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Erectile dysfunction (ED) is a treatable condition, and various medications can help, such as sildenafil and tadalafil. The pills that people find most effective will depend on their individual needs and lifestyles.
All ED pills are available via prescription only, so a person must first speak with a doctor or healthcare professional to discuss symptoms. Some companies offer telehealth consultations. The healthcare professional will then decide whether ED medication is appropriate.
Examples of ED pills include:
Research from 2019 shows that phosphodiesterase type 5 (PDE5) inhibitors can effectively improve erectile function and the prognosis of people with cardiovascular disease.
These drugs impede the functioning of PDE5, an enzyme within the blood vessel walls that helps control blood flow.
Following arousal, the body releases enzymes that cause blood vessels in the smooth muscles to relax, allowing for more blood flow. PDE5 inhibitors block the degradation of these enzymes, increasing blood flow and resulting in an erection.
It is important to note that a person needs to be aroused for a PDE5 inhibitor to help with ED.
This article focuses on PDE5 inhibitors. It discusses what erectile dysfunction is and what may cause it and looks at the common PDE5 medications for ED in detail.
Researchers note that some people will not find success in the first PDE5 medication they try. However, they suggest that up to 50 percent of people will respond to a different type of PDE5 medication.
The following characteristics may vary between types of PDE5:
- onset, or the time it takes to work
- duration, or how long it lasts
- the best way to take it, with food or on an empty stomach
- dosage
- cost
Individuals who want a medication that acts quickly might prefer 100 milligrams (mg) or 200 mg doses of avanafil. However, people who consider cost the main factor might choose medications that cost less per dose, such as generic sildenafil.
Below is a comparison table of these oral ED treatments.
| Sildenafil (Viagra) | Tadalafil (Cialis) | Vardenafil (Levitra or Staxyn) | Avanafil (Stendra or Spedra) | |
|---|---|---|---|---|
| Dosage options | 25 mg, 50 mg, 100 mg | 2.5 mg, 5 mg, 10 mg, 20 mg | 2.5 mg, 5 mg, 10 mg, 20 mg | 50 mg, 100 mg, 200 mg |
| Typical dosage | 50 mg | 10 mg as needed or 2.5 mg per day | 10 mg (5 mg for people 65 years or older) | 100 mg |
| When to take (onset) | 30–60 minutes before sex | 30 minutes before sex | 60 minutes before sex | 15 minutes before sex for 100 mg and 200 mg, 30 minutes before sex for 50 mg |
| How long it lasts (duration) | 4 hours | up to 36 hours | 4–5 hours | 6 hours |
| How to store | around room temperature, from 68–77°F (20–25°C) | at 77°F (25°C) | at 77°F (25°C) | around room temperature, from 68–77°F (20–25°C) |
Erectile dysfunction occurs when a person cannot develop or maintain an erection. The condition may affect an individual’s quality of life, sexual activity, or relationships.
According to a
ED can differ from one person to another. While some people can get an erection, they may not be able to maintain it, and they may not be able to get one every time they want to have sex. Others may not be able to get an erection at all.
According to a
ED may occur due to
Possible causes of long-term ED may
- depression
- performance anxiety
- other sexual disorders
- aging
- heart problems
- high blood pressure
- diabetes
- metabolic syndrome
- neurological disorders, such as multiple sclerosis
- hormone changes
- traumatic injuries
- stroke
- sleep apnea
- chronic obstructive pulmonary disease
- glaucoma
- priapism
- prostatic hyperplasia
- medication side effects
Below is detailed information about the PDE5 inhibitor drugs available.
Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.
Medical News Today follows a strict product selection and vetting process. Learn more.
Sildenafil (Viagra)
Sildenafil (Viagra) is common in the treatment of ED. It can also treat conditions such as pulmonary hypertension, a type of lung high blood pressure.
The pills come in 25 mg, 50 mg, or 100 mg.
Some healthcare professionals may prescribe Revatio (sildenafil), which comes in 20 mg. However, this drug is for the treatment of pulmonary hypertension, and healthcare professionals are more likely to prescribe Viagra or generic sildenafil.
Some advantages of taking sildenafil for ED include:
- Fast-acting: It starts working around 30 minutes after taking the pill.
- Research: Clinical trials and studies confirm its effectiveness.
- Lasting effects: Up to 4 hours.
- Side effects: Serious side effects are rare, though they can include allergic reactions and heart problems.
Some disadvantages include:
- Short-term use: According to clinical trials, sildenafil is effective for
12-16 weeks . - Unsuitable for some health conditions: Sexual activity can present a risk for people with cardiovascular disease. Viagra’s prescribing information states that people with cardiovascular disease should take Viagra with caution. This also applies to people with aortic stenosis, idiopathic hypertrophic subaortic stenosis, or those with severely impaired autonomic blood pressure control. MedlinePlus states people with serious liver conditions, low blood pressure, multiple myeloma, or sickle cell anemia should speak with a doctor before taking Viagra.
