Is Levitra better than sildenafil? This is a common question for men considering treatment for erectile dysfunction (ED). Both Levitra (vardenafil) and sildenafil (Viagra) are phosphodiesterase type 5 (PDE5) inhibitors that work by enhancing blood flow to the penis during sexual stimulation. Clinical evidence shows similar overall effectiveness for both medications, with success rates typically between 60% and 80%. The choice between them often depends on individual factors such as cost, food interactions, onset of action, and personal tolerability rather than one being definitively superior. In UK practice, generic sildenafil is usually recommended as first-line treatment on cost grounds, as advised by NICE and the BNF.
Summary: Neither Levitra nor sildenafil is definitively better—both PDE5 inhibitors show similar effectiveness (60–80% success rates) for erectile dysfunction, with the optimal choice depending on individual factors such as cost, food interactions, and tolerability.
- Both medications are PDE5 inhibitors that enhance blood flow to the penis during sexual stimulation and require a prescription in the UK.
- Vardenafil (Levitra) may have slightly faster onset (15–30 minutes) and is less affected by food, whilst sildenafil is typically more cost-effective as a generic.
- Common side effects include headache, facial flushing, nasal congestion, and dyspepsia; both drugs share a similar safety profile.
- Both medications are contraindicated with nitrates, nicorandil, or riociguat due to severe hypotension risk, and should not be taken more than once daily.
- Generic sildenafil is recommended as first-line treatment in the UK on cost grounds, with other PDE5 inhibitors considered if response is inadequate.
- Erectile dysfunction can indicate underlying cardiovascular disease or diabetes, so comprehensive GP assessment is important before starting treatment.
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What Are Levitra and Sildenafil?
Levitra (vardenafil) and sildenafil (commonly known by the brand name Viagra) are both prescription medications used to treat erectile dysfunction (ED) in men. They belong to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which work by enhancing blood flow to the penis during sexual stimulation, thereby facilitating the achievement and maintenance of an erection.
Sildenafil was the first PDE5 inhibitor to receive regulatory approval, launched in 1998, and has since become one of the most widely prescribed treatments for ED worldwide. It is available both as a branded product and in generic formulations. In the UK, sildenafil 50 mg is also available as a Pharmacy medicine (Viagra Connect) following assessment by a pharmacist, whilst higher doses remain prescription-only. Vardenafil (Levitra) was introduced several years later and was developed to offer similar therapeutic benefits with potentially different pharmacokinetic properties.
Mechanism of action: Both medications inhibit the PDE5 enzyme, which normally breaks down cyclic guanosine monophosphate (cGMP) in the smooth muscle cells lining blood vessels in the penis. By blocking PDE5, these drugs allow cGMP levels to remain elevated, promoting smooth muscle relaxation and increased blood flow. It is important to note that sexual stimulation is required for these medications to be effective—they do not cause spontaneous erections.
Both sildenafil and vardenafil are licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK. On the NHS, generic sildenafil is typically the preferred first-line treatment on cost grounds, as recommended by NICE and the BNF, whilst other PDE5 inhibitors may be subject to prescribing restrictions or require specialist advice. They are taken orally, typically 30–60 minutes before anticipated sexual activity. Sildenafil is usually prescribed at doses of 25–100 mg (starting at 50 mg), whilst vardenafil is typically prescribed at 5–20 mg (starting at 10 mg). Neither medication should be taken more than once in a 24-hour period.
Comparing Effectiveness: Levitra vs Sildenafil
When comparing the effectiveness of Levitra and sildenafil, clinical evidence suggests that both medications demonstrate similar overall efficacy in treating erectile dysfunction, with success rates typically ranging from 60% to 80% across various patient populations. Head-to-head trials and systematic reviews have not consistently shown one drug to be definitively superior to the other in terms of achieving erections sufficient for sexual intercourse.
However, there are some pharmacokinetic differences that may influence individual patient response:
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Onset of action: Vardenafil may have a slightly faster onset, with some patients reporting effects within 15–30 minutes, compared to sildenafil's typical 30–60 minute window. This difference is modest and may not be clinically significant for all users.
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Duration of effect: Sildenafil's effects generally last 4–6 hours, whilst vardenafil has a similar duration of action.
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Food interactions: High-fat meals can significantly delay and reduce the absorption of sildenafil, potentially diminishing its effectiveness. For optimal results, sildenafil should ideally be taken on an empty stomach or after a light meal. Vardenafil appears to be less affected by food intake, though a heavy meal may still slow absorption to some degree.
