Millions of men around the world suffer from erectile dysfunction, making it difficult to choose a treatment because each type acts differently in the body. While Avanafil, Sildenafil, Tadalafil and Vardenafil all belong to the same class of PDE5 inhibitors, they have different timing, duration and outcomes of tolerance. The Emedstrip content team has developed this Publication by using Clinical Accuracy and a Medical Expert Review to provide guidance on each medication and assist men in conducting informed discussions with their Health Care Provider.
Comparison Table: Avanafil vs Sildenafil vs Tadalafil vs Vardenafil
| Parameter | Avanafil (Stendra) | Sildenafil (Viagra) | Tadalafil (Cialis) | Vardenafil (Levitra) |
| Onset | 15–30 minutes | 30–60 minutes | 30–120 minutes | 30–60 minutes |
| Duration | 4–6 hours | 4–5 hours | Up to 36 hours | 4–5 hours |
| Food Effect | Minimal | High-fat meals may delay absorption | No significant effect | High-fat meals may reduce effect |
| Daily Option | No | No | Yes | No |
| Generic Form | Yes | Yes | Yes | Yes |
| Approx. US Price | $25–$300 | $40–$358 | $58–$300 | $34–$285 |
1. What Is Avanafil?
Avanafil is one of the newest FDA-approved ED medications and is sold under the brand name Stendra. It was developed to offer rapid onset, fewer food interactions, and predictable performance. Many men choose it when they prefer spontaneous intimacy without long waiting periods.
How It Works
Avanafil blocks the PDE5 enzyme, preserving cGMP levels that support blood vessel relaxation during sexual stimulation. This improves blood flow to the penis and helps maintain an erection. It does not increase desire and only works when arousal triggers the nitric oxide pathway.
| Key Features | Precautions & Side Effects |
| 1. Works within 15 to 30 minutes 2. Minimal impact from food 3. Shorter duration that prioritizes convenience 4. Ideal for men who want fast readiness rather than long coverage | Common effects include headache, flushing, nasal congestion, and mild back discomfort. It must not be used with nitrates, and individuals with heart concerns or uncontrolled blood pressure should seek medical advice before use. |
2. What Is Sildenafil?
Sildenafil, widely known as Viagra, is the original FDA-approved ED medication. It remains a first-line choice because of its long clinical history, strong effectiveness, and affordable generic availability.
How It Works
Sildenafil enhances nitric oxide activity by inhibiting PDE5. This helps maintain cGMP during sexual stimulation, promoting better blood flow. High-fat meals may delay its effect, so timing awareness is helpful.
| Key Features | Precautions & Side Effects |
| 1. Onset: 30 to 60 minutes 2. Duration: about 4 to 5 hours 3. Reliable, well-documented performance 4. One of the most accessible and cost-effective ED medications | Possible effects include flushing, headache, nasal congestion, and temporary visual color shifts. It must not be taken with nitrates due to severe blood pressure risks. |
3. What Is Tadalafil?
Tadalafil, sold as Cialis, is known for its long-lasting effect, often up to 36 hours. It is available in both as-needed and low-dose daily versions, offering flexibility for men who want to maintain readiness at any time.
How It Works
By inhibiting PDE5, tadalafil sustains cGMP levels during sexual arousal, improving blood flow. Its long half-life creates a wide activity window, which reduces the pressure of timing intimacy.
| Key Features | Precautions & Side Effects |
| 1. Duration: 24 to 36 hours 2. Works reliably even with food 3. Daily dose option improves spontaneity 4. May also help men with urinary symptoms caused by BPH | Headache, flushing, muscle aches, and back pain are possible. Side effects may last longer because the medication stays in the body longer. Avoid using it with nitrates or without medical clearance for heart, liver, or kidney conditions. |
4. What Is Vardenafil?
Vardenafil, known as Levitra, is similar to sildenafil but may be better tolerated by some men. It is available in both tablet and orally disintegrating forms, which offer convenience for individuals who prefer not to swallow pills.
How It Works
Vardenafil blocks PDE5, allowing nitric oxide to support stronger erections during arousal. Its clinical effect closely resembles sildenafil, though some individuals respond differently depending on absorption and metabolism.
| Key Features | Precautions & Side Effects |
| 1. Onset: 30 to 60 minutes 2. Duration: 4 to 5 hours 3. High-fat meals may reduce effectiveness 4. ODT version offers fast absorption and ease of use | Headache, flushing, nasal congestion, and indigestion are possible. Avoid taking it with nitrates. Rarely, dizziness or visual changes may occur. |
How These Medications Work
All four drugs are PDE5 inhibitors. During sexual arousal, nitric oxide increases in the penile blood vessels, stimulating cGMP production. This chemical relaxes smooth muscle, allowing increased blood flow.
PDE5 enzymes break down cGMP. These medications block PDE5, allowing cGMP to persist longer and supporting an erection when sexual stimulation is present.
They do not cause erections on their own.
