Originally Posted by androNYC
Do they all function in the exact same way?
Yes. Although the active drug is slightly different in each product, they all target phosphodiesterase enzymes as provided by archcore above. The trick is that there are different kinds of phosphodiesterase enzymes that work in different parts of the body. For example, there’s a slightly different phosphodiesterase in our noses that causes our nasal passages to constrict (leads to congestion, but the constriction is useful physiologically). There are others with various functions as well. Each member of this family of phosphodiesterase enzymes is indeed unique, but they look very similar to each other structurally. So a drug that binds to one to block it will bind to the others and block them as well. Thus, in brief, is the explanation for most side effects of most drugs.
The phosphodiesterase-5 that controls erections normally functions to inhibit the erection. When it is naturally blocked and the right combination of physiological signals are present (ie you are horny), the blood vessels change shape to allow blood to fill the penis without letting it leave, causing an erection. Targeting this enzyme with a drug takes the place of the natural targeting that causes an erection.
Tadalafil, the active drug in Cialis, happens to have a structure that binds more specifically to the phosphodiesterase-5 that controls erections than do the other ED drugs. It also binds more tightly. Higher specificity PLUS higher affinity. This means it targets the other forms of phosphodiesterase less, and sticks to the erection phosphodiesterase more. Nothing is perfect, and it still also can target the other enzymes, which is why many men here are being honest when they say Cialis has side effects for them.