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Selectivity: Vardenafil is reported to have greater selectivity for the PDE5 enzyme compared to other PDE isoforms, which theoretically could translate to fewer side effects, though clinical significance remains debatable.
Patient response to PDE5 inhibitors can be highly individual. It is important to allow several attempts (typically at least 4–8 doses) and to optimise the dose before concluding that a medication is ineffective. Some men may find one medication more effective or better tolerated than another, and it is not uncommon for clinicians to trial different options to optimise treatment outcomes. In UK practice, generic sildenafil is usually recommended as the first-line treatment primarily on cost grounds, rather than superior efficacy.
Side Effects and Safety Considerations
Both Levitra and sildenafil share a similar side effect profile, as would be expected given their common mechanism of action. The most frequently reported adverse effects include:
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Headache (affecting 10–15% of users)
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Facial flushing
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Nasal congestion
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Dyspepsia (indigestion)
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Dizziness
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Visual disturbances (such as altered colour perception or increased sensitivity to light)
These side effects are generally mild to moderate in severity and tend to resolve spontaneously. Visual disturbances occur because PDE5 inhibitors can also affect PDE6, an enzyme present in the retina, though this is typically transient and reversible.
Serious adverse effects are rare but require immediate medical attention:
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Priapism: A prolonged erection lasting more than 4 hours constitutes a medical emergency and requires urgent treatment to prevent permanent damage to penile tissue. Conditions that predispose to priapism (such as sickle cell disease, multiple myeloma, leukaemia, or anatomical deformation of the penis) require particular caution.
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Sudden vision loss: Non-arteritic anterior ischaemic optic neuropathy (NAION) has been reported rarely with PDE5 inhibitors. Patients experiencing sudden vision loss should discontinue the medication immediately and seek urgent medical advice.
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Sudden hearing loss or decrease in hearing: This has been reported rarely with PDE5 inhibitors. Patients should stop the medication and seek medical advice promptly if this occurs.
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Serious allergic reactions: Though rare, severe hypersensitivity reactions can occur. Seek immediate medical help if you experience symptoms such as difficulty breathing, swelling of the face or throat, or severe skin reactions.
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Cardiovascular events: Both medications can cause a modest reduction in blood pressure. Patients with pre-existing cardiovascular disease should be carefully assessed before treatment initiation.
Contraindications (when these medications must not be used):
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Concurrent use of nitrate medications (e.g., glyceryl trinitrate, isosorbide mononitrate) or nicorandil, as the combination can cause severe, potentially life-threatening hypotension. This includes recreational nitrates ("poppers" such as amyl nitrite).
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Concurrent use of riociguat (a guanylate cyclase stimulator used for pulmonary hypertension)
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Potent CYP3A4 inhibitors (such as ketoconazole, itraconazole, ritonavir) are contraindicated specifically with vardenafil
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Severe hepatic impairment (contraindicated for vardenafil; sildenafil requires dose adjustment and caution)
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Known hypersensitivity to the active substance or any excipients
Important warnings and precautions:
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Recent stroke or myocardial infarction (typically within 6 months) requires careful cardiovascular risk assessment before use
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Hypotension or uncontrolled hypertension
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Hereditary degenerative retinal disorders
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Anatomical deformation of the penis or conditions predisposing to priapism
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Bleeding disorders or active peptic ulceration
Drug interactions:
Patients should inform their GP or prescriber of all medications they are taking, including over-the-counter products and recreational substances. Important interactions include:
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Alpha-blockers (used for prostate enlargement or hypertension) require careful dose titration and timing to minimise hypotensive effects. A time interval between doses may be advised.
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Other antihypertensive medications may have additive blood pressure-lowering effects
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CYP3A4 inhibitors (including grapefruit juice) can increase blood levels of both drugs, particularly vardenafil, and may require dose adjustment
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Recreational nitrates ("poppers") are absolutely contraindicated due to severe hypotension risk
If you experience any side effects, including those not listed here, you should report them via the MHRA Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for "Yellow Card" in the Google Play or Apple App Store.
Which Treatment Is Right for You?
Determining whether Levitra or sildenafil is more appropriate depends on individual patient factors rather than inherent superiority of one medication over the other. Both are effective, evidence-based treatments for erectile dysfunction, and the choice often comes down to practical considerations, tolerability, and personal preference.
Factors to consider when choosing between treatments:
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Cost and availability: Generic sildenafil is widely available and typically less expensive than branded Levitra, making it a cost-effective first-line option for many patients. On the NHS, generic sildenafil is usually the preferred first-line treatment on cost grounds. Other PDE5 inhibitors may be subject to prescribing restrictions or require specialist advice. This may also be relevant for those paying privately. Sildenafil 50 mg is available as a Pharmacy medicine (Viagra Connect) following pharmacist assessment, offering over-the-counter access for suitable patients.
