Tadalafil vs Other ED Medicines (Including Vardenafil)

Tadalafil is one of several PDE5 inhibitors available for treating erectile dysfunction in the UK. This guide compares tadalafil with other ED medications, including vardenafil and avanafil, helping you understand how they differ and why doctors might recommend one over another.

The PDE5 Inhibitor Family

All these medications work by inhibiting the enzyme phosphodiesterase type 5 (PDE5):

Available in the UK:

• Sildenafil (Viagra) - covered separately in tadalafil vs sildenafil
• Tadalafil (Cialis)
• Vardenafil (Levitra)
• Avanafil (Spedra)

Each has similar mechanisms but different characteristics that influence prescribing decisions.

Tadalafil vs Vardenafil

Duration of Action

The most notable difference:

Tadalafil:

• Effects last up to 36 hours
• Nicknamed the “weekend pill”
• Provides extended window for sexual activity

Vardenafil:

• Effects last 4-5 hours
• Similar to sildenafil
• Requires more precise timing

Onset of Action

Tadalafil:

• Typically begins working in 30-60 minutes
• Maximum effect around 2 hours

Vardenafil:

• Often works within 25-60 minutes
• Slightly faster onset than tadalafil for some users

Food Interactions

Tadalafil:

• Can be taken with or without food
• Fatty meals have minimal effect

Vardenafil:

• High-fat meals can delay absorption
• Better absorbed on an empty or light stomach
• Food has more impact than with tadalafil

Effectiveness

Both medications are highly effective:

• Success rates are similar in studies
• Individual response varies
• Some men respond better to one than the other
• No way to predict which will work best without trying

Side Effects

Common side effects overlap:

Both can cause:

• Headache
• Flushing
• Nasal congestion
• Indigestion

Differences:

• Tadalafil: More commonly causes back pain and muscle aches
• Vardenafil: Side effect profile very similar to sildenafil

Dosing Options

Tadalafil:

• 2.5mg, 5mg (daily)
• 10mg, 20mg (on-demand)
• Flexible dosing approaches

Vardenafil:

• 5mg, 10mg, 20mg (on-demand only)
• No daily low-dose option
• Orodispersible tablets available

Cost Comparison

Generic versions of both are now available in the UK:

• Vardenafil generics tend to be competitively priced
• Tadalafil generics also cost-effective
• Prices vary between suppliers

For detailed pricing, see our tadalafil prices guide.

When Doctors Might Prefer Each

Tadalafil may be preferred for:

• Patients wanting spontaneity
• Those with frequent sexual activity
• Men who also have BPH symptoms
• People preferring longer duration
• Those wanting daily low-dose option

Vardenafil may be preferred for:

• Patients who prefer shorter duration
• Those who respond better to it specifically
• Men who had issues with tadalafil
• When faster onset is valued

Tadalafil vs Avanafil

Avanafil (Spedra) is the newest PDE5 inhibitor:

Onset of Action

Avanafil’s main advantage:

• Can work as quickly as 15-30 minutes
• Fastest-acting PDE5 inhibitor
• Useful when spontaneity is particularly valued

Tadalafil:

• 30-60 minute onset typical
• Slower initial action but longer duration

Duration

Avanafil:

• Effects last approximately 6 hours
• Longer than sildenafil/vardenafil
• Shorter than tadalafil

Tadalafil:

• Up to 36 hours
• Significantly longer duration

Selectivity

Avanafil:

• Highly selective for PDE5
• Minimal activity on other PDE enzymes
• Theoretically fewer side effects from off-target effects

Tadalafil:

• Also selective but affects PDE11 to some degree
• Well-tolerated despite this

Food Interactions

Avanafil:

• Can be taken with moderate amounts of food
• Less affected by food than sildenafil or vardenafil
• Similar to tadalafil in this respect

Availability and Cost

Avanafil:

• Newer medication
• Less widely prescribed in the UK
• May be more expensive than older alternatives
• Not as readily available as tadalafil

Tadalafil:

• Well-established
• Widely available
• Multiple generic options
• Generally cost-effective

Comparing All PDE5 Inhibitors

Duration of Effect

From shortest to longest:

1. Sildenafil / Vardenafil: ~4-5 hours
2. Avanafil: ~6 hours
3. Tadalafil: up to 36 hours

Onset of Action

From fastest to slowest:

1. Avanafil: 15-30 minutes
2. Vardenafil: 25-60 minutes
3. Sildenafil: 30-60 minutes
4. Tadalafil: 30-60 minutes (max effect ~2 hours)

Food Sensitivity

From most to least affected:

1. Sildenafil: notably affected by fatty meals
2. Vardenafil: moderately affected
3. Avanafil: minimally affected
4. Tadalafil: minimally affected

Dosing Flexibility

Most flexible: Tadalafil (daily and on-demand options)

Standard on-demand only: Sildenafil, vardenafil, avanafil

Factors Influencing Choice

Medical Factors

Doctors consider:

• Other medications the patient takes
• Existing health conditions
• Kidney or liver function
• Cardiovascular health
• Previous medication responses

Lifestyle Factors

Tadalafil advantages:

• Suits unpredictable sexual activity timing
• Allows weekend dosing
• Daily option for frequent activity
• Minimal food considerations

Shorter-acting options advantages:

• Preferred by some for defined treatment window
• Less prolonged medication exposure
• May suit less frequent sexual activity

