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Cialis vs Viagra: Your Best Option in 2024
Apr 02, 2024
Fact Checked
Viagra is the original ED pill, but Cialis is better for spontaneous sex and after-dinner encounters.
Erectile dysfunction (ED) becomes more common with age, but it doesn’t have to signal the end of your sex life. Numerous ED treatments exist today, and urologists feel confident they can help any man* get an erection regardless of what’s causing the ED. [1] Ferrini, M. G., et al. Translational Andrology and Urology. 2017. Aging Related Erectile Dysfunction—Potential Mechanism to Halt or Delay Its Onset.
According to expert interviews conducted by our Reviews Team, urologists typically prescribe Viagra or Cialis before trying more invasive erectile dysfunction treatments. These pills have a good track record of treating ED, but they provide different “windows of opportunity” and may produce different side effects.
If you’re interested in getting Cialis or Viagra through a telehealth platform like Hims, it’s even more important to understand their differences. After vetting 25 telehealth platforms offering ED treatment, our Reviews Team found that many require patients to choose their preferred ED medication and dosage, which then gets approved, modified, or rejected by a provider based on the patient’s medical history.
Our guide will explain the major differences between Cialis and Viagra, but we recommend consulting your primary care physician or a urologist before making a final decision.
*For brevity, we refer to all people assigned male at birth as men throughout this guide.
Hims
Hims is a popular telehealth platform for ED diagnosis and treatment offering a straightforward process, variety of treatments, and free consultations.
Hims
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Name-brand and generic Cialis and Viagra
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Tadalafil (generic Cialis) available as a mint
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Free, discreet shipping within five days
Our Hims experience
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Generic Viagra price: $4–$8 per dose, may differ based on location •
Generic Cialis price: $1.33–$7.50 per dose, may differ based on location •
Consultation price: Free •
Shipping time: Two to five business days Special considerations: Erectile dysfunction medication for older adults
Viagra and Cialis may be ineffective or dangerous based on your health history and current medications.
Some of the most common chronic conditions affecting older adults—including high blood pressure, high cholesterol, heart disease, and diabetes—can damage penile blood vessels and nerves, leading to new or worsening ED that doesn’t respond to Viagra or Cialis. [2] Defeudis, G., et al. Diabetes/Metabolism Research and Reviews. 2022. Erectile Dysfunction and Diabetes: A Melting Pot of Circumstances and Treatments Fortunately, several other ED treatments are available, such as penile injections, vacuum erection devices, and a discreet penile prosthesis. [3] McMahon, C. N., et al. BMJ. 2006. Treating Erectile Dysfunction When PDE5 Inhibitors Fail.
ED can also appear as one of the first symptoms of cardiovascular disease, hypertension, anxiety, and other chronic health concerns. If you haven’t had a physical exam within the last year, don’t try to get ED medication online. Visit your doctor in person to ensure underlying conditions are diagnosed and treated alongside ED.
Who shouldn’t take Viagra or Cialis
Viagra and Cialis shouldn’t be taken with some of the medications used to treat chest pain, high blood pressure, or lower urinary tract symptoms. Viagra should also be avoided in men taking protease inhibitors—a specific class of medications used to treat HIV.
Combining nitrates or alpha-blockers with ED pills may cause a severe, life-threatening drop in blood pressure, which can be associated with feeling dizzy, fainting, falling, and even death.
This is not a complete list of medications that can cause complications with Viagra and Cialis. Talk to your provider about everything you take—including recreational drugs—when discussing potential ED treatments.
Cialis and Viagra also shouldn’t be taken by people with low resting blood pressure, uncontrolled high blood pressure, inherited disorders of the eye or retina, recent heart attack or stroke, or uncontrolled heart disease. Cialis and Viagra may worsen abdominal pain in men with stomach ulcers.
What is the difference between Cialis vs. Viagra?
Cialis and Viagra differ in convenience, duration, affordability, and tolerability.
