The Most Popular Erection Drug Is ... NOT Viagra

Men and couples prefer Cialis to Viagra.

Posted Sep 15, 2010

More than a decade after it took the world by storm, Viagra ranks among the best-known brand names on earth, up there with Coca-Cola and McDonald's. But in recent years, sales of Viagra have been going, well, flaccid.

As recently as 2007, Viagra controlled 62 percent of the U.S. erection-medication market, while Cialis ran a distant second at 26 and Levitra was just a blip on the radar at 12 percent. Since then, it's not exactly clear what's been happening to sales. The companies that manufacture the drugs make contradictory claims. However, one thing seems certain. Cialis is gaining on Viagra, especially outside the U.S. Eli Lilly, maker of Cialis, says its drug is number one worldwide, though Pfizer, maker of Viagra, disputes this. Viagra is still the top-seller in the U.S., but its market share has been slipping.

The reason is that Cialis has a longer duration of action. Take one Cialis pill, and a man gains erection assistance for 72 hours. Viagra and Levitra last for about four hours (though recent studies suggest some benefit for up to about 10 hours). But even granting Viagra extended benefit, Cialis still works much longer. In Europe, it's marketed as "the weekend pill." One dose and a man gets an erection boost for three days.

In eight published studies, researchers have asked couples to try both Viagra and Cialis. Participants used each drug for two to six months. By the end of all eight trials, the couples preferred Cialis, typically by ratios of more than two-to-one. The main reason: Its longer duration of action offers greater freedom from sexual time pressure.

Chemically, the three erection medications are quite similar, with similar side effects. But individual men react differently to them. If you'd like to use one, it's best to try all three to see which provides the greatest benefit with the fewest side effects.

These drugs work in 60 to 70 percent of older men, but they don't help about 30 to 40 percent, so don't be surprised if you notice little or no benefit.

However, even when they work, erection drugs do not produce the rock-hard erection men recall from their youth or see in pornography. Porn actors are overwhelmingly young men at the stage of life when erections are most firm (not to mention that porn actors pop erection drugs like candy). After around 45, erections become less firm and firmness continues to subside with advancing age. A man in his fifties who takes an erection drug may have a firmer erection than he would without the medication, but chances are it won't be as firm as the erections he recalls from his twenties.

In addition, erection medications are not aphrodisiacs. They do not boost sexual desire or arousal. They just increase blood flow into the penis. In young men, erection and arousal are typically synonymous. But as men age, erection and arousal become uncoupled, and older men may enjoy drug-fueled erections but not feel aroused.

For most, but not all men, erection drugs are safe. The most frequent side effects include: headache (16 percent of users), flushing (like menopausal hot flashes, 10 percent), upset stomach (7 percent), nasal congestion (4 percent), and rarely, visual disturbances, mostly in men with severe diabetes or chronic eye conditions such as macular degeneration.

But, some men should absolutely never use erection drugs, those taking nitrate medication for heart disease, notably nitroglycerine for angina, or the party drug, amyl nitrate ("poppers"). The combination of Viagra and nitrate drugs can cause a precipitous drop in blood pressure-and possibly death. Before this problem was identified, the combination of Viagra and nitrate medication killed more than 500 men. If you take any nitrate drug, don't use Viagra, Levitra, or Cialis.

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