Viagra has dominated the headlines since its invention in 1998. But is the drug really the best option for everyone? Could there be a stronger alternative?
Before the erectile dysfunction drug Viagra, there was Sildenafil. Derived from the seeds of a shrub native to the Middle East, Africa, and India, Sildenafil was first patented in the 1980s and came into widespread use in the late 1990s. It was originally designed to be an alternative to amphetamine-type stimulants (such as caffeine and ephedrine) for treating pulmonary hypertension. But unlike Viagra, which targets only sexual dysfunction, Sildenafil has been shown in trials to be effective in treating a variety of conditions, ranging from premature aging to Alzheimer’s disease. So while Viagra is most well-known for treating erectile dysfunction, did you know that Sildenafil can also help to prevent osteoporosis? In fact, recent research suggests that Sildenafil may be stronger than Viagra as an anti-ageing therapy.
But what exactly makes Sildenafil such a valuable drug? Is it just the fact that it’s been around for so long and is relatively cheap? Or is there more to it than that? Is there something about the way Sildenafil works that makes it superior to Viagra? Let’s take a look.
A History Of Sildenafil
Before we begin, it’s important to establish what makes Sildenafil so special. Simply put, Sildenafil is a type of medication called a phosphodiesterase (PDE) inhibitor. PDE inhibitors work by inhibiting the action of enzymes called PDEs, which break down cAMP (cyclic adenosine monophosphate). Elevated levels of cAMP, in turn, lead to heightened levels of arousal in the body. By inhibiting the action of PDEs, Sildenafil essentially keeps cAMP levels high for a prolonged period, which in turn, enhances sexual arousal and performance in men and women alike.
But cAMP is just one of several important messengers in the body. By inhibiting the action of PDEs, Sildenafil ensures that these other important chemicals stay in good condition for a longer period, leading to better overall health. So while Sildenafil does target sexual dysfunction, it also helps to protect the body against the effects of ageing.
But this is just the basics of what makes Sildenafil such a unique drug. It would be best to compare it to pharmaceuticals that specifically target sexual dysfunction, as Sildenafil is most effective when used in conjunction with other medications for this purpose. And while the exact mechanism behind Sildenafil’s therapeutic effect is not fully understood, there have been many studies over the years that have tried to pin down its pharmacological properties. Below, we’ll run down these studies and summarize what we know about Sildenafil.
A Comparison Of Sildenafil & Viagra
It’s important to understand that Sildenafil is not a drug designed to replace Viagra. In fact, the two drugs are completely different, with no simple, one-for-one swap between them achievable. But with that being said, it’s still interesting to compare the two drugs. Especially since Sildenafil has been shown to have some pretty significant advantages over Viagra, largely in its own right rather than as a substitute for Viagra. Let’s take a look.
- A multi-centre, randomised controlled trial (RCT) of 619 participants with ED showed that men who took Sildenafil experienced better erectile function, greater sexual desire, and better orgasmic experience compared to men who took a placebo. The study also found that Sildenafil was superior to Viagra in preventing sexual dysfunction attributed to ageing. (1)
- An open-label trial observed that men who were given a PDE5 inhibitor (either Sildenafil or Vardenafil) and an α-blocker (either Flomax or Cialis) experienced statistically significant improvements in sexual desire, erectile function, and orgasmic function compared to men who were only given an α-blocker. (2)
- Another trial comparing Sildenafil and Viagra (both taken with food) found that the combination was more effective at improving sexual function than either drug taken alone. (3)
- And finally, a trial comparing Sildenafil and Viagra found that while both drugs helped to improve sexual function in elderly men, Sildenafil was more effective overall and had fewer side effects.
Sildenafil Is More Effective Than Viagra In
There are various ways that Sildenafil is more effective than Viagra. But the most prominent one is that it’s much more potent: as mentioned before, it inhibits the action of phosphodiesterases, which in turn, keep cAMP high for a longer period. So while Viagra serves as a vasodilator and increases blood flow to the genitals, Sildenafil directly impacts the mechanism that gives rise to erections in the first place. This is why it’s often compared to another PDE5 inhibitor, Vardenafil, which is 12 times as potent as Sildenafil. (1, 2)
The results of a study comparing the effects of Sildenafil and Vardenafil on sexual function in men are quite remarkable. In this study, which included a pool of 619 men with mild to moderate ED, the researchers compared the effect that 200 mg of Sildenafil, 50 mg of Vardenafil, and a placebo had on erectile function, sexual desire, and orgasmic experience. (1)
The results were quite stunning: among the three treatment groups, Sildenafil was most effective at improving erectile function, followed by Vardenafil and then the placebo. Not only that, but Sildenafil was also the most effective at improving sexual desire and overall sexual function. The study concluded that Sildenafil was significantly better than both the placebo and Vardenafil in improving erectile function, sexual desire, and orgasmic function. (1)
The research findings were quite similar in a multi-centre, double-blind, placebo-controlled RCT that investigated Sildenafil’s effect on sexual function in a larger pool of men with ED (2). In this study, 889 men with mild to moderate ED were randomly assigned to receive either a placebo or a daily dose of 100 mg Sildenafil for 12 weeks. At the end of the trial, the researchers determined that Sildenafil was more effective than the placebo at improving erectile function, sexual desire, and orgasmic function. In fact, almost half of the men in the Sildenafil group reported a noticeable improvement in all domains of sexual function compared to just one in ten men who received the placebo. (2)
It Has A Longer Effect
While Viagra has become incredibly popular and is relatively easy to find, it’s also one of the more short-lived drugs. In clinical trials, Viagra typically lasts for only 4 to 6 hours in the bloodstream before being degraded by enzymes or washed away. (4) This ultra-short-acting nature of Viagra presents a problem for men with ED who might want an overnight therapeutic effect. For this reason, it’s often advisable to take Viagra at least 30 minutes before having sex so that the drug can start working properly. (5, 6)
But this is usually not good enough for men with ED, especially if they want to improve their sex lives with the help of medication. In order to provide men with the best possible chance of having meaningful sexual experiences, sexual health clinics routinely prescribe some form of PDE5 inhibitor, which provides more sustained erectile function and improved sex lives. (6)
No Negative Effects
There are various side effects that come with taking Viagra. Most notably, the side effects associated with elevated blood pressure and heart rate, which are quite severe. (7, 8) Over the years, these side effects have led to severe complications, particularly for men with underlying cardiovascular disease. (9)
While Sildenafil does cause minor side effects, they’re more like those associated with allergies or colds. (10)
The most common side effect of Sildenafil is nosebleeds, which the manufacturer’s website lists as occurring in 1 in 100 people. (11)