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Many people diagnosed with impotence and different erectile problems will benefit from Sildenafil citrate, which is trademark name for Viagra. However, there are some downsides, too, so, what is the best alternative to Viagra?
Let's start with this question. How do Viagra and other generic drugs that treat erectile dysfunction maintain an erection? They do this by blocking an enzyme, phosphodiesterase type 5, found in penile tissues. What happens then? Well, once blocked, a chemical called cGMP, which causes the smooth muscles of the penis to relax, does not break down from PDE 5. Men, therefore, can achieve and maintain more rigid and longer lasting erections. [1]
 
It is very important to know that these drugs do not act as aphrodisiacs — they only supply the erection. Now, there are several other medications which are made to treat erectile dysfunction as well as some natural alternatives. Several drug companies are hard at work on new approaches to treatment. Besides the fact that the Viagra really works, a big problem with a short-term solution such as Viagra is that it encourages people to forget about seeking treatment. That’s why, instead of visiting a doctor to correct the penile dysfunction, most men just pop up a pill and achieve an instant result. In cases when men have problems with hypertension or diabetes, to name a few,  what is the best alternative to Viagra?
 

Viagra’s Big Boom!

The popularity of Viagra has increased dramatically over the past decades. This amazing little blue pill has brought passion and excitement back into people's sex lives and there is a reason — it works for many people. Despite side effects such as headaches and several reports of possible links to heart attacks, it has helped millions.
 
A few more drugs have developed since Sildenafil became available, including vardenafil (Levitra) and Tadalafil (Cialis). [2
 
It is proven that Viagra can work in as little as 14-30 minutes, and Levitra should be taken approximately 60 minutes prior to sexual activity. Cialis can work in as little as 30 minutes and work up to 36 hours.  Although these drugs work for most men, it is important to know that they may not be suitable for men who have coronary artery disease or are taking medicines containing nitrates such as nitroglycerine or isosorbides. Possible side effects are [3]:
  • Headaches
  • Flushing
  • Indigestion
  • Runny nose
  • Diarrhea
  • Dizziness
  • Temporary vision loss
  • Hearing loss 

The Anatomy and Physiology of an Erection 

An erection is the result of a complicated series of mechanisms involving blood flow. Blood is released into the penis and then trapped there. What is the exact mechanism of developing an erection? Well, it is proven that physical or psychological stimulation triggers impulses from the brain, causing the muscles of the penis to relax. After this has happened, blood can enter two cylinders on either side of the penis called corpora cavernosa. A membrane called the tunica albuginea surrounds the cylinders, trapping the blood to sustain the erection through orgasm. So, it is important to remember that when that flow is prevented or interrupted, erectile dysfunction occurs. [4]

Possible Causes of Erectile Dysfunction

Several types of research done in the past have shown that certain illnesses, stress, medications, and drugs contribute to erectile dysfunction, as do poor lifestyle choices, such as smoking, excessive alcohol consumption, and inadequate physical activity.
Risk factors include [5]:
  • Certain diseases and conditions interfering with blood flow
  • Drugs and medications, including illegal ones like cocaine
  • Damage to nerves from stroke, spinal cord injury, or prostate and other types of surgery
  • Stress, anxiety, guilt, depression, low self-esteem, and fear of performance failure
  • Smoking, because it accelerates atherosclerosis
  • Aging — starting at midlife, the vessels of the penis begin to stiffen and become less pliable, making it difficult for the blood to easily flow through them

Medications That Could Be an Alternative to Viagra

Cialis – The “weekend pill”

Most people already know that Cialis or Adcirca (Tadalafil) is a drug used to treat male erectile dysfunction. This pill is famous due to its 36-hour effect. That’s why it is also known as the "Weekend Pill". Chemically it is almost identical to Levitra because it also belongs to the group of medications called selective inhibitors of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5).

