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Potency pills Sildenafil, Tadalafil, Vardenafil and Avanafil in comparison
The range of therapy options for erectile dysfunction has greatly improved over the past two decades. Today, a number of treatment options are available to patients with potency problems, consisting of herbal remedies for early stages of erectile dysfunction, mechanical aids such as penis rings and vacuum pumps, oral sexual enhancers and erectile tissue autoinjections for intermediate stages, as well as hormone replacement therapy and vascular surgery for advanced stages.
Even if the oral sexual enhancers are only one of several therapeutic options for erectile dysfunction, they are by far the most popular choice. They are only used when needed and are therefore a very convenient and economical alternative.

Effect of PDE-5 inhibitor sexual enhancers

Four drugs are currently approved as oral sexual enhancers to help manage the symptoms of erectile dysfunction. All four (Sildenafil Citrate, Tadalafil, Vardenafil and Avanafil) belong to the same class of vasodilator drugs, the so-called PDE-5 inhibitors.
The PDE-5 inhibitors block the activity of the enzyme phosphodiesterase-5, which is responsible for the rapid breakdown of nitric oxide. The nitric oxide controls the erection through its vasodilating effect. When the concentration of nitric oxide in the blood is high enough, the erection is strong and lasts longer. By inhibiting nitric oxide, which is important for maintaining an erection, the PDE-5 inhibitors promote a naturally strong erection.
Although the mechanism of action of all four active ingredients is the same, they differ from one another in certain properties such as the speed at which the effect occurs, duration of effect, half-life, interactions with foreign substances and tolerability. These therapeutic properties determine the suitability of the individual PDE-5 inhibitors for certain patient groups.
In brief, sildenafil can be described as the most effective PDE-5 inhibitor, tadalafil as the sexual enhancer active ingredient with the longest duration of action, vardenafil is the most well-tolerated drug from this class, while avanafil is an all-rounder.
Unpredictable lowering of blood pressure in combination with certain medications is the common and greatest risk with the use of all PDE-5 inhibitor sexual enhancers.

Sildenafil Citrate

Sildenafil Citrate was the first PDE-5 inhibitor in history to have a beneficial effect on male virility. As a result, a few years later in September 1998, sildenafil was approved as the first oral drug under the trademark Viagra by the European Medicines Agency for the treatment of erectile dysfunction. The patent protection for Viagra expired in Europe in June 2013.
Sildenafil has the shortest duration of action, the slowest onset of action but the highest efficiency of all PDE-5 inhibitors and is very universally applicable. According to statistics, sildenafil helps more than 84 percent of chronic erectile dysfunction patients achieve a normal "then" erection. Its efficiency is the same for all age groups of men.
However, this active ingredient is sometimes criticized for its side effects, which are more common than other PDE-5 inhibitors. However, due to the short half-life of sildenafil, the side effects are mostly short-lived.
In addition to the original Viagra, Sildenafil Citrate is now also found in some other sexual enhancers, generics and branded generics that make the treatment of erectile dysfunction cheaper. Kamagra and Silagra are among the best-known branded generics with the active ingredient Sildenafil.
Since 2005, Sildenafil (as Revatio) has also been approved for idiopathic pulmonary arterial hypertension. Sildenafil is used "off-label" to combat various other health conditions, including as a female Viagra against arousal disorders in women.
Sildenafil should be taken about 45 minutes to 1 hour before starting sexual activity. The effect sets in after a maximum of 45 minutes and lasts about 4 hours after the ride.

Tadalafil

Tadalafil was the second PDE-5 inhibitor after sildenafil, which was approved by the European Medicines Agency as Cialis for the treatment of impotence in November 2002. The patent protection for the original Cialis preparation expired in Germany and in all other EU countries in November 2017.
Despite the fastest onset of action of around 15-20 minutes, tadalafil has the longest duration of action of the PDE-5 inhibitor potency drugs, which is 36 hours in most patients. Its general tolerance is better than that of Sildenafil Citrate, although its effect is only minimally delayed by high-fat foods. Tadalafil is also the only sexual enhancer active ingredient that is well tolerated by alcohol, provided that alcohol consumption is moderate.
Because of its very long duration of action, this sexual enhancer is prescribed to young, capable men who can have sex several times in a row within its long duration of action.
Tadalafil is the only sexual enhancer that is prescribed for long-term therapy to improve general sexual function in low doses of 2.5-5mg per day.
Similar to Sildenafil, Tadalafil is also offered in new, innovative galenic forms, such as chewable tablets, gelatine capsules or jellies, in order to make it even more tolerable and effective. In addition to Cialis, tadalafil is the only active ingredient in branded generics such as Apcalis, Tadacip or Tadalis.
In addition to its use as a sexual enhancer, tadalafil was approved in 2010 as Adcirca for pulmonary arterial hypertension and in 2011 as Cialis 5mg for benign prostate syndrome.
Tadalafil should be used about 20 minutes before you intend to have sexual intercourse. The effects set in within 20 minutes and can be felt for 36 hours.

Vardenafil

Vardenafil, known as the trademark Levitra, was approved as the third PDE-5 inhibitor in March 2003 by the European Medicines Agency for the treatment of erectile dysfunction. The patent protection for Levitra on the European market expired at the end of October 2018.
Vardenafil has a rapid onset of action (almost like Tadalafil) and a relatively short duration of action (about an hour longer than Sildenafil). The greatest advantage of Vardenafil compared to other sexual enhancer active ingredients is its very good compatibility with medicinal substances, so that when using this sexual enhancer the risk of possible interactions with other medicinal products is greatly minimized. Thus, vardenafil is mostly prescribed to older men who also have to take other drugs every day. Vardenafil is also said to be well tolerated with alcohol, but it is not recommended to take it while consuming alcohol.
A small disadvantage is a somewhat weaker efficiency in comparison with other sexual enhancer active ingredients, which, however, as with all drugs, is heavily dependent on the individual constitution.
Because this drug was patented until recently, there are no branded generic drugs with the active ingredient vardenafil.
It is recommended to take Vardenafil about 30-45 minutes before you are likely to have sexual activity. The effects can be felt within 30 minutes (sometimes a little later) and enjoyed for another 5 to 6 hours.

Avanafil

Avanafil, the youngest active ingredient from the class of PDE-5 inhibitors for the treatment of impotence, was only approved as STENDRA by the European Medicines Agency in June 2013 (in Switzerland as Stendra even in 2016) and is therefore still under patent protection. Therefore, there are no generic or branded generic drugs with this drug.
The duration of action is given as 6 hours (similar to Vardenafil) but the long half-life of 12 hours indicates a much longer duration of action, which is up to 12 hours in some patients. The onset of action is just as fast as with Tadalafil, although the efficiency is just under as high as with Sildenafil Citrate.
According to studies, tolerability should have been extremely high, but Avanafil has only been on the market for a short time and customer reports are still relatively sparse to confirm this claim.
Avanafil should be taken approximately 20-30 minutes before intended sexual activity. The effect sets in after 15-20 minutes and is felt by the patient for over 6 hours.
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