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Lifestyle and timing: If spontaneity is important and meals cannot be timed around medication, vardenafil's reduced food interaction may offer an advantage. Conversely, if cost is a primary concern, sildenafil taken on an empty stomach or after a light meal may be preferable.
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Previous treatment response: If you have tried one PDE5 inhibitor without adequate response after several attempts at the optimal dose, or experienced intolerable side effects, switching to an alternative agent is reasonable and may yield better results.
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Underlying health conditions: Patients with diabetes, cardiovascular disease, or neurological conditions may respond differently to various PDE5 inhibitors. Your GP or specialist can provide tailored advice based on your medical history.
When to seek medical advice:
Erectile dysfunction can be an early indicator of cardiovascular disease, diabetes, or other underlying health conditions. If you are experiencing ED, it is important to consult your GP for a comprehensive assessment, including:
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Cardiovascular risk evaluation (blood pressure, cardiovascular risk tools)
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Blood tests as indicated: fasting glucose or HbA1c, lipid profile, and renal and liver function tests. Testosterone should be checked only if there are clinical features of hypogonadism (such as reduced libido, fatigue, loss of morning erections, or reduced muscle mass).
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Review of current medications that may contribute to ED
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Discussion of psychological factors and relationship issues
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Lifestyle modification advice: smoking cessation, weight management, reducing alcohol intake, and increasing physical activity are important interventions that can improve erectile function
Referral to specialist services may be warranted if:
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ED does not respond to optimal doses of PDE5 inhibitors after adequate trials
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There are features of Peyronie's disease (penile curvature or plaques)
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High cardiovascular risk requires cardiology review before resuming sexual activity
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Symptoms suggest hypogonadism or other endocrine causes
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Neurological signs are present
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Psychosexual therapy is needed
Your GP can determine whether PDE5 inhibitors are safe and appropriate for you, and which specific medication might be most suitable. Never purchase ED medications from unregulated online sources, as these may contain incorrect doses, contaminants, or entirely different substances, posing serious health risks.
Ultimately, there is no definitive answer as to whether Levitra is better than sildenafil—both are effective, well-tolerated treatments. The optimal choice is the one that works best for you in terms of efficacy, tolerability, convenience, and cost, determined through discussion with your healthcare provider. In most cases, generic sildenafil is recommended as the first-line option in the UK, with other PDE5 inhibitors considered if there is inadequate response or intolerance.
Frequently Asked Questions
Can I take Levitra or sildenafil with food?
Sildenafil is significantly affected by high-fat meals, which can delay and reduce its absorption, so it should ideally be taken on an empty stomach or after a light meal for optimal effectiveness. Vardenafil (Levitra) is less affected by food intake, though a very heavy meal may still slow its absorption somewhat.
Which works faster, sildenafil or Levitra?
Vardenafil (Levitra) may have a slightly faster onset of action, with some patients reporting effects within 15–30 minutes, compared to sildenafil's typical 30–60 minute window. However, this difference is modest and may not be clinically significant for all users, and both medications require sexual stimulation to work.
Is sildenafil cheaper than Levitra in the UK?
Yes, generic sildenafil is typically much less expensive than branded Levitra and is the preferred first-line treatment on the NHS on cost grounds. Sildenafil 50 mg is also available as a Pharmacy medicine (Viagra Connect) for purchase following pharmacist assessment, whilst higher doses remain prescription-only.
What should I do if sildenafil doesn't work for me?
You should allow at least 4–8 attempts at the optimal dose before concluding that sildenafil is ineffective, ensuring you take it correctly (on an empty stomach, with sexual stimulation). If it remains ineffective or causes intolerable side effects, your GP can consider switching to an alternative PDE5 inhibitor such as vardenafil, adjusting the dose, or referring you for specialist assessment.
Can I drink alcohol when taking Levitra or sildenafil?
Moderate alcohol consumption is generally acceptable, but excessive drinking can impair erectile function and increase the risk of side effects such as dizziness and low blood pressure when combined with PDE5 inhibitors. Limiting alcohol intake is advisable both for medication effectiveness and overall sexual health.
How do I get a prescription for sildenafil or Levitra?
You need to consult your GP for a comprehensive assessment, including cardiovascular risk evaluation, blood tests if indicated, and review of medications and lifestyle factors. Your GP will determine whether PDE5 inhibitors are safe and appropriate for you and can prescribe the most suitable option, typically starting with generic sildenafil in the UK.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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