All three drugs work by inhibiting the same enzyme. Levitra is a more potent molecule, and it seems to work faster and on a full stomach. (Expect more studies from Pfizer, showing that Viagra works fast and with food, to keep up.) Levitra also clearly works better in hard-to-treat cases, such as men whose impotence is caused by diabetes. Cialis, on the other hand, clearly works for 36 hours or more, making it an ideal choice for men who are very sexually active. Viagra is on the edge in treating female sexual dysfunction, a yet-unapproved but potentially lucrative use. Pfizer is five years ahead of the competition in that area. Viagra patients have been ordering high-dose pills and splitting them, because all doses come at the same cost. Levitra, a small, hard orange pill, is much more difficult to cut, so at least it won't have to deal with sales reduced by pill splitting.

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If you are taking sildenafil to treat erectile dysfunction, follow your doctor's directions and the guidelines below. Take Viagra (sildenafil) as needed before sexual activity. The best time to take sildenafil is about 1 hour before sexual activity, but you can take the medication any time from 4 hours to 30 minutes before sexual activity. Sildenafil usually should not be taken more than once every 24 hours. If you have certain health conditions or are taking certain medications, your doctor may tell you to take sildenafil less often. You can take sildenafil with or without food. However, if you take sildenafil with a high-fat meal, it will take longer for the medication to start to work.

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