Individual Response

• Some men respond better to specific PDE5 inhibitors
• Trial may be needed to find optimal medication
• Switching between options is safe under medical supervision

Cost Considerations

With generic versions now available:

• Cost differences have narrowed
• All PDE5 inhibitors have affordable generic options
• Price may still influence choice for some users

Special Populations

Older Men

All PDE5 inhibitors can be used safely in older adults with appropriate medical assessment:

• May start on lower doses
• Tadalafil’s long duration may be advantageous or disadvantageous depending on individual factors
• Cardiovascular assessment particularly important

Men with Diabetes

All PDE5 inhibitors are effective in diabetic men:

• May require higher doses than non-diabetic men
• Response rates slightly lower overall but still good
• Tadalafil and other options all viable

Men with BPH

Tadalafil unique advantage:

• Licensed for treating both ED and BPH
• Daily 5mg can address both conditions
• Other PDE5 inhibitors not licensed for BPH

This makes tadalafil particularly suitable when both conditions are present.

Combining or Switching Medications

Never Combine PDE5 Inhibitors

Taking multiple PDE5 inhibitors together is dangerous:

• Risk of severe hypotension (low blood pressure)
• Increased side effects
• No additional benefit
• Potentially life-threatening

Switching Between Medications

Switching from one PDE5 inhibitor to another:

• Is safe under medical supervision
• Requires waiting 24 hours between different medications
• Should be discussed with your doctor
• May help find optimal treatment

Trial and Error

Finding the best ED medication often involves:

• Trying different options
• Assessing effectiveness and side effects
• Patient preference consideration
• Cost-benefit analysis

Effectiveness Comparison

Clinical Trial Success Rates

All PDE5 inhibitors show similar effectiveness:

• 60-80% of men report improved erections
• Individual response varies more than average differences between medications
• Head-to-head studies show comparable results

Real-World Effectiveness

In clinical practice:

• All four medications work well for most men
• Individual preference and response patterns emerge
• Some men strongly prefer one over others
• “Best” medication varies by individual

Drug Interactions

All PDE5 inhibitors share important interactions:

Absolute Contraindications

Nitrates: Never combine any PDE5 inhibitor with nitrates

• Includes nitroglycerin, isosorbide
• Recreational “poppers” (alkyl nitrites)
• Can cause life-threatening blood pressure drop

Significant Interactions

All PDE5 inhibitors interact with:

• Alpha-blockers (blood pressure/prostate medications)
• Some antibiotics and antifungals
• HIV medications
• Other blood pressure medications

Specific interaction profiles vary slightly between medications. Always inform doctors of all medications when being prescribed any PDE5 inhibitor.

Non-PDE5 Inhibitor Alternatives

Beyond PDE5 inhibitors, other ED treatments exist:

• Alprostadil injections: Direct penile injections
• Vacuum erection devices: Mechanical aids
• Penile implants: Surgical option
• Testosterone replacement: If low testosterone is the cause
• Psychological therapy: For psychological ED

Doctors may suggest these if PDE5 inhibitors prove unsuitable or ineffective.

Frequently Asked Questions

Which PDE5 inhibitor is most effective?

Clinical studies show similar effectiveness across all PDE5 inhibitors, with success rates of 60-80%. Individual response varies more than average differences between medications. The “most effective” medication differs for each person and can only be determined through trial under medical supervision.

Can I switch from tadalafil to vardenafil or vice versa?

Yes, switching between PDE5 inhibitors is safe under medical guidance. Wait at least 24 hours between taking different medications, and discuss the switch with your doctor who can adjust dosing appropriately. Some men find one works better for them than another.

Why might a doctor prescribe vardenafil instead of tadalafil?

Doctors might prefer vardenafil for patients who want a shorter duration of action, respond better to it specifically, had side effects with tadalafil, or prefer a more defined treatment window. Individual patient factors and preferences influence this choice.

Is avanafil available on the NHS?

Avanafil availability on the NHS is limited, as it’s newer and more expensive than well-established alternatives. Many areas restrict NHS prescribing to sildenafil, tadalafil, or vardenafil. Private prescriptions for avanafil are available but typically cost more.

Do all PDE5 inhibitors have the same side effects?

The side effect profiles are similar across all PDE5 inhibitors, with headache, flushing, nasal congestion, and indigestion being most common. Tadalafil more frequently causes back pain and muscle aches, whilst sildenafil more often causes visual disturbances. Individual tolerance varies.

Can I take different PDE5 inhibitors on different occasions?

Yes, you can use different PDE5 inhibitors at different times under medical supervision, but never within 24 hours of each other. Some men keep different medications on hand for different situations, though this should be discussed with a doctor.

Related Information

For more comparisons and context:

• Tadalafil vs Sildenafil - Detailed comparison with Viagra
• What Is Tadalafil? - Overview of tadalafil
• How Does Tadalafil Work? - Mechanism of action
• Tadalafil Dosage and Duration - Dosing information

The Bottom Line

All PDE5 inhibitors are effective ED treatments with similar mechanisms but different characteristics. Tadalafil’s unique advantage is its extended 36-hour duration and availability as a daily low-dose option. Vardenafil and sildenafil offer shorter durations, whilst avanafil provides faster onset. The choice between them depends on individual medical factors, lifestyle preferences, and personal response patterns.