What this match review actually locks
Chest pain that needs a nitrate after any of these tablets is emergency care. Call emergency services. Do not pick a 'softer' PDE5.
Readers keep mixing three brand stories into one question. Cialis as a weekend habit. Viagra as the original blue tablet. Levitra as the fast one. Sephira will not rate those folklore handles. The review locks daily tadalafil at 2.5 mg or 5 mg, sildenafil across 25 mg, 50 mg, and 100 mg, and vardenafil from 2.5 mg through 20 mg.
A 10 mg or 20 mg tadalafil taken before a Saturday still exists on the Cialis label. It is not this match. If that is the script you hold, open the tadalafil panel and the weekend signal. Here the daily bottle is the only tadalafil row.
Scan, tag, board-check, then post. Yuki Tanaka will not stamp a comparison that quietly slides a 20 mg weekend NDC into a daily-cash cell.
Locked ranges on this sheet
Calendar coverage versus a single evening
Tadalafil's mean terminal half-life is 17.5 hours. Daily 2.5 mg or 5 mg builds a low, steady level over about five days. Couples who hate a countdown like that. Men who want a clean Tuesday off the drug often do not.
Sildenafil and its N-desmethyl metabolite clear with a terminal half-life near four hours. Vardenafil and its M1 metabolite sit at about four to five hours. Those two stays are evening tools. They do not keep Friday's tablet alive for Sunday breakfast.
Fasted Tmax is slower on daily tadalafil (near two hours) than on sildenafil (median sixty minutes, range 30-120) or vardenafil (median sixty minutes, range 30-120 after a 20 mg dose). Peak speed is not an erection. Stimulation still has to arrive.
| Lock | Terminal t½ | What the clock buys |
|---|---|---|
| Daily Cialis 2.5-5 | ~17.5 h | Steady cover after ~5 days; 48 h nitrate wait |
| Viagra 25-100 | ~4 h | One evening; plasma ~2 ng/mL at 24 h after 100 mg |
| Levitra 2.5-20 | ~4-5 h | One evening; no daily ED regimen on the label |
Grey-market tablets void the whole review
Unmarked tablets sold as 'Cialis daily' or 'Levitra 20' skip every row at once. Dose, impurity, and undeclared PDE5 are unknown. Toronto public-health notes keep catching that pattern. This sheet rates labeled generics and the old brand names as handles, not courier blister packs.
Suhagra 100 mg is an export sildenafil brand. It is not a fourth lock on this match. Nearest published US cash for a sildenafil 100 mg ten-count is the $201.93 / $10.62 pair already in the table. See the Suhagra panel if that is the blister in hand.
Telehealth that skips the nitrate list, the QT list, and the CYP list is not a faster review. Mail [email protected] about the pages. Do not mail a chart and ask Yuki Tanaka to pick your milligrams.
What does not belong on this match
- Map every blister to INN plus milligrams before you compare cash.
- Adcirca 40 mg and Revatio 20 mg TID are PAH schedules, not ED locks.
- Prior-auth letters can cite these rows. They cannot replace a visit.
What readers actually rate after a month
Headache, flush, dyspepsia, and a stuffy nose are class noise on all three locks. Daily tadalafil adds a recognizable delayed backache: bilateral lumbar or gluteal ache that often starts 12-24 hours after a dose and settles inside forty-eight hours. That pattern showed up in the once-daily Cialis trials and still shows up in mail to [email protected].
Sildenafil at 100 mg is the row most likely to bring a blue or hazy visual note, because PDE6 sits in the retina and high peaks hit it harder. Daily 2.5-5 mg tadalafil rarely earns that complaint. Vardenafil can do visual change; the louder vardenafil-specific tag remains QT, not color.
Priapism past four hours, sudden vision loss, and sudden hearing loss are class emergencies. Switching from Viagra 50 mg to Levitra 10 mg does not change those clocks. Partners need the four-hour rule on whichever blister is in the house.
| What gets rated | Daily Cialis 2.5-5 | Viagra 25-100 | Levitra 2.5-20 |
|---|---|---|---|
| Headache / flush | Common | Common | Common |
| Back / muscle ache | Often the tell | Less often the lead | Less often the lead |
| Visual hue | Uncommon on daily | More talk at 100 mg | Possible |
| QT language | Class vasodilator | Class vasodilator | Dedicated study pair |
| Meal fights | Low | High | Moderate to high |
Published GoodRx cash on the locked counts
Sephira does not invent a dollar. The pairs below are the published GoodRx boards already sitting in the lock file for these three panels. Retail is the average list. Coupon is the printed discount. Your window will quote something else.
Daily tadalafil is priced as a thirty-count. That is a month of 2.5 mg or 5 mg if one tablet is taken each day. Sildenafil is priced as a ten-count across 25, 50, and 100 mg. Vardenafil shows a thirty-count at 2.5 mg and a ten-count at 20 mg, dated 06 July 2026 on that board.
