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An excerpt from the Johns Hopkins Medical Letter: Health After 50

Beyond the Little Blue Pill

A little blue pill called Viagra (sildenafil) broke the wall of silence surrounding impotence, or erectile dysfunction (ED).

Although only 10% to 15% of men with erectile dysfunction seek treatment, the recent introduction of two more erectile dysfunction medications may prompt more men to seek help for an often treatable condition. If erectile dysfunction is a symptom of an underlying medical problem like diabetes or heart disease, treating the problem sometimes improves erectile dysfunction without a medication. But if more help is needed, men now have three erectile dysfunction drugs available: Viagra, Levitra (vardenafil), and Cialis (tadalafil) All three block the action of an enzyme known as PDE5, to permit more blood flow to the penis during sexual stimulation. More blood means a harder erection.

What every man wants to know

How long before having sex should I take the medication?
Most men get good results taking the medication about an hour before anticipated intercourse. One study suggests that Levitra was ten times more effective than Viagra in inhibiting PDE5, and some research suggests that higher doses of Levitra may have a faster effect.

How long will the medication last?
Viagra and Levitra typically improve erections for about 4 hours. However, they should not be taken more than once daily. Cialis is effective for 24 to 36 hours, and the advantage is obvious. You can take your medication Friday night and be "good to go" for much of the weekend.

It could take some experimentation, directed by your doctor, to find the best option for you. These drugs are not recommended for men who use nitroglycerin tablets or patches, and liver or kidney impairment may preclude them, or affect the dosage you take. Drug interactions are also possible.

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