Possible side effects of Cialis

Several types of research done in the past have shown that several side effects can occur from using Cialis. Some of the most common are [6]:
  • An allergic reaction: chest pain or irregular heartbeats     
  • Dizziness, nausea, or angina (pain, tightness, discomfort, numbness, or tingling in the chest, arms, neck, or jaw)      
  • Swelling of the ankles or legs   
  • Shortness of breath       
  • Prolonged or severe dizziness     
  • A prolonged (lasting longer than 4 hours) or painful erection

Levitra

Almost everyone has heard about Levitra or Staxyn — an FDA-approved oral prescription medication for the treatment of erectile dysfunction in men. It is available in 2.5-mg, 5-mg, 10-mg, and 20-mg tablets and is taken only when needed. An important thing to know is that main regulators of tissue concentration of cGMP are phosphodiesterases! The main ingredient of Levitra is the cGMP-specific phosphodiesterase type 5. This substance triggers smooth muscle relaxation, allowing increased blood flow into the penis, resulting in an erection. Levitra or Staxyn is available in tablet and disintegrating tablet form. To be effective, it should be taken an hour before sex. It can be effective for up to 7 hours.

Levitra side effects

Several studies have been conducted on the Levitra effects and side effects and most of the studies have shown that [7]:
  • It helps increase blood flow to the penis, so it may help men with erectile dysfunction  
  • It provides first-time success and reliable improvement of erection quality
  • It can help almost all men, including those with high cholesterol, high blood pressure, or diabetes
  • It enables harder erections and greater success at maintaining their erections long enough to finish having sex

Levitra contraindications

  • Nitrates
Several types of research done in the past have come to the conclusion that administration of Levitra with nitrates and nitric oxide donors is contraindicated. A suitable time interval following Levitra usage for the safe administration of nitrates or nitric oxide donors has not been determined.
  • Hypersensitivity
Reasonably, this medication is contraindicated in patients with a known hypersensitivity to any component of the tablet.

Avanafil

Avanafil is another oral drug for erectile dysfunction, marketed in the U.S. as Stendra. Avanafil pill can be taken 15 to 30 minutes before sex and can last up to 6 hours. [8]

Natural Alternatives to Viagra

Several types of research done in the past have shown that every man can do a lot about increasing his own libido and erectile properties. 

The natural approach consists of:
  1. A positive focus on emotional and spiritual life, which is the most important consideration in any illness.
  2. Diet and lifestyle choices.
  3. Exercise.

Natural Remedies as Viagra Alternatives

Although most people don’t know anything about this, for centuries, certain herbal products have been known to increase sex drive and one's ability to sexually perform better.  
  • Ginkgo Biloba
Everyone has heard about Ginkgo Biloba — an herb that is commonly taken as a memory booster. It is proven it may also provide some sexual benefits. It supposedly acts by enhancing blood flow and seems relatively free of side effects. How to know how much is enough? Well, the suggested dose is 80 mg three times a day, standardized to contain 24% flavone glycosides and 6% terpene lactones. Read more about ginkgo biloba and erectile dysfunction here. 
  • Arginine
Most people don’t know that Arginine is an amino acid that also enhances blood flow. It is important to remember that only the ones who might benefit from it are men who have circulatory disorders that may be contributing to sexual problems. Dozing is simple-suggested dose is 1 gram three times a day; sold as L-Arginine. Read more about arginine and erectile dysfunction here.
 
Remember: As with Viagra, you should avoid Arginine if you are taking the heart medication nitroglycerin because the combination may cause a dangerous drop in blood pressure. 
  • DHEA
Probably everyone has heard about supplement called DHEA! This supplement may also provide benefits for men who have low levels of this hormone. What is important about this DHEA? It is proven that it helps bodies make estrogen and testosterone. High concentrations of DHEA are naturally present in young men, whereas a progressive decline in DHEA levels in the blood occurs with age. The suggested dose is 5 mg each morning for men. Read more about DHEA supplements and erectile dysfunction here. 
  • Yohimbe
Several studies have shown that this herb may correct impotence, but it is important to remember that this herb can cause a dangerous rise in blood pressure, as well as anxiety and other side effects. Read more about Yohimbe and erectile dysfunction here. 
  • Damiana
Damiana is a very interesting herb from Mexico. It’s interesting to note that its genus and species Latin name is turnera aphrodisiaca, which tells us that it has been known for at least hundreds of years as an aphrodisiac.  
  • Muira puama
This is another herb that may be very helpful in this area. This is an herb from Brazil and the Amazon; it has been used there as an aphrodisiac for thousands of years. In the few tests that have been done in a clinical setting, Muira puama had very, very good results.  
  • Kava Kava
Kava kava (Piper methysticum) is well known in the US. It is an herb most often used as an anti-anxiety treatment. It possesses the added benefit of producing a very low level of side effects. It simply puts people in a good, relaxed mood.