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7:435, 2002) In brief, efficacy is approximately 70% with all 3 drugs. The side effect profile is similar among the 3 drugs, except that blue discoloration of vision (overlap with PDE-6 in the retina) is seen only with Viagra (<0.5%) and muscle aches only with Cialis (~5%). Otherwise, vasodilatory side effects (headaches, nasal congestion, flushing) are common with all, but are mild, and only rarely cause men to drop out of clinical trials (2-3% quit rate). All 3 will carry a contra-indication in men using organic nitrates. Otherwise, the long half-life of Cialis (17.5 hours) is noteworthy, earning this drug the nickname & 8216;weekender,& 8217; as a single dose taken on Friday would still be exerting an effect Sunday (or even Monday). Conclusion Alternative PDE-5 inhibitors Cialis and Levitra will soon be in competition with Viagra, and the launch of these new drugs is certain to bring many men with ED into doctors& 8217; offices. Aside from the long half-life of Cialis, and the excellent track record of Viagra, the differences between the 3 drugs are not great. All appear to be effective and safe, provided concomitant nitrates are avoided,. A potential for serious hypotension exists should an organic nitrate be used along with any of these three PDE-5 inhibitors. Peer-reviewed References Viagra (sildenafil) Phase III Trial Data (Goldstein in NEJM, 1998) First & 8216;real-world& 8217; study of use in a clinical practice (Marks in Urology, 1999) Cialis (Lilly ICOS) Phase III Trial Data (Brock in J. Urol., 2002) Levitra (Bayer) Phase III Trial Data (Hellstrom, in J. Andro
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