The 50 mg sildenafil ten-count retail print ($646.10) sitting next to a $11.35 coupon is a published pair, not a typo we 'fixed'. Do not average those two numbers into a fake mid-price. Ask the window to price the strength on the script.
| Lock + count | Retail | Coupon | Board note |
|---|---|---|---|
| Tadalafil 2.5 mg x 30 | $313.08 | $16.93 | Daily lock |
| Tadalafil 5 mg x 30 | $365.04 | $13.70 | Daily lock; also BPH 5 mg |
| Sildenafil 25 mg x 10 | $67.14 | $13.53 | Low rung of 25-100 |
| Sildenafil 50 mg x 10 | $646.10 | $11.35 | Usual start; published pair |
| Sildenafil 100 mg x 10 | $201.93 | $10.62 | Ceiling of the ladder |
| Vardenafil 2.5 mg x 30 | $1,100.46 | $289.61 | 06 July 2026 |
| Vardenafil 20 mg x 10 | $573.78 | $44.21 | 06 July 2026 |
Dinner still decides the Viagra ladder
A high-fat meal delays sildenafil Tmax by about sixty minutes and cuts Cmax by about 29%. That is why a 100 mg tablet after steak can feel like a weak 50 mg on an empty stomach. The sildenafil meal tag is the short read when every failure story starts in a restaurant.
Vardenafil food studies cut Cmax by 18% to 50% after a high-fat plate. Timing gets sloppy. Absolute bioavailability is already only about 15%, so a heavy dinner is a poor place to judge the 10 mg or 20 mg rung.
Daily tadalafil may be taken without regard to food. That is the practical reason restaurant weeks lean toward the 2.5-5 mg bottle, not a claim that tadalafil is 'stronger'. If the plate is the problem, fix the plate before you abandon the Viagra ladder.
| Lock | Food note from the labels |
|---|---|
| Daily Cialis 2.5-5 | May be taken without regard to food |
| Viagra 25-100 | High-fat: Tmax +60 min, Cmax -29% |
| Levitra 2.5-20 | High-fat: Cmax down 18-50% |
BPH at 5 mg is not a second PDE5
Five milligrams daily already covers labeled BPH, labeled ED-plus-BPH, and the top of the daily ED lock. Men who feel that 5 mg 'is only for prostate' and then add Viagra 50 mg are stacking. One bottle. One mechanism.
If LUTS stay loud on 5 mg tadalafil, the next talk is urology, not a second oral PDE5. Adding an alpha-blocker on top of daily tadalafil for BPH is the combination the Cialis label tells you not to start.
Finasteride plus daily 5 mg tadalafil has a labeled window of up to twenty-six weeks when both are begun for BPH. That is still one PDE5, at the 5 mg lock, not a license to keep a Viagra bottle 'for weekends'.
The three ranges Sephira will review
Once-daily tadalafil starts at 2.5 mg at about the same clock each day, without tying the swallow to sex. The Cialis label lets the prescriber move to 5 mg if 2.5 mg is weak and the man tolerates the flush. Five milligrams is also the labeled daily dose when BPH sits on the same chart.
Sildenafil still opens at 50 mg for most men, about an hour before activity, with room down to 25 mg or up to 100 mg. One tablet in twenty-four hours. Age over 65, cirrhosis, creatinine clearance under 30 mL/min, or a strong CYP3A4 inhibitor usually starts the ladder at 25 mg.
Vardenafil's usual start is 10 mg about sixty minutes ahead. The labeled span runs 2.5, 5, 10, and 20 mg. The 2.5 mg tablet is not a vanity starter. It is the ceiling with ritonavir (one 2.5 mg dose in seventy-two hours) and with several other strong CYP3A4 inhibitors (one 2.5 mg dose in twenty-four hours). Moderate hepatic impairment starts at 5 mg and stops at 10 mg.
| Lock | How it is taken | Usual start | Labeled rungs |
|---|---|---|---|
| Daily Cialis | Once daily, any time of day | 2.5 mg | 2.5 or 5 mg |
| Viagra ladder | As needed, once / 24 h | 50 mg (25 mg if tagged) | 25 / 50 / 100 mg |
| Levitra range | As needed, once / 24 h | 10 mg (2.5-5 if tagged) | 2.5 / 5 / 10 / 20 mg |
Kidney and liver cuts on the locked rungs
Daily tadalafil is the pickiest renal row on this sheet. Under 30 mL/min, it is not recommended. At 30-50 mL/min, start 2.5 mg. Sildenafil simplifies to a 25 mg start when clearance is under 30 mL/min or the liver is cirrhotic. Vardenafil's sharper cut is hepatic: Child-Pugh B starts at 5 mg and stops at 10 mg; Child-Pugh C was never studied.
Age over 65 slows all three. That is why 25 mg sildenafil and 5 mg vardenafil are common first rungs in a geriatric list, and why daily tadalafil often stays at 2.5 mg until the first month is scored.
