How do Viagra, Cialis and Levitra compare? They work the same way and differ mainly in timing. All three are PDE5 inhibitors: they increase blood flow to the penis and only help an erection happen when there is sexual stimulation (healthdirect). The effects of Viagra (sildenafil) can last up to 4 hours (healthdirect — Sildenafil), of vardenafil, the medicine in Levitra, four to five hours (EMA — Levitra leaflet), and of Cialis (tadalafil) up to 36 hours (Cialis CMI). All three need a prescription in Australia, where the Levitra brand is not registered but generic vardenafil is (ARTG).
How do Viagra, Cialis and Levitra compare side by side?
From the Australian Viagra CMI and Cialis CMI, the EMA Levitra leaflet and the ARTG:
| Viagra (sildenafil) | Cialis (tadalafil) | Levitra (vardenafil) | |
|---|---|---|---|
| Usual dose | 50 mg; 25 mg to 100 mg | 10 mg, up to 20 mg; or 5 mg once a day | 10 mg; 5 mg to 20 mg |
| When to take it | About one hour before sex | At least 30 to 60 minutes before sex | About 25 to 60 minutes before sex |
| How long it can work | Up to 4 hours | Up to 36 hours | From 25 minutes to four to five hours |
| With food | Slower after a heavy meal | With or without food | Slower after a heavy or high-fat meal |
| How often | No more than once a day | ||
| On the ARTG | Viagra 25, 50 and 100 mg | Cialis 2.5, 5, 10 and 20 mg | Generic vardenafil 5, 10 and 20 mg; not the Levitra brand |
How they work in the body: how does Viagra work?
Which one starts working fastest?
On the labels, the three are close. Viagra "normally takes between half an hour and one hour" (Viagra CMI) — see how long does sildenafil take to work? Cialis is taken "at least 30-60 minutes prior to anticipated sexual activity" (Cialis CMI), vardenafil about 25 to 60 minutes before (EMA). A fourth medicine of the class, avanafil (Spedra), is taken 15 to 30 minutes before sex (Spedra CMI): does Spedra work better than Viagra? Speed alone is the subject of which ED medicine works fastest?
How long does each one last?
Cialis, by far. "Lasting" means the time in which arousal can still lead to an erection. "CIALIS has been proven to be effective for up to 36 hours" (Cialis CMI). Sildenafil's effects last up to 4 hours (healthdirect — Sildenafil; how long does sildenafil last?). With vardenafil, an erection is possible "anywhere from 25 minutes up to four to five hours" after the tablet (EMA leaflet). After you come, see can Viagra keep you hard after ejaculation? An erection lasting more than 4 hours needs the nearest hospital emergency department (healthdirect — Sildenafil).
Does food or grapefruit change how they work?
Food slows Viagra and vardenafil, not Cialis. "You may find VIAGRA takes longer to work if you take it with a heavy meal" (Viagra CMI); vardenafil is best not taken "after a heavy or high-fat meal as this may delay the effect" (EMA leaflet); "CIALIS can be taken with or without food" (Cialis CMI). Grapefruit juice differs: the Levitra leaflet says not to drink it, the Cialis CMI lists it among things that may interfere, and for sildenafil a study in 24 men found it raised the amount absorbed, with the authors advising against the combination (Jetter et al., 2002; does grapefruit juice enhance the effects of Viagra?).
Do their side effects differ?
Mostly not. All PDE5 inhibitors commonly cause headache, facial flushing, nasal congestion and indigestion or reflux; rarer and serious are vision changes, an erection that won't go down, sudden hearing loss, dizziness or fainting, and allergic reactions (healthdirect). Each label adds its own emphasis: back pain and muscle pain with Cialis (Cialis CMI); dizziness is common with vardenafil (EMA leaflet); with Viagra, vision changes "such as blurring, a blue colour to your vision or a greater awareness of light" need urgent attention (Viagra CMI). None of them can be taken with nitrates for angina or with riociguat (EMA — Viagra; EMA — Cialis; EMA — Levitra). More in Cialis vs Viagra: effectiveness and side effects and does Viagra make you harder?
Which of them are approved in Australia?
Viagra, Cialis and generic vardenafil; not the Levitra brand. The register lists Viagra since 1998 and vardenafil from Apotex since 2018; a search for "levitra" returns no entry (ARTG). Spedra (avanafil) 50, 100 and 200 mg has been registered since April 2016 (ARTG — Spedra). Cialis has a second approved use: "urinary symptoms associated with benign prostatic hyperplasia in adult men" (Cialis CMI). Sildenafil also comes under names other than Viagra: generic sildenafil vs brand-name Viagra.
Which one should you choose?
The one your doctor prescribes after assessing you (healthdirect). The practical choice is between a tablet about an hour before sex and a window of up to 36 hours. Which works best is answered in which erectile dysfunction drug is best?
The short answer
Same kind of medicine, different clocks: hours for Viagra and vardenafil, up to 36 for Cialis. The common side effects are shared, and nitrates are ruled out for all three. More in our guide to how well Viagra works and how long it lasts.
