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have low blood pressure or have high blood pressure that is not controlled directions for cialis Levitra is used in the treatment of erectile dysfunction or impotency. By relaxing the muscles of the penis and increasing blood flow to it, Levitra helps produce an erection in men. Levitra is also used to treat a number of other conditions.5 mg Placebo CialisFlushing 1% 1% 3%

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Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and corpus cavernosal smooth muscle. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum. The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Tadalafil inhibits PDE5. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 by tadalafil has no effect in the absence of sexual stimulation.