- Drug interactions: It can interact with other drugs, including some heart disease and blood pressure medications.
- Preference: People seem to prefer an alternative drug called tadalafil, especially those with sustained morning erections, according to a 2022 study. However, both have similar effectiveness.
There are also some possible side effects of sildenafil, including:
- a stuffy or runny nose
- hot flashes
- headaches
- a fever
- nausea
- chest pains
- painful erections lasting several hours
- dizziness
- vision problems
- indigestion
Where to buy sildenafil (Viagra)
The following companies offer sildenafil:
| Roman | Lemonaid | Blink Health | Optum Perks | BlueChew | Hims | REX MD | |
|---|---|---|---|---|---|---|---|
| Cost | starting from $4 per dose | starting at $2 per pill | initial cost of $10, then around $9.95 per month, excluding refills | dependent on pharmacy | starting from $20 per month | starting from $4 per dose | starting from $2 per dose |
| Available dosage | 20–100 mg, according to a doctor’s recommendation | 20 mg; doctors may recommend taking multiple pills to create a 40 mg, 60 mg, 80 mg, or 100 mg dose | 20 mg, 25 mg, 50 mg, 100 mg | 20–100 mg, according to a doctor’s recommendation | 30 and 45 mg | 20–100 mg | 25–100 mg |
Tadalafil (Cialis)
Tadalafil (Cialis) works by increasing blood flow to the penis. Doctors also use the drug to treat high blood pressure in the lungs and enlargement of the prostate. For ED, people take it as an oral tablet.
Some advantages of tadalafil include the following:
- Longest lasting: It is the longest lasting PDE5 drug for ED, typically lasting up to 36 hours, though some reports suggest it can last up to 72 hours.
- Longer-term use: It is possible to take a low dose of 2.5–5 mg once per day for a longer-term solution.
- Daily use: People who regularly engage in sexual activities may prefer taking a daily pill.
- Increased confidence: Research suggests that people who take tadalafil experience more sexual confidence than those who do take sildenafil.
- Multipurpose use: Tadalafil has FDA approval to treat the symptoms of benign prostatic hyperplasia.
However, the disadvantages include the factors below:
- Cost: Taking it every day can have a higher cost.
- Hidden underlying ED causes: Taking it long term may prevent or delay treatment for the underlying cause of ED, which may be psychological.
- Drug interactions: Tadalafil can interact with several types of medication, including common blood pressure drugs.
There are also possible side effects from tadalafil, including:
- a stuffy or runny nose
- hot flashes
- indigestion
- headaches
- pain in the limbs
- muscle pain
- back pain
Where to buy tadalafil (Cialis)
Tadalafil is available to purchase from the following companies:
| Roman | Lemonaid | Blink Health | Optum Perks | BlueChew | Hims | REX MD | |
|---|---|---|---|---|---|---|---|
| Cost | starting at $8 per pill | starting at $8 per pill, with subscription | initial cost of $10 for first month, excluding refills. $17 per refill. | dependent on pharmacy | starting at $20 per month | starting at $40 per month | starting at $6 per dose |
| Available dosage | 2.5, 5 mg, 10 mg, 20 mg | 5 mg, 10 mg, 20 mg | 2.5 mg, 5 mg, 10 mg, 20 mg | 2.5, 5 mg, 10 mg, 20 mg | 6 and 9 mg | 2.5-20 mg | 10-20 mg |
Avanafil (Stendra)
Avanafil (Stendra) is another PDE5 drug. It works similarly to other drugs in its class by increasing blood flow to the penis.
Some advantages of avanafil include:
- Fast-acting: Avanafil can start working
15 minutes after taking the drug. - Safe: Research has found that avanafil is a safe and effective ED treatment.
- More effective: Recent research has found that avanafil is more effective than sildenafil at improving erectile function over a
12-week period.
However, a disadvantage of the drug is that it is currently unavailable in generic form, making it more expensive than other PDE5 drugs.
There are also some possible side effects of taking avanafil, including:
- headaches
- flushing
- nasal congestion
- back pain
Where to buy avanafil (Stendra)
The following companies offer avanafil (Stendra).
| Optum Perks | Hims | |
|---|---|---|
| Cost | dependent on pharmacy | starting from $53 per dose |
| Available dosage | 50 mg, 100 mg, 200 mg | 50 mg, 100 mg, 200 mg |
Vardenafil (Levitra)
Similar to other PDE5 medications for ED, vardenafil (Levitra) works by increasing blood flow to the penis.
