change, rash, and dizziness.
Side effects include flushing, back pain, headaches, muscle pain, and upset stomach.

Pros of Cialis

  • lasts longer than Viagra
  • unaffected by food intake

Cons of Cialis

Pros of Viagra

  • leaves the body faster than Cialis, which may be helpful if you’re concerned about side effects

Cons of Viagra

Viagra can take 30 to 60 minutes to work in the body, while Levitra takes 60 minutes. The effects of both drugs last for about 4 hours.

Levitra does have fewer common side effects than Viagra, and it’s not associated with rash or muscle aches. Vision color changes are considered side effects of both Viagra and Levitra.

Similarities Differences
They’re both PDE5 inhibitors. Viagra can be taken 30 minutes before sex, while Levitra should be taken 1 hour before.
Side effects include stuffy or runny nose, headaches, dizziness, flushing, and back pain. Viagra can cause rash and muscle aches, while Levitra is not associated with these side effects.

Pros of Levitra

Cons of Levitra

Pros of Viagra

Cons of Viagra

Stendra is the newest drug on the market. No generic version is available for sale yet.

A hallmark of Stendra is its fast-acting nature. You can take the 100-mg and 200-mg doses as shortly as 15 minutes before sexual activity.

As a second-generation medication, Stendra also seems to have milder side effects than Viagra and the other PDE5 inhibitors that came before it. Side effects commonly caused by Viagra — but not Stendra — include vision changes, nausea, and muscle aches.

The only common side effect caused by Stendra — but not Viagra — is a sore throat.

Similarities Differences
They’re both PDE5 inhibitors. Stendra can be taken 15 minutes before sex, while Viagra should be taken at least 30 minutes beforehand.
Side effects include stuffy or runny nose, headaches, flushing, and back pain. Viagra can cause side effects including nausea, muscle aches, vision changes, and rashes.

Pros of Stendra

  • works within 15 minutes
  • lasts slightly longer than Viagra

Cons of Stendra

Pros of Viagra

  • leaves the body faster than Stendra, which may be helpful if you’re concerned about side effects

Cons of Viagra

  • takes longer to work than Stendra
  • causes more side effects than Stendra

As mentioned earlier, Cialis can be used as a daily medication to treat enlarged prostate, unlike Levitra, which is strictly used as a treatment for erectile dysfunction.

Cialis is also faster acting than Levitra. You can take it 30 minutes before sexual activity, while you should take Levitra at least 1 hour in advance.

Cialis and Levitra both have similar side effects, but some side effects unique to Cialis include muscle aches and pain in the limbs.

Similarities Differences
They’re both PDE5 inhibitors. Cialis can be taken 30 minutes before sex, while Levitra should be taken at least 60 minutes beforehand.
Side effects include stuffy or runny nose, headaches, flushing, upset stomach, indigestion, and back pain. Cialis can cause muscle aches and pain in the limbs, while Levitra does not.

Pros of Levitra

  • leaves the body faster than Cialis, which may be helpful if you’re concerned about side effects

Cons of Levitra

Pros of Cialis

  • works more quickly than Levitra
  • effects last longer than Levitra

Cons of Cialis

Here are the basic features of each of these drugs:

Viagra Cialis Levitra Stendra
What’s the generic name? sildenafil tadalafil vardenafil avanafil
Is a generic version available? yes yes yes no
What form does it come in? oral tablet oral tablet oral tablet oral tablet
What strengths does it come in? 25 mg, 50 mg, 100 mg 2.5 mg, 5 mg, 10 mg, 20 mg 5 mg, 10 mg, 20 mg 50 mg, 100 mg, 200 mg
What’s the typical dosage? 50 mg 10 mg as needed or 2.5 mg daily 10 mg (5 mg if you’re 65 years or older) 100 mg
When do I take it? 30–60 minutes before sex 30 minutes before sex 60 minutes before sex 15 minutes before sex for 100 mg and 200 mg, 30 minutes before sex for 50 mg
How long does it work? 4 hours up to 36 hours 4–5 hours 6 hours
How do I store it? around room temperature, between 68–77°F (20–25°C) at 77°F (25°C) at 77°F (25°C) around room temperature, between 68–77°F (20–25°C)

These medications are available in a variety of doses, ranging from 2.5 mg to 200 mg. You can take all of them with or without food. However, taking Viagra, Levitra, or Stendra after eating a high fat meal does slow the rate of absorption.

Most of them stay in your bloodstream for about 4 to 5 hours. Cialis is the exception, as it remains in your bloodstream for up to 36 hours. The length of time a drug stays in your system may be important if you’re taking other medications.

Do not take any of these medications more than once in a 24-hour period.

The side effects of these medications are mostly similar, and they’re usually mild. Tell your doctor if you have any side effects that linger and do not go away on their own.