Cialis is safe to take daily at a low-dose and can be ingested on a full stomach without altering its efficacy or creating unpleasant side effects. It can take up to two hours to start working but stays in the system for 24–36 hours, allowing plenty of time for spontaneous romance. [4] Drugs.com. July 23, 2023. Cialis Prescribing Information. Found on the internet at https://www.drugs.com/pro/cialis.html
In contrast, taking Viagra requires some planning. It can be taken once every 24 hours but works for six to eight hours, on average. [5] Drugs.com. July 5, 2023. Viagra Prescribing Information. Found on the internet at https://www.drugs.com/pro/viagra.html It’s less effective when taken after a meal, especially one high in fat. But Deepti Padakala, a pharmacist at Marley Drug Pharmacy in Winston-Salem, North Carolina, said Viagra has one major advantage over Cialis: It starts working in 30–60 minutes. Keep in mind that physical stimulation is required to initiate an erection when taking these pills—neither produces a spontaneous erection.
Finally, Viagra tends to cost more than Cialis—even when comparing generic versions.
Side effects of Viagra vs. Cialis
Viagra and Cialis can cause similar side effects, especially headache, facial flushing, runny nose, and heartburn. Side effects often improve or completely resolve after several weeks of taking the medication.
Each medication can also cause unique side effects, which may influence the decision to choose one or the other. “Viagra can uniquely cause visual disturbances such as double vision, blurry vision, or impaired color vision,” said Kian Asanad, MD, a urologist at Northwestern Memorial Hospital in Chicago. “On the other hand, Cialis can cause backache and muscle cramps in the legs, which is rarely seen with Viagra.”
Urologists say their patients tend to report fewer side effects with Cialis than Viagra, and our January 2024 survey backs up this claim. Zero side effects were reported by nearly 83% of survey respondents taking Cialis or generic tadalafil, but only 28.5% of those taking Viagra or generic sildenafil reported no side effects.
“The fewer side effects likely stem from Cialis causing a more ‘gentle’ rush of an erection thanks to its longer half-life, while Viagra can feel more ‘intense’ due to a shorter half-life,” said Asanad.
“I had the same side effects with both Cialis and Viagra. I felt like my eyes were bulging out, I was very thirsty, and I had muscle cramping in my hands, legs, and sometimes in my chest. So I had to go to my doctor for that for sure.”
Focus group participant
“When choosing between Cialis and Viagra, health care providers consider factors such as patient preference, medical history, frequency of sexual activity, timing preferences, and potential drug interactions,” said Pikdala. For example, people with benign prostatic hyperplasia (BPH) and erectile dysfunction are usually prescribed low-dose daily tadalafil (Cialis), which treats both conditions. “It’s about finding the best fit for the person’s needs and health profile.”
| Cialis | Viagra | |
|---|---|---|
| Active ingredient | Tadalafil | Sildenafil |
| Year approved by the FDA | 2003 | 1998 |
| Cost (brand) | Starts at $57 per pill | Starts at $74 per pill |
| Cost (generic) | Starts at $0.17 per pill | Starts at $0.99 per pill |
| Typical dosage | 5 mg daily or 10 mg as needed | 50 mg as needed |
| Common side effects | Headache Runny nose Heartburn Facial flushing Backache Muscle cramping in legs | Headache Runny nose Heartburn Facial flushing Blurry vision Blue-tinged vision |
| Can it be taken with or after a meal? | Yes | Not recommended |
| How long does it take to work? | 30–120 minutes | 30–60 minutes |
| When is most of it absorbed? | 2 hours, hours, on averageⓘ Drugs.com. July 23, 2023. Cialis Prescribing Information | 1 hour, on averageⓘ Drugs.com. July 5, 2023. Viagra Prescribing Information |
| How long does it stay effective? | 24–36 hours | 6–8 hours |
How we research and evaluate erectile dysfunction platforms
Based on our expert consultations, research, and testing, we determined the following factors to be essential for our readers when signing up for an erectile dysfunction medication platform:
- Ability to conduct live calls (video or phone) with prescriber
- Ability to message prescriber through the platform
- Ability to get an ED diagnosis through the platform
- Name-brand and generic prescriptions available
- Discreet shipping
- Affordable prices for medications and consultations
- Ease of use of the app or website
We had all of our reviews medically reviewed by an expert in the field to ensure the information is appropriate for NCOA readers’ needs. Read more on our methodology here.