Diabetes enrolled in all three registration programs with slightly harder response numbers than healthier ED cohorts. The match still follows meals and QT, not a special 'diabetes brand'. Nephropathy that drops clearance under 30 mL/min knocks daily tadalafil out first.
| Cut | Daily Cialis 2.5-5 | Viagra 25-100 | Levitra 2.5-20 |
|---|---|---|---|
| CrCl <30 or dialysis | Daily not recommended | 25 mg start | Use labeled caution |
| CrCl 30-50 | Start 2.5 mg | Usual or 25 mg if frail | Usual start unless other tags |
| Child-Pugh B | Caution; little daily data | 25 mg start if cirrhotic | 5 mg start, 10 mg max |
| Child-Pugh C | Avoid / specialist | Specialist | Do not use |
| Age >65 | Often stay at 2.5 first | Often 25 mg first | Often 5 mg first |
When daily Cialis is the wrong match row
Creatinine clearance under 30 mL/min, or dialysis, takes daily tadalafil off the table. The Cialis label says once-daily use is not recommended there. As-needed tadalafil has its own 5 mg-every-72-hours ceiling, and that is still not this match.
Clearance 30-50 mL/min starts daily tadalafil at 2.5 mg; 5 mg is a later step if the man responds. Mild or moderate hepatic impairment has little daily-use data, so caution is the labeled word. Strong CYP3A4 inhibitors cap once-daily tadalafil at 2.5 mg.
Men who have sex twice a month and want a cheap ten-count often waste a thirty-count daily bottle. The GoodRx 2.5 mg x 30 coupon print ($16.93) can still beat a habit of 100 mg tablets if intimacy is frequent. Rare use leans toward the Viagra ladder if the stomach can be empty.
| Pattern | Often the better lock |
|---|---|
| Sex most weeks; hates a countdown | Daily Cialis 2.5, then 5 if needed |
| ED plus BPH on one chart | Daily Cialis 5 mg (not plus an alpha-blocker) |
| Rare evenings; can skip dinner fat | Viagra 25-100 |
| Wants a short peak; QT list is clean | Levitra 10 mg, then 5 or 20 |
| CrCl <30 mL/min | Not daily tadalafil; prescriber picks another row |
| Amiodarone or long QT | Not the Levitra range until cardiology reads |
How a switch between these three should look
AUA sequencing still treats oral PDE5 drugs as first-line and allows a second member after a fair trial. A fair trial is several attempts at a labeled dose with meals tagged. Two steak-night 50 mg tablets are not a sildenafil failure.
Leaving daily tadalafil for a Viagra evening needs the long tail in mind. Five half-lives after the last 5 mg is a rough fade, not a home recipe. Residual tadalafil plus a new 100 mg sildenafil is a stack by another name. The prescriber sets the overlap, not a forum thread.
Brand Levitra left many US shelves. Generic vardenafil 2.5-20 mg is the same lock. Mapping a travel 'Levitra' blister to a Canadian or US generic does not open a new PK line. PAH products (Adcirca 40 mg daily, Revatio 20 mg three times daily) stay off these ED rows.
| Move | Board habit |
|---|---|
| Viagra 50 after dinner, weak | Repeat fasted, or step to 100, before a switch |
| Viagra 100 fasted, two clean misses | Daily Cialis 2.5-5 or Levitra if QT is clear |
| Daily 2.5, weak at five days | 5 mg if kidneys and CYP list allow |
| Daily 5 to a PRN sibling | Prescriber-planned fade; no same-day add-on |
| Levitra 10, QT drug appears | Stop the range; do not hide at 2.5 mg |
Why Levitra 2.5-20 starts with a QT look
Vardenafil's label is the only one of these three that spends real ink on QT. A study in fifty-nine healthy men compared 10 mg and 80 mg vardenafil with moxifloxacin 400 mg. Therapeutic and supratherapeutic doses produced similar QTc rises. A later add-on study with gatifloxacin 400 mg showed an additive QTcF change of 9 msec from baseline (90% CI 6-11).
Congenital long QT and class IA or class III antiarrhythmics (quinidine, procainamide, amiodarone, sotalol) are the usual stop signs. The 2.5 mg tablet does not wash those tags away. Lower milligrams still need the same screen; they exist because CYP3A4 blockade, not because QT vanished.
Sildenafil and daily tadalafil carry class vasodilator language. They do not carry that vardenafil-specific QT study pair. If the med list already has amiodarone, cardiology reads first. Do not 'try Levitra at 2.5' as a workaround.
Why 2.5 mg sits on the Levitra lock
- Ritonavir: one 2.5 mg vardenafil dose in 72 hours.
- Indinavir, saquinavir, atazanavir, ketoconazole 400 mg, itraconazole 400 mg, clarithromycin: one 2.5 mg dose in 24 hours.
- Ketoconazole 200 mg or erythromycin: 5 mg max in 24 hours.
- Child-Pugh B: start 5 mg, ceiling 10 mg. Child-Pugh C: do not use.
What Yuki stamps before this sheet posts
The posted review still has to match the three locks: daily tadalafil 2.5-5, sildenafil 25-100, vardenafil 2.5-20. If a sentence praises weekend Cialis 20 mg as if it were this sheet, the sentence is wrong.
Bring a meal log and a full med list, including poppers and QT drugs, to the clinician who can actually write a script. Dr. Yuki Tanaka last reviewed this match on 21 August 2026 against the Cialis, Viagra, and vardenafil labels plus the GoodRx boards in the lock file. Corrections: [email protected].