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[ 11 ] physicians rated that 72% of patients allocated to the sildenafil?tadalafil sequence and 61% allocated to the tadalafil?sildenafil sequence preferred tadalafil; 76% of partners of patients allocated to the sildenafil?tadalafil sequence and 65% allocated to the tadalafil?sildenafil sequence preferred tadalafil. This study is also unique in showing how 6–8% of patients refused both sildenafil and tadalafil, and wanted to try another medication, and 2%

preferred

[ 7 ] was not influenced by age, country, presence of comorbidities, aetiology and severity of ED, previous treatment with sildenafil, titration of sildenafil dose or treatment sequence.

The same was observed in other sildenafil tablets online studies [ 5, 6, 8 ], in which both the pre?study sildenafil dose [ 5, 6, 8 ] and the duration of ED [ 5 ] did not influence the preference rate.

[ 12 ] also conducted a post hoc analysis of the data in an attempt to identify patient characteristics associated with their preference. The only baseline characteristic that was significantly associated with preference was hyperlipidaemia, which increased the preference for sildenafil from 27% to 49% ( P = 0.01); no explanation for this finding is given by the authors.

One possibility is that patients preferred tadalafil because of its more flexible instructions for use (drug to be taken 0.5–24 h before sexual activity, vs 0.5–4 h before, for sildenafil) and efficacy not influenced by food intake. [ 7 ], who found that significantly more patients preferred the instructions for tadalafil (67% vs 33%, P = 0.04). Thus, the difference in instructions for use contributes to the preference for tadalafil. Another possibility is that tadalafil was preferred because it is better tolerated.

[ 12 ] showed that the perception of side?effect severity was associated with preference ( P = 0.001).

However, the safety profile of the two drugs is comparable according to the Summary of Product Characteristics (Available at: http://www.emea.europa.eu/humandocs/Humans/EPAR/vigra/vigra.htm; http://www.emea.europa.eu/humandocs/Human/EPAR/cialis/cialis.htm). The most common events (?2% of patients) are similar with both drugs: headache (the most frequent, occurring in 10.8% of patients with sildenafil and 14.5% with tadalafil), dyspepsia, flushing and nasal congestion, dyspepsia being more common with tadalafil (12.3% vs 3.0%) and flushing being more common with buy generic viagra online without prescription sildenafil (10.9% vs 4.1%); in addition, sildenafil is associated with visual alterations (3.6%), whereas tadalafil is buy generic viagra online without prescription associated with back pain (6.5% and myalgia (5.7%). A third possibility is that tadalafil was preferred because of its efficacy.

Two patient?preference studies also collected efficacy information via the International Index of Erectile Function (IIEF) questionnaire [ buy generic viagra online without prescription 8, 9 ]. In both studies there was a trend towards greater improvement in IIEF scores with tadalafil; in the study by Tolra et al. [ 9 ] the median IIEF score increased from 17 at baseline to 29 with sildenafil and to 30 with tadalafil ( P = 0.09), and in the

study

[ 8 ] the mean difference was 9.6 with sildenafil and 10.1 with tadalafil ( P = 0.08).

An analysis of the difference in IIEF domain scores showed that the trend in favour of tadalafil was due to significantly greater improvement in orgasmic function (difference, +0.28 95% CI 0.02–0.53, P = 0.03) and sexual desire (+0.19 95% CI 0.02–0.35, P = 0.02). The analysis of the association between the change in IIEF domain scores vs baseline and patient preference showed that greater changes in erectile function, sexual desire, intercourse satisfaction and overall satisfaction were significantly associated with patient preference (all P 12 ]. However, such numeric differences might not be regarded as clinically relevant.

The hypothesis that some patients preferred tadalafil to sildenafil because of greater efficacy is better discussed considering the three patient?preference trials in which the patients were asked the reasons for their preference.

[ 11 ] physicians provided reasons for patient preference.

According to them, the main reason for preferring tadalafil was either its longer duration of action (45%) or greater efficacy (better erections) (34–37%), but on the other side, greater efficacy (better erections viagra prescription buy in 64%) was also the main reason sildenafil the generics pharmacy for preferring sildenafil. [ 9 ] patients provided the reasons for their preferences directly: the main reason for preferring tadalafil was the awareness of the opportunity of being able to have a second intercourse the following day, with the same quality of erection (48.9%), or achieving a more intense and longer?lasting erection (23.4%). In the minority of patients who did not prefer tadalafil, the main reason for preferring sildenafil and vardenafil was the achievement of a more buy generic viagra online without prescription intense and longer?lasting erection (84% and 88.9%, respectively).

[ 9 ] also showed that the median EDITS score was significantly higher after tadalafil than after sildenafil (41 vs 38, P = 0.01).

The PAIRS questionnaire was administered in the studies by Eardley et al.

Tadalafil improved several PAIRS domains to a significantly greater extent vs baseline than did sildenafil: sexual self?confidence (+0.17 95% CI 0.09–0.25, P 13 ]; greater changes in these PAIRS domain scores were significantly associated with patient preference ( P 12 ]. [ 13 ] also evaluated the Drug Attribute Questionnaire, which asked what was the best and second?best

reason