The erectile dysfunction market is a massive one, with sales reaching nearly £7billion per year.1 With countless products on the market, it’s no surprise that many men are confused as to which is the best treatment for their needs.
Amongst the sea of treatments, there are two major brands that every man should know about: Tadalafil and Vigara. We’ll compare their efficacy and side effects, and help you to determine which one is the best for you.
What is Tadalafil?
Tadalafil is a PDE-5 inhibitor, which is a type of medication commonly used for treating erectile dysfunction (ED).
Tadalafil acts by relaxing the muscles in the penis, allowing for easier penetration by a sexual partner. It also helps to improve blood circulation in the penis, resulting in a fuller and harder erection that lasts longer. Tadalafil is generally considered one of the most effective treatments for ED, with many men noting significant improvement in their quality of life.
How does Tadalafil differ from other PDE-5 inhibitors?
Tadalafil is different from other PDE-5 inhibitors because of its selectivity for the enzyme. This means that it has a higher tolerance for safety-related factors, such as hERG channel inhibition and cytochrome P450 (CYP) interaction – the latter of which is particularly pertinent as we’ll see in a bit. This higher tolerance is likely a result of its selective inhibition of only one of the isoforms of the enzyme – although we won’t be discovering that in this review!
Tadalafil is considered a first-line treatment for erectile dysfunction
According to the latest guidelines, PDE-5 inhibitors are considered first-line treatments for erectile dysfunction, with the exception of apomorphine injections and vacuum erection devices.2 The guideline developers recommend that these patients first try an oral PDE-5 inhibitor, such as tadalafil, before moving on to more invasive treatments.3 Furthermore, some physicians have noted that oral PDE-5 inhibitors, such as tadalafil, are much more effective when started early, before the onset of ED – giving it the ‘first-line’ designation.
We should also point out here that whilst the above-referenced guidelines were published in 2018, their recommendations were only reviewed and approved in 2019. This is likely why many physicians are unaware of the existence of these guidelines, and continue to recommend more invasive treatments for ED patients even after they’ve tried and failed oral PDE-5 inhibitors. We’ll discuss the implications of this in the next section.
What is Vigara?
Like tadalafil, Vigara is also a PDE-5 inhibitor, and is meant to treat erectile dysfunction. The similarities between the two extend beyond their chemical makeup and intended use, however, as they are both selective for the same isoform of the enzyme.
The major difference between the two is in the dosage form. Vigara is available in a sublingual tablet, whilst tadalafil is available in a gel cap form for convenience of oral administration. Vigara is also less expensive than tadalafil, with the price ranging from £20 to £26 per month, compared with £36 per month for tadalafil.4 The convenience of having a sublingual tablet that you simply place under your tongue for 30 seconds, before swallowing is certainly a draw, particularly for those who experience swallowing difficulties as a result of their medications. We should also point out that whilst Vigara was initially available for sale in the UK, it was only recently approved for use here, and many men in the UK are not yet aware of its existence. This is further evidence of the undertreatment of ED in the country.
Vigara is used as a second-line treatment for erectile dysfunction
Just like tadalafil, Vigara is also a first-line treatment for erectile dysfunction in the latest guidelines. However, unlike tadalafil, it is not generally considered a safe treatment for those with heart or liver conditions.5 Furthermore, older generations of PDE-5 inhibitors, such as sildenafil, have been known to cause liver damage in some patients – although we should stress that this is extremely rare.
As mentioned, Vigara is a sublingual tablet, and this is why it needs to be swallowed – it doesn’t simply slip down your gullet unnoticed, as is the case with some liquids and some medications that you take by mouth. This particular formulation makes it more accessible for people with swallowing problems. As a result of these accessibility issues, it is generally considered a second-line treatment for erectile dysfunction. In fact, the guideline developers recommend that those with less severe cases of the condition try a different treatment first, before moving on to Vigara.6 Like tadalafil, the key takeaway from this is that whilst Vigara is a safe and effective treatment for some men with erectile dysfunction, it should not be the first choice for every man with the condition.
Which one should you try first?
It is important to try and establish what your current limitations are, before we can determine which treatment is best suited to you. You should certainly try tadalafil first, as it is a safe and effective treatment for most men with the condition. If you have tried and failed to get an erection despite trying various methods, you should ask your doctor about trying Vigara – although, again, not as a first-line treatment.
Whilst tadalafil and Vigara are both safe and effective treatments for erectile dysfunction, some men may experience side effects from the medication. The major side effect that both medications are known to cause is headaches, which can be extremely irritating and even severe in nature. The guideline developers recommend against combining both medications, due to the potential for these severe headaches to occur.7 If you experience headaches as a side effect of either of these drugs, then it would be in your best interest to try an alternative treatment instead.