Levitra vs. Cialis: Differences, similarities, and which is better for you

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

Erectile dysfunction (ED) can be a temporary or long-term problem for many men. Around 24% of men in the United States have ED, with the prevalence increasing for older men. Due to the stigma surrounding this common sexual disorder, the percentage of men with ED may be underreported. However, in today’s world, ED treatment is more accessible, with several options available. 

The most commonly prescribed ED medications belong to a class of drugs called phosphodiesterase (PDE5) inhibitors. Levitra and Cialis are two PDE5 inhibitors that primarily work by increasing blood flow to get and maintain an erection. While brand-name Levitra was discontinued in 2018, the generic version, vardenafil, remains available.

Although these drugs work in similar ways, they do have some differences to be aware of when choosing the best treatment option. Your healthcare provider may recommend lifestyle changes as well as a medication like vardenafil or Cialis to help improve your sex life. 

Main differences between Levitra and Cialis
	Levitra	Cialis
Drug class	PDE5 inhibitor	PDE5 inhibitor
Brand/generic status	Brand and generic available	Brand and generic available
What is the generic name?	Vardenafil	Tadalafil
What form(s) does the drug come in?	Oral tablet	Oral tablet
What is the standard dosage?	5 to 20 mg as needed before sexual activity	5 to 20 mg as needed before sexual activity or 2.5 to 5 mg once daily
How long is the typical treatment?	This medication is taken as needed. Long-term daily use is not recommended.	This medication is taken as needed. Daily use may be appropriate for some people.
Who typically uses the medication?	Adults 18 years of age and older	Adults 18 years of age and older

What are the main differences between Levitra and Cialis?

Vardenafil and Cialis are two different drugs. Cialis is a brand-name drug containing the active ingredient tadalafil, while vardenafil is a generic drug and the active ingredient in the now-discontinued brand-name drug Levitra. 

Vardenafil can take up to an hour to start working. Once it kicks in, its effects can last 5 to 7 hours, and in some cases, effects can last up to 12 hours. On the other hand, Cialis typically starts working faster, within 20 to 30 minutes, and its effects can last much longer—up to 36 hours.

Vardenafil and Cialis can be taken with or without food, as indicated on their drug labels. However, the absorption of Levitra may be affected by a high-fat meal, while Cialis remains largely unaffected by food intake.

Conditions treated by Levitra and Cialis

Vardenafil and Cialis are both FDA-approved to treat ED. This sexual disorder is diagnosed after a medical evaluation by a healthcare provider. ED can be caused by both psychological problems and physical health issues that cause a persistent inability to get or keep an erection.

While PDE5 inhibitors have been studied to improve benign prostatic hyperplasia (BPH), Cialis is the only one that is FDA-approved to treat it. BPH is a medical condition characterized by an enlarged prostate. It can cause symptoms like an increased need to urinate, difficulty urinating, and an inability to fully empty the bladder.

Off-label uses of Levitra and Cialis include treating Raynaud’s phenomenon and pulmonary arterial hypertension (PAH). Raynaud’s phenomenon is a rare condition in which the fingers or toes can become discolored or numb due to cold temperature changes. PAH is another rare disorder caused by high blood pressure in the lungs and can lead to shortness of breath and chest pain. 

The active ingredients of Levitra and Cialis have also been shown to prevent and improve altitude sickness. These drugs may be useful for climbers who are at risk of experiencing high-altitude pulmonary edema (HAPE), a condition caused by fluid leakage in the lungs. This condition can be fatal if it’s not treated in a timely manner. 

Condition	Levitra	Cialis
Erectile dysfunction	Yes	Yes
Benign prostatic hyperplasia	Off-label	Yes
Raynaud’s phenomenon	Off-label	Off-label
Pulmonary arterial hypertension	Off-label	Off-label
Altitude sickness	Off-label	Off-label

Is Levitra or Cialis more effective?

When taken as prescribed, vardenafil and Cialis can be effective ED treatments. However, Cialis may be preferred for its once-daily dosing option, longer duration of action, and approved use for BPH.

According to a meta-analysis, tadalafil was found to be the most effective agent for ED, followed by vardenafil. This meta-analysis included 118 different trials and compared seven different medications. All PDE5 inhibitors in the studies were found to have similar safety profiles. 

However, one study found that sildenafil, the active ingredient in Viagra, may be the most effective PDE5 inhibitor for ED in the general population. The study noted that while PDE5 inhibitors are generally effective and safe compared to a placebo, more high-quality studies that directly compare these medications are needed.

Levitra or Cialis may be more effective, depending on your preferences and other health conditions. Your healthcare provider can help you decide which ED medication is best for you. 

Coverage and cost comparison of Levitra vs. Cialis

Most Medicare and commercial insurance plans don’t generally cover ED pills like vardenafil and Cialis. Therefore, you may have to pay out of pocket for these medications. Some health insurance plans may be more likely to cover Cialis if it’s prescribed for BPH. Still, you may want to contact your pharmacist or insurance company directly about insurance coverage for ED drugs.

Vardenafil is a generic medication that may be cheaper than brand-name alternatives. The average retail price may be around $479 for 10 tablets with a strength of 20 mg. Cialis is available as a brand-name and generic drug. For 30 tablets with a strength of 5 mg, the average retail price of generic Cialis is around $448. 

If you’re looking to save on the retail cost of vardenafil or Cialis, you may want to use a SingleCare savings card. You may find that SingleCare helps you save up to 80% on brand-name and generic medications. Another potential alternative is to check out SingleCare’s partnership with Lemonaid Health, where you can get Sildenafil for as little as $2 per pill.

