IN Toronto magazine

“Which one of the erection drugs is the best choice? Viagra?”

Many guys can and do benefit from the use of erection-enhancing drugs. Seeking a prescription for these medications is often filled with embarrassment but shouldn’t be. These pills are not just for those who have true erectile dysfunction (significant problems arising with erections) but also guys who need a little confidence-booster — a little extra “wood in their trunk.”

Anything from stress and anxiety to medical conditions like diabetes can interfere with your performance. Erectile drugs belong to a class called phosphodiesterase-5 inhibitors (PDE-5 inhibitors). Erections are caused by blood flowing into the penis, achieved when a substance called cGMP is released during arousal. In turn, cGMP is broken down by the PDE-5 enzyme. PDE-5 inhibitors work by blocking PDE-5, allowing cGMP to carry on giving you a very solid erection. Choosing the right drug for erectile dysfunction can be confusing.

There are three federally approved drugs currently on the market: Viagra, Cialis and Levitra. While Viagra is certainly well known due to its prominent ad campaigns and being first on the market, it may not always be the best choice to perk up your droopy little guy.

First question to ask: Are you looking for a short-term result or something long-acting? For those who anticipate having sex repeatedly over a longer period of time (like a weekend), then Cialis is the better choice since it lasts up to 36 hours (although I have had patients report up to two to three days of benefit). The others last four or five hours only. All three drugs need to be taken about 30 minutes beforehand.

Secondly: Are you going to be drinking alcohol or eating? In that case, if you are choosing a shorter-acting drug, Levitra is the better option since Viagra needs to be taken on an empty stomach. This is why I personally tend to prescribe Levitra more between the two.

Potential side effects for all three include nasal congestion, skin/face flushing, and headache. Viagra may cause more temporary visual disturbance or bluish vision, while Cialis may cause more gastrointestinal upset in users. Guys with blood pressure or heart problems should check with their physician before using. Anyone taking nitrates like nitroglycerine or poppers (amyl nitrate) should not use PDE-5 inhibitors since they can cause dangerous and even fatal drops in your blood pressure.

The costs of the drugs per pill are more or less equivalent. Since Cialis lasts longer, you get more “bang for your buck” (couldn’t resist, sorry). Always ask for the double strength ones since they cost the same and you can chew off half, cutting down on costs.

In conclusion: Cialis works longer, Levitra is better with food and alcohol, they are all expensive (ask for the double dose) and never use with poppers or nitroglycerine. Happy humping!

Dr Keith Loukes works in emergency in a Toronto hospital. Send him your sexual health question at This e-mail address is being protected from spambots. You need JavaScript enabled to view it This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

This column should not be viewed as medical advice; always consult your physician.