Sildenafil, Tadalafil, Dapoxetine – A Comparative Review
Sildenafil, Tadalafil and Dapoxetine are the pharmaceutical names of drugs famous for being the most effective and popular means to enhance men’s sexual life. The drugs are sold under dozens of different brand names, since the original patents for their production already expired in some countries, and the number of manufacturers consequently increased. If you would like to know more about the properties and differences between the three, this comparative review will help to answer most of your questions. For one thing, it will be useful to look upon a very brief history of ED and PE treatment, where these drugs play a leading role.
Revolution in Erectile Dysfunction Treatment
Erectile dysfunction is a problem that has probably been there since the beginning of humanity itself. The history knew a lot of complex and ineffective ways to deal with this condition occurring in men of different ages and lifestyles. However, everything changed when Viagra – a small pill that could literally “fix” men’s sexual function in half an hour – became widely available. Viagra is nothing else than sildenafil, which was synthesized in Pfilzer’s research lab for the treatment of hypertension and angina. When researchers discovered sildenafil to promote natural erection, the company decided to market the drug as a remedy for ED; by 1998, Viagra had received all necessary patents and approvals to enter the market. Sildenafil produced a real revolution since no similar drugs were available before. Viagra was the first pill – simple and safe to use – for a rapid elimination of erectile dysfunction symptoms.
Similar in action but different in structure, tadalafil is a drug approved by FDA in 2003. Tadalafil was synthesized by Glaxo Wellcome and has been sold under the brand name Cialis ever since. Although the working mechanisms of Viagra and Cialis are almost identical, Cialis has one advantage significant for some consumers. It remains in the body much longer than Viagra and allows to observe positive effects up to 36 hours. Later tadalafil was approved for the treatment of another disease, benign prostatic hyperplasia, which can lead to some unpleasant symptoms such as urinary incontinence and a frequent urge to urinate.
Much like Viagra, dapoxetine was not originally developed for the treatment of sexual dysfunction. Initially intended as an antidepressant, it didn’t work well as a such. Only later it was found that the drug causes significant improvements in men with premature ejaculation. In 2009-2010, dapoxetine, well known under the brand name of Priligy, was approved in more than 50 countries. Although drugs like fluoxetine were already used off-label to treat premature ejaculation, dapoxetine had an advantage. It worked quickly and was shortly excreted from the body, did not require regular intake to achieve notable results, and therefore did not create a risk of drug accumulation.
Thus, over the years sildenafil, tadalafil and dapoxetine proved to be effective and safe to address erectile dysfunction and premature ejaculation, being pretty much the only medical drugs to tackle sexual problems with a high success rate.
Working Mechanisms Behind Sildenafil, Tadalafil and Dapoxetine Drugs
Sildenafil and tadalafil, as well as a similar drug called vardenafil, belong to the group of PDE5 inhibitors. Their intake results in a sequence of biological processes, briefly described as relaxation of smooth muscles in the penile area, the subsequent expansion of blood vessels, and an increase in blood flow to the genitals. As a result, most patients are able to achieve a natural erection with no obstacles. This effect is obtained by protecting cyclic guanosine monophosphate from breakdown. When nitric oxide binds to the receptors of guanosine monophosphate, there is an increase in concentration of this substance, which brings the vessels to expand. In 1998, scientist won the Nobel Prize in medicine for discovering and describing this process.
Dapoxetine belongs to another group of substances, namely serotonin reuptake inhibitors. Until now the exact working mechanism of dapoxetine was not discovered or described by official medicine. It is assumed that dapoxetine’s influence on premature ejaculation is associated with inhibition of serotonin reuptake by neurons, followed by an increase in the action of the neurotransmitter on pre- and postsynaptic receptors. The mechanism of ejaculation is regulated mainly by the sympathetic nervous system. Postganglionic sympathetic nerve fibers innervate the seminal vesicles, the vas deferens, the prostate, the urethra and the neck of the bladder, causing their coordinated contraction to achieve ejaculation. Dapoxetine influences the ejaculation reflex, thus increasing the latent period. Although the exact working mechanism is not clear to the researchers, in practical terms improvements can be apparent to the consumers already after the first intake of dapoxetine.