Below are the most common side effects, according to their manufacturers:

Side effect Viagra Cialis Levitra Stendra
stuffy or runny nose x x x x
headache x x x x
dizziness x x
upset stomach x x x
nausea x
indigestion x x
vision changes x
rash x
flushing x x x x
back pain x x x x
pain in the limbs x
muscle aches x x
sore throat x

Priapism warning

If you have an erection that lasts longer than 4 hours, contact your doctor right away. This condition, known as priapism, is a risk associated with all of these ED drugs.

In order to get any ED medication, you’ll need a prescription. You can get a prescription through your doctor or online through telehealth companies.

Usually, you’ll go to the pharmacy to pick up your Viagra, Cialis, Levitra, or Stendra prescription. If you have health insurance, keep in mind that most insurance companies will not cover the cost of your prescription. However, if you have certain medical conditions, your health plan may pay for the drug with prior authorization.

The exact price you pay for any drug will depend on your insurance plan, if you have one, and your pharmacy.

Generic versions of Viagra, Cialis, and Levitra can cost half as much as their brand-name counterparts, if not less.

Make sure to talk with your doctor or a healthcare professional before purchasing any ED medications, especially if you are buying them online. Unless prescribed by a doctor, online ED medications are not FDA approved and may contain ineffective or harmful ingredients.

Each drug comes with the risk of drug interactions. Since PDE5 inhibitors work on the body in similar ways, Viagra, Cialis, Levitra, and Stendra lead to similar interactions.

All four of these drugs interact with:

    , such as isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat)
  • certain blood pressure drugs, such as calcium channel blockers
  • alpha-blockers, which can treat high blood pressure or an enlarged prostate
  • certain pulmonary hypertension drugs, such as riociguat (Adempas) , a class of HIV medications
  • antifungal drugs, such as ketoconazole and itraconazole (Onmel, Sporanox)
  • antibacterial drugs, such as clarithromycin (Biaxin)

Avoid drinking alcohol excessively while on any PDE5 inhibitor. Do not combine them with different ED drugs.

Cialis may also be less effective if used alongside antiseizure medications such as carbamazepine (Tegretol) and phenobarbital.

For specifics on which medications are safe for you to use, it’s best to consult your doctor or pharmacist.

In some cases, using these medications may mean you need to completely avoid PDE5 inhibitors. In other cases, your doctor or a healthcare professional may adjust your medication dosage, which can help lower the possibility of drug interactions while using PDE5 inhibitors.

Are Cialis and Viagra the same?

No. Although Cialis and Viagra are both PDE5 inhibitors that boost nitric oxide in your body to help with ED, they’re different medications.

Cialis comes in a lower dose than Viagra and can be taken daily. Also, the effects of Cialis last longer than the effects of Viagra.

How long does it take for Cialis to peak?

It depends on the individual and the level of arousal. It’s recommended that you take Cialis 30 minutes before engaging in sexual activity, but it may take as long as 2 hours to take effect. Cialis also requires sexual stimulation in order to work, so arousal also factors into this equation.

Do ED medications make you last longer?

These medications are meant to help you have an erection long enough to have sex. However, medications like Viagra aren’t approved to treat premature ejaculation.

Can Viagra and Cialis be taken together?

It’s unnecessary to take Viagra and Cialis together. They’re both PDE5 inhibitors that help achieve the same goal. Your doctor can help you decide which would be best for you, but there’s no need to take both.

Is there a generic of Stendra?

No, there is currently no generic of Stendra available in the United States.

Which ED medication is best?

It depends on the individual. While all ED medications help achieve the same goal, they differ in dosage, length of effects, and potential side effects. Consider all of these factors when determining which ED medication might work best for you.

Which ED medication causes the fewest side effects?

Stendra has the fewest side effects. Viagra, although the most well-known, has the most side effects.

If you have ED, talk with your doctor about Viagra, Cialis, Levitra, and Stendra. Tell your doctor if you take other over-the-counter or prescription drugs or supplements. Be sure to mention all other health conditions you have.

When used correctly, each of these drugs has been shown to help people with ED. Take them exactly as your doctor prescribes. If you have questions or concerns, talk with your doctor.

All of these medications have been shown to lead to good results, but it may take a little time and patience to find the right one for your needs. If one drug does not work or produces unpleasant side effects, you can try another one.

It may also take some trial and error to find the dosage that works best for you. If you’re not sure that using ED medication is right for you, you can also give natural ED treatments a try.

If you’re considering natural ED treatments, talk with your doctor or a healthcare professional first to learn more about risks, benefits, and potential drug interactions.

Last medically reviewed on November 12, 2021

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Medically reviewed by Jennie Olopaade, PharmD, RPH — Written by Ann Pietrangelo — Updated on November 12, 2021

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© 2005-2022 Healthline Media a Red Ventures Company. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. See additional information.