Some advantages of vardenafil include clinical trials finding it to be effective. In addition, unlike avanafil, vardenafil is available in a more affordable, generic form.
Its disadvantages are that the drug can take comparatively longer to start working, and a person needs to take it 1 hour before sexual activity. In addition, compared with tadalafil and sildenafil, vardenafil has no unique advantages.
Some possible side effects of vardenafil include:
- a stuffy or runny nose
- facial flushing
- headaches
- stomach problems
- heartburn
- flu-like symptoms
Vardenafil is unsuitable for people taking type 1A or type I3 anti-arrhythmic drugs, as they
Where to purchase vardenafil (Levitra)
Levitra and its generic version, vardenafil, are only available to purchase once a doctor has prescribed them.
The cost of four 8-mg tablets starts at $20 and four 10-mg tablets start at $112.19 at the time of publication, while thirty 20-mg tablets can cost up to $622.12.
The following companies offer vardenafil (Levitra).
| Blink Health | Optum Perks | BlueChew | |
|---|---|---|---|
| Cost | $126.08 for 6 20-mg tablets | dependent on pharmacy | starting from $20 per month |
| Available dosage | 20 mg | 2.5, 5, 10, 20 mg | 4, 8, 15, 30 mg |
People can purchase ED medications with a valid doctor or healthcare professional prescription at a pharmacy.
Alternatively, they can purchase them online, usually after completing an online questionnaire reviewed by a doctor or healthcare team.
Individuals should check reviews of the health company before purchasing a product and consult a doctor or pharmacist if they have any concerns.
ED pills are only available with a prescription, and each dispensing pharmacy or telehealth service may charge different amounts.
However, persons purchasing ED pills can save money in several ways.
Using telehealth websites
Telehealth websites, such as Hims, Roman, and Lemonaid, offer ED pill subscriptions for a lower price. These websites often offer medication starting at around $2 per pill.
Many of these websites offer free initial consultations with healthcare professionals or at a lower price than many in-person health clinics.
While ED pills may be cheaper to purchase through telehealth websites, it is important to note that many do not accept insurance.
Pill splitting
People can also ask a healthcare professional about pill splitting. This means that a doctor prescribes double the usual dose and a person then splits the pill in half, receiving twice the amount for a lower price.
Pill-splitting involves some storage considerations. Split tablets may also be more affected by temperature, humidity, and moisture changes. It is important that a person only splits another pill once they have finished their current one. However, even with these concerns, a 2022 literature review determined that tablet-splitting could be a safe and helpful practice.
Using manufacturer discount programs
Some manufacturers may offer discounts and saving programs. This may benefit people who cannot take generic versions of the medication.
For example, Viagra offers a Viagra Saving Card. The company states that eligible customers can save up to 50% on up to 12 prescriptions of name-brand Viagra per year.
Manufacturer discount programs have terms and conditions. A person should carefully read through these to ensure the program suits their situation. For example, the Viagra Saving Card is not suitable for people who receive part or whole reimbursement from any federal or state healthcare program.
ED pills are safe and effective when someone takes them under a doctor’s supervision.
Results may vary between individuals, but a 2021 review of 23 studies found that 50 mg and 100 mg sildenafil pills were more effective than a placebo. However, there is insufficient data to compare the different PDE5 inhibitor pills.
ED pills are typically taken around 1 hour before sex. However, instructions may vary between medications.
Some pills require people to take them with food, and other pills on an empty stomach.
A person should always follow the instructions before taking any prescription medication.
While ED medications are often effective, some individuals may prefer to try other methods of ED treatment,
- Diet, exercise, and healthy habits involve staying active, following a nutritious diet, and avoiding smoking.
- Psychotherapy: Dealing with underlying emotional or psychological issues may help ease ED.
- Vacuum devices: These devices use suction to bring blood into the penis to achieve an erection.
- Surgery: When all other treatments are ineffective, a doctor may recommend a surgical implant to help a person achieve or maintain their erections.
Some people may consider using ED rings. These devices use constriction to maintain an erection. A person puts this device around the base of their penis. An example of this is Eddie by Giddy. The product comes in different sizes, and the website provides full instructions. Learn more about the Eddie product.
Read about some of the best available ED rings.
Individuals should stay in regular contact with their doctor if they experience prolonged ED, as an underlying health condition may need exploration.
After taking ED pills, a person may experience side effects such as headaches, indigestion, dizziness, or a stuffy nose. These are common and usually subside over time.
However, a person should consult their doctor if these side effects become severe or persistent.
Although rare, ED medications can also cause more serious side effects, including:
- chest pain
- vision problems
- hearing loss
- seizures
- skin reactions, including itchy, red, or swollen skin
- priapism, a painful erection lasting more than 4 hours
If someone experiences any of these side effects, they should discontinue using the drug immediately and seek medical advice.