Effects of Sildenafil, Tadalafil and Dapoxetine
As mentioned before, sildenafil and tadalafil facilitate a natural erection by increasing the flow of blood. Now this doesn’t mean that erection will arise spontaneously during a certain time after the intake, as some people might think. As under natural conditions, stimulation is necessary to achieve the result after taking the pill. In popular culture, there is a belief that sildenafil, commonly known as Viagra, increases libido, enhances sensations during sex, and even increases the penis size. Such rumors made non-medical use of sildenafil and tadalafil quite common among young people. Unfortunately, at the moment there are no studies that confirm these rumors are true. Many people not suffering from ED most likely will not feel a change after taking sildenafil and tadalafil. However, studies show that half of men aged 40 to 70 have ED of some degree.
Research confirmed that another drug from our review, dapoxetine, leads to a significant delay in ejaculation, increases the sense of control and overall satisfaction. Since premature ejaculation is often associated with stress and depression, dapoxetine, being an antidepressant, can effectively cope with this condition. Unlike some antidepressants, dapoxetine does not cause addiction and withdrawal symptom.
Research and Possible Side Effects
Since the listed drugs have been on the move for years, much research was done to test their effectiveness and safety. A 4-year trial with almost 1000 participants aged 27 to 82 years showed that 94% of men observed a positive effect on erection when taking sildenafil. At the same time, 4% had side effects that required a dosage reduction, while only 6% stopped the treatment due to a lack of effect. Headache, indigestion, and facial redness are among must common side effects for sildenafil-containing drugs. Dizziness and altered vision occurred very rare.
Tadalafil was thoroughly studied by another research group, which concluded that 84% of men with varying degrees of ED noted improvement after taking the medication. Headache and indigestion appear quite common in patients, while muscle pain, dizziness and stuffy nose were observed in some participants.
Dapoxetine deals with premature ejaculation that, according to statistics, is the most common violation of sexual function affecting about 30% of men. As a result of the research, it was found that taking dapoxetine significantly prolongs sexual intercourse; after taking the drug for 12 weeks, at least good control of ejaculation is achieved. Another trial has shown that approx. 5% of men discontinued the treatment because of adverse events. Nausea (~15%) and dizziness (~7%) are among common side effects of dapoxetine.
Since people with erectile dysfunction often suffer from premature ejaculation as well, simultaneous use of sildenafil/tadalafil and dapoxetine became widespread. Studies have shown that these drugs do not interact and their simultaneous intake is safe.
Despite the encouraging results, there are common side effects and contraindications to take these drugs. It is highly recommended to consult a doctor before starting to use any of them.
Intake and Duration of Action
Although nowadays sildenafil, tadalafil and dapoxetine are produced in several different forms, pills remain the most popular and common among others.
For pills, the following times apply for onset and duration of action:
- Sildenafil: average time of onset is 30 minutes. It is recommended to take Viagra or other sildenafil-based drugs 1 hour before sex. Duration of action ranges from 4 to 8 hours.
- Tadalafil: average onset time is same with sildenafil. Positive effects of tadalafil can be noticed for approx. 36 hours.
- Dapoxetine: maximum level of concentration in blood is reached 1-2 hours after intake. Dapoxetine should be taken 1-3 hours before sex.
Onset and duration of action depends on many conditions, including individual physical features, food and alcohol intake, individual tolerability, etc. Some men say they notice the effect of Viagra during approximately 4 hours, while others claim to observe positive effects until the next morning after sex. That is to say, there can be a notable difference in response and duration of action for different men. As a general recommendation, to improve experience with ED and PE pills, the drug should be taken on an empty stomach or after a light meal. It is not recommended to take any of drugs with alcohol. Other forms of drugs, such as soft tabs and strips, have shorter onset times and do not depend on food intake.
While sildenafil and tadalafil are competing drugs with a similar mechanism of action for the treatment of ED, dapoxetine is designed to tackle premature ejaculation and can be taken along with ED pills if necessary. Three of them have shown to be very effective to treat conditions, which are unfortunately quiet common among men. Apart from the branded products like Viagra, Cialis, and Priligy, there is a wide selection of generic drugs that cost less but have a similar composition and work same as their brand-name counterparts. Like any other medical drugs, sildenafil, tadalafil, and dapoxetine have a number of contraindications and side effects that must be taken into account before you start the treatment.