Sildenafil vs. Vardenafil

See how Sildenafil and Vardenafil compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Sildenafil and vardenafil are both oral PDE5 inhibitors taken as needed before sex, with similar rates of headache and flushing.

  • Sildenafil is also FDA-approved for pulmonary arterial hypertension, while vardenafil is approved only for erectile dysfunction.

  • Vardenafil is available as an orally disintegrating tablet and carries extra warnings for dialysis, severe liver impairment, and QT prolongation that sildenafil's label does not include.

Sildenafil vs. Vardenafil Drug Summary

Sildenafil

Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor used to treat erectile dysfunction by increasing blood flow to the penis during sexual stimulation. It is an oral tablet taken as needed, about 30 minutes to an hour before sexual activity, in doses of 25 mg, 50 mg, or 100 mg. It is also FDA-approved under the brand name Revatio to treat pulmonary arterial hypertension.

Vardenafil

Vardenafil is also a PDE5 inhibitor and works the same way as sildenafil, relaxing blood vessels to help achieve an erection. It is taken as needed before sexual activity in doses of 5 mg, 10 mg, or 20 mg, and comes as a standard tablet or an orally disintegrating tablet. Vardenafil is FDA-approved only for erectile dysfunction.

Sildenafil vs. Vardenafil Side Effects

Sildenafil

Most common
headache (up to 16%)
flushing (up to 10%)
dyspepsia (up to 7%)
nasal congestion (up to 4%)

Vardenafil

Most common
headache (up to 16%)
flushing (up to 11%)
dyspepsia (up to 4%)
nasal congestion (up to 9%)

Sildenafil vs. Vardenafil Dosage

Sildenafil

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25 mg as needed At the start
Maximum dose 100 mg as needed If needed
Dose changes 2 increases As tolerated

Vardenafil

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg as needed At the start
Maximum dose 20 mg as needed If needed
Dose changes 2 increases As tolerated

Sildenafil vs. Vardenafil Indications

Sildenafil

Sildenafil's main FDA-approved use is erectile dysfunction, and it is also approved as Revatio for pulmonary arterial hypertension. Some clinicians prescribe it off-label for other blood-flow related conditions.

  • Erectile dysfunction

  • Pulmonary arterial hypertension (as Revatio)

  • Off-label: Raynaud's phenomenon

  • Off-label: female sexual arousal disorder

Vardenafil

Vardenafil is FDA-approved only to treat erectile dysfunction in adult men. It has not been studied or approved for pulmonary conditions or the other off-label uses sometimes tried with sildenafil.

  • Erectile dysfunction

  • Available as standard tablet or orally disintegrating tablet

  • Taken as needed before sexual activity

  • No established off-label uses

Sildenafil vs. Vardenafil Pros and Cons

Sildenafil

Sildenafil has the longest track record of any PDE5 inhibitor and the broadest FDA approval, covering both erectile dysfunction and pulmonary arterial hypertension. Generic versions are widely available, though how and when it's taken with food can affect how well it works.

Pros

  • Also FDA-approved for pulmonary arterial hypertension (marketed as Revatio)

  • Longest real-world track record among PDE5 inhibitors, approved in 1998

  • Used off-label for conditions like Raynaud's phenomenon and female sexual arousal disorder

Cons

  • High-fat meals can significantly delay how fast it starts working

  • Vision changes such as blurred or blue-tinted vision occur in up to 3% of users

  • Not available as an orally disintegrating tablet like vardenafil

  • Urinary tract infection reported in up to 3% of users in trials

Vardenafil

Vardenafil works similarly to sildenafil but comes with an orally disintegrating tablet option and a narrower FDA approval limited to erectile dysfunction. Its label includes additional cautions for men with certain heart, liver, or kidney conditions.

Pros

  • Available as an orally disintegrating tablet, letting some men take it without water

  • Approved in 2003, giving it a well-established track record as an alternative if sildenafil doesn't work well

  • Only generic versions are sold in the US now, since brand-name Levitra and Staxyn were discontinued

Cons

  • Not FDA-approved for pulmonary arterial hypertension, unlike sildenafil (Revatio)

  • Not recommended for men on renal dialysis

  • Contraindicated in severe liver impairment (Child-Pugh C)

  • Contains phenylalanine and carries extra warnings for men with QT prolongation risk

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