	Levitra	Cialis
Typically covered by insurance?	No	No
Typically covered by Medicare?	No	No
Quantity	10 tablets (20 mg)	30 tablets (5 mg)
Typical Medicare copay	Varies	Varies
SingleCare cost	$36	$11

Common side effects of Levitra vs. Cialis

Vardenafil and Cialis tend to have similar side effects since they’re both in the same drug class. The most frequently reported side effects include headaches, nasal congestion or a stuffy nose, indigestion, and back pain. In addition, both medications may lead to facial flushing, characterized by redness and warmth in the face.

Other common side effects of vardenafil are dizziness, flu symptoms, and inflamed sinuses (sinusitis). Other common side effects of Cialis include muscle pain and pain in the arms or legs. 

Most side effects with these medications are mild and go away on their own. If you experience serious side effects, such as visual changes or sudden hearing loss, seek medical attention immediately. 

	Levitra		Cialis
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Headache	Yes	15%	Yes	11%
Flushing	Yes	11%	Yes	3%
Nasal congestion	Yes	9%	Yes	3%
Indigestion	Yes	4%	Yes	8%
Dizziness	Yes	2%	No	–
Nausea	Yes	2%	Yes	*not reported
Back pain	Yes	2%	Yes	5%
Pain in the arms or legs	No	–	Yes	3%
Sinusitis	Yes	3%	No	–
Flu syndrome	Yes	3%	No	–
Muscle pain	No	–	Yes	4%

This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.

Source: DailyMed (Levitra), DailyMed (Cialis)

Drug interactions of Levitra vs. Cialis

PDE5 inhibitors like vardenafil and Cialis work by relaxing and widening blood vessels. This effect can help with the intended benefits of these medications, but it can also lead to some unwanted side effects.

Combining vardenafil or Cialis with nitrates, alpha-blockers, or other blood pressure medications (antihypertensives) can lead to a dangerous drop in blood pressure, which may be fatal in severe cases. Vardenafil and Cialis should not be used with guanylate cyclase (GC) stimulators like riociguat for this same reason. 

Vardenafil and Cialis are both metabolized or processed in the liver. The doses of these drugs may need to be adjusted when taking other drugs that alter certain liver enzymes, such as the CYP3A4 enzyme. Therefore, caution is recommended when mixing vardenafil or Cialis with certain antibiotics, antifungals, and anticonvulsants (seizure medications), among others. In addition, grapefruit juice may increase the levels of vardenafil and Cialis in the body, which may lead to adverse effects. 

Drug	Drug Class	Levitra	Cialis
Nitrostat (nitroglycerin) Imdur (isosorbide mononitrate) Isordil (isosorbide dinitrate) Nipride (nitroprusside)	Nitrate	Yes	Yes
Minipress (prazosin) Hytrin (terazosin) Cardura (doxazosin)	Alpha-blocker	Yes	Yes
Prinivil (lisinopril) Cozaar (losartan) Norvasc (amlodipine) Calan (verapamil) Coreg (carvedilol)	Antihypertensive	Yes	Yes
Adempas (riociguat) Verquvo (vericiguat)	Guanylate cyclase (GC) stimulator	Yes	Yes
Erythrocin (erythromycin) Biaxin (clarithromycin) Rifadin (rifampin)	Antibiotic	Yes	Yes
Nizoral (ketoconazole) Sporanox (itraconazole)	Antifungal	Yes	Yes
Tegretol (carbamazepine) Dilantin (phenytoin)	Anticonvulsant	Yes	Yes
Norvir (ritonavir) Crixivan (indinavir)	Antiviral	Yes	Yes

This is not a complete list of drug interactions. Please consult your doctor before taking these medications.

Warnings of Levitra and Cialis

Taking a drug like vardenafil or Cialis may increase the risk of heart attack, stroke, or other heart problems in people with heart disease. The use of vardenafil and Cialis should be avoided in people with a history of unstable angina (chest pain), uncontrolled high blood pressure, stroke, heart attack, arrhythmia, and/or severe heart disease.

PDE5 inhibitors can increase the risk of dangerously low blood pressure, particularly when combined with other blood pressure medications. It is important to monitor blood pressure regularly if you are prescribed these drugs.

If you experience priapism, or a painful erection that lasts longer than 4 hours, seek emergency medical attention. Priapism can cause damage to the penile tissue if it’s not treated promptly.

Visual problems, such as sudden vision loss, are rare adverse effects of vardenafil and Cialis. Using these medications can also increase the risk of a sudden decrease or loss of hearing. Seek prompt medical attention if you experience these effects.

Frequently asked questions about Levitra vs. Cialis

Are Levitra and Cialis the same?

Levitra and Cialis belong to the same class of drugs called PDE5 inhibitors, but they are not the same drugs. These drugs contain different active ingredients and can be used in different ways. Cialis is available as a once-daily pill, while Levitra is only taken as needed.

Is Levitra or Cialis better?

Choosing which is better can depend on personal preferences and how often you plan to be intimate. Cialis may work faster and have effects that last longer than vardenafil. In addition, Cialis may be preferred by those who also have BPH or want a once-daily option. It’s best to consult a doctor for medical advice about the best option for you.

Can I use Levitra or Cialis with alcohol?

Taking Levitra or Cialis along with alcohol may increase the chances of side effects. Since alcohol affects blood vessels in a way similar to these medications, you might experience more noticeable symptoms, like flushing and dizziness. While small amounts of alcohol might be okay, drinking too much can make these medications less effective. Talk to a doctor about how much alcohol is safe to drink while using these medicines.

Which erectile dysfunction drug is best?

There is no single ED drug that is considered the best. ED treatment is highly individualized, and thus, the better choice is the one that helps you the most. Price and potential side effects should also be considered when picking an ED drug with your healthcare provider.