Bottom line
Talk to a doctor if you’re not sure which ED medication is right for you. Your medical history and current medications may affect the provider’s decision to prescribe Viagra instead of Cialis, or vice versa. If both medications seem appropriate and you indicate no personal preference, providers will typically prescribe one to see how you tolerate it and will switch to the other if side effects occur.
That said, Cialis is generally tolerated better than Viagra, lasts longer for more spontaneous encounters, can be conveniently taken with or shortly after a meal, and is typically more affordable.
Frequently asked questions
To understand how ED pills like Viagra and Cialis work, it’s important to first learn how erections work. Erections start in the brain with an arousing thought, and a chemical reaction causes the penile blood vessels to dilate so that more blood can enter. The inflow of blood causes the erectile tissue of the penis to expand, which then compresses the veins and limits the outflow of blood. This balance of increased blood inflow and minimal blood outflow ultimately results in an erection.
cGMP is one of the compounds responsible for dilating the blood vessels and facilitating an erection. cGMP levels are kept in check by an enzyme called phosphodiesterase 5, or PDE5. Erectile dysfunction can occur when PDE5 breaks down cGMP faster than it can be produced.
Viagra and Cialis are PDE5 inhibitors. They bind to PDE5 before it can bind to cGMP, allowing cGMP levels to increase sufficiently for an erection.
No, Cialis and Viagra are different medications. The main ingredient in Cialis is tadalafil, and the main ingredient in Viagra is sildenafil. Both belong to a category of drugs called PDE5 inhibitors.
On average, it takes two hours for the body to absorb the maximum amount of Cialis. [4] Drugs.com. July 23, 2023. Cialis Prescribing Information. Found on the internet at https://www.drugs.com/pro/cialis.html In some people, this process takes 30 minutes to six hours.
According to Asanad, a urologist may prescribe a low dose of daily Cialis with as-needed Viagra to improve treatment outcomes. But taking Viagra and Cialis together increases the risk of side effects like headache, runny nose, or heartburn and should only be done with a doctor’s supervision.
Cialis can be taken every day in 5 mg doses or as needed in 10 mg or 20 mg doses. Doctors also prescribe Cialis in doses as low as 2.5 mg or 5 mg daily to treat benign prostatic hyperplasia (BPH), also known as an enlarged prostate.
Viagra is available in 25 mg, 50 mg, or 100 mg. According to the manufacturer, 50 mg is the recommended dose for most people. Your doctor will monitor your side effects and ED symptoms to determine if you need a higher or lower dosage.
Cialis generally costs less than Viagra. To save the most money, choose the generic forms of each drug: tadalafil (Cialis) and sildenafil (Viagra). On average, one pill of generic Cialis costs $5, whereas one pill of generic Viagra costs about $5.65. Pharmacies and online platforms sell these medications for less than $1 per generic pill to more than $95 per name-brand pill, so shop around to find the best deal.
Have questions about this review? Email us at reviewsteam@ncoa.org.
Sources
- Ferrini, M. G., et al. Aging Related Erectile Dysfunction—Potential Mechanism to Halt or Delay Its Onset. Translational Andrology and Urology. Feb. 9, 2017. Found on the internet at https://doi.org/10.21037/tau.2016.11.18
- Defeudis, G., et al. Erectile Dysfunction and Diabetes: A Melting Pot of Circumstances and Treatments. Diabetes/Metabolism Research and Reviews. February 2022. Found on the internet at https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3494
- McMahon, C. N., et al. Treating Erectile Dysfunction When PDE5 Inhibitors Fail. BMJ. March 11, 2006. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1397768/
- Drugs.com. Cialis Prescribing Information. July 23, 2023. Found on the internet at https://www.drugs.com/pro/cialis.html
- Drugs.com. Viagra Prescribing Information. July 5, 2023. Found on the internet at https://www.drugs.com/pro/viagra.html
- Cui, H., et al. Efficacy and Safety of Long-Term Tadalafil 5 mg Once Daily Combined with Sildenafil 50 mg As Needed at the Early Stage of Treatment for Patients With Erectile Dysfunction. Andrologia. February 2015. Found on the internet at https://onlinelibrary.wiley.com/doi/10.1111/and.12216