Brand Comparisons: Stendra vs Viagra vs Cialis vs Levitra
| Feature | Stendra (Avanafil) | Viagra (Sildenafil) | Cialis (Tadalafil) | Levitra (Vardenafil) |
| Onset Time | Fastest, 15–30 min | 30–60 min | 30–120 min | 30–60 min |
| How Long It Lasts | 4–6 hours | 4–5 hours | Up to 36 hours | 4–5 hours |
| Best For | Spontaneous sex, minimal planning | Occasional use, proven reliability | Longer window, weekend flexibility | Alternative to Viagra if response varies |
| Food Interactions | Minimal impact | High-fat meals delay absorption | No meaningful impact | High-fat meals reduce impact |
| Side Effects Tendency | Fewer headaches and flushing (varies by user) | More visual color changes | More muscle/back pain | Mild side effects, similar to sildenafil |
| Dose Options | 50 mg, 100 mg, 200 mg | 25 mg, 50 mg, 100 mg | 2.5 mg, 5 mg, 10 mg, 20 mg | 5 mg, 10 mg, 20 mg |
| Daily Use Option | No | No | Yes (2.5 mg, 5 mg daily) | No |
| Speed vs Duration | Fastest speed | Balanced | Longest duration | Balanced |
| Generic Available? | Yes (avanafil) | Yes | Yes | Yes |
| Brand Notes | Known as Spedra in Europe | Most widely recognized globally | Called the “weekend pill” | Available in standard and ODT form |
| Who May Prefer It | Men who want the quickest results | Men who want classic, proven therapy | Men who want flexibility and long action | Men who don’t fully respond to Viagra |
What Is the Best ED Medicine?
There is no single best ED medicine for everyone. Each option works well, but the right choice depends on how quickly you want it to act, how long you want it to last, your medical history, and how your body responds.
- Fastest option: Avanafil (Stendra)
Works in as little as 15 minutes, ideal for men who want quick readiness. - Longest duration: Tadalafil (Cialis)
Lasts up to 36 hours and also comes in a daily dose, offering the most flexibility. - Most affordable and widely used: Sildenafil (Viagra)
Well studied, reliable, and available in many generic forms. - Best alternative when Viagra doesn’t work: Vardenafil (Levitra)
Similar to sildenafil but sometimes better tolerated or more effective for certain men. - Most convenient for regular intimacy: Tadalafil Daily
Provides steady support without needing to plan around timing.
Since responses vary from person to person, healthcare providers often recommend trying a medication for multiple attempts before deciding if it is the right fit. A licensed clinician can guide you based on health conditions, other medications, and lifestyle preferences.
Final Expert Perspective
Each ED medication has unique strengths. Avanafil offers unmatched speed, sildenafil provides proven reliability, tadalafil delivers long duration, and vardenafil serves as a helpful alternative when other options are less effective. The best choice depends on lifestyle, timing, health conditions, and personal response. A licensed clinician can help determine the safest and most effective option.
FAQs
How do I choose between these medications?
Consider timing needs, frequency of intimacy, health conditions, and prior experiences. Healthcare guidance is essential.
Can I switch between them?
Yes, many men try different PDE5 inhibitors before finding the best fit.
Are generics as effective?
FDA-approved generics contain the same active ingredients and are required to meet bioequivalence standards.
How long should I try one before switching?
Providers often recommend at least 4–6 attempts before evaluating effectiveness.
Can I combine these drugs with alcohol?
Moderation is typically acceptable, but excessive drinking can impair performance and increase side effects.
What if I experience side effects?
Most side effects are mild and temporary. Seek immediate care for severe symptoms such as prolonged erection or sudden vision changes.
Which ED pill works fastest?
Avanafil, known by the brand name Stendra, is usually the fastest. Many men feel the effect within 15 to 30 minutes. It also has fewer food interactions, so timing is easier. Sildenafil and vardenafil may take 30 to 60 minutes, while tadalafil can take longer depending on the dose.
Which ED medication lasts longest?
Tadalafil, sold as Cialis, lasts the longest by a wide margin. Its effect can continue for up to 36 hours, which gives a wide window for intimacy and reduces pressure around timing. This is why it’s often called the weekend option. Tadalafil also comes in a low-dose daily form for men who want regular readiness.
Can I drink alcohol with PDE5 inhibitors?
Moderate alcohol is usually acceptable, but heavy drinking can reduce erection quality and increase side effects like dizziness or low blood pressure. Combining a PDE5 inhibitor with several drinks may also make it harder to achieve an erection. Men with heart or liver issues should be more cautious and speak with a clinician about safe limits.
Can I switch between Viagra and Cialis?
Yes, many men try more than one PDE5 inhibitor before deciding which works best. Your healthcare provider may adjust the dose or suggest a different medication if results are inconsistent. You should not take them at the same time or within overlapping windows. Wait until one medication has fully cleared your system before switching, and always follow medical guidance.
Are generics safe?
FDA-approved generics contain the same active ingredients, strength, and quality standards as the brand versions. They work the same way and offer a more affordable option for most men. The important part is to use a reputable pharmacy. Avoid unverified online sellers since counterfeit ED pills are common and may contain unsafe ingredients.