Symptoms, such as wheezing, tightness in the chest or throat, difficulty breathing, and swelling of the mouth, throat, lips, or tongue, may have links with anaphylaxis, a life threatening allergic reaction.
If a person notices any symptoms of anaphylaxis, they should call 911 or go to the nearest emergency room.
Some people should not take ED medications or should take them with caution. Some examples include:
- Those avoiding sexual activity: Individuals with recommendations from a healthcare professional to avoid sexual activity due to health concerns should not take any ED drugs.
- Those consuming grapefruit or grapefruit juice: A person should not take PDE5 inhibitors with grapefruit or grapefruit juice because it
may affect how the drugs work. - Those with a history of adverse reactions: People who previously experienced sudden hearing loss or vision problems should not use the drugs. If someone new to ED drugs experiences these symptoms, they should discontinue use and seek immediate medical attention.
ED medications may also interact with other drugs, including:
- nitrates
- certain blood pressure medications
- alpha-blockers
- guanylate cyclase stimulators
- certain antifungal medications and antibiotics
Additionally, individuals taking HIV protease inhibitors, such as ritonavir (Norvir), should not take avanafil. Prescribing information states that people with severe liver or kidney problems do not take avanafil.
Those who experience an erection lasting more than 4 hours should also consult their doctor.
Herbal supplements
A person should be cautious when considering herbal supplements that claim to help with ED. This is because very little research proves their effectiveness, and the FDA has not approved these products.
Specifically, the
Here are some common questions about ED and medications for the condition.
ED can develop due to some emotional factors, like relationship issues, or mental health conditions, including stress, anxiety, or depression.
ED has many physical causes, such as heart disease, diabetes, reduced physical activity, and high blood pressure. Smoking tobacco, consuming high amounts of alcohol, and taking certain medications may also contribute to the condition.
A doctor or healthcare professional can determine whether a person’s ED is due to physical or mental health factors by collecting information about their medical and sexual history. They may also conduct a physical exam.
Healthcare professionals may also recommend an overnight erection test, which involves placing a device around the penis to measure the number of nocturnal erections. If a person can achieve a set number of erections at night, it may indicate that their ED is due to psychological problems rather than physical conditions.
A person may also undergo an intracavernosal test. During this test, doctors inject a small amount of medication into the base of the penis to cause an erection. Imaging techniques, such as an ultrasound, can also help determine whether there are any problems with blood flow.
To get a pill for ED, a person needs a prescription from a doctor or an online telehealth service. Once the prescription is ready, the cost will depend on whether an individual’s insurance plan covers all or some of the costs.
Typically, generic versions of ED pills, such as sildenafil, cost significantly less than brand-name versions, such as Viagra.
Each medication mentioned in this article is effective at treating ED. However, according to research from 2022, avanafil may be the fastest-working medication with the least visual side effects.
It is important to note that for any of these medications to work, a person requires sexual stimulation.
The type of ED medication a person should take depends on individual needs. Each medication type may have different side effects, dosage requirements, and times to work properly.
Individuals should consider these factors before trying these medications.
All four of the main ED pills — sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) — are safe for most people to use. These drugs are FDA-approved for use in ED. A person must ensure their medication is doctor-prescribed and comes from a legitimate source.
Health experts advise against combining ED medications unless a doctor advises otherwise.
If one medication for ED is not working, a person should consult their doctor to determine whether alternative treatment options may work better or if other underlying factors may contribute to ED.
The most commonly prescribed erectile dysfunction medications are sildenafil (Viagra) and tadalafil (Cialis).
Can you get ED medications over the counter?
Most ED medications require a prescription from a doctor. However, people can buy ED devices such as vacuums and rings online.
All the medications discussed in this article are FDA-approved and effective. However, each medication has different strengths and weaknesses. Individuals should work with their doctors to determine which medication best meets their needs.
PDE5 inhibitors, the type of medication discussed in this article, are all prescribed to help persons achieve erections and maintain them long enough for sexual intercourse. This means sildenafil, tadalafil, avanafil, and vardenafil could help people meet their objectives.
Cialis and Viagra are very comparable. Both of these medications are proven to help the majority of people who take them get and maintain erections. It takes 30-60 minutes for Viagra to take effect and 30 minutes for Cialis to take effect. The effects of Viagra last for about four hours and the effects of Cialis last for up to 36 hours.
Several medications can treat ED, and many drugs — including those in this article — work by blocking the PDE5 enzyme, increasing blood flow to the penis.
The best choice of ED medication will depend on various factors. For example, people who regularly engage in sexual activities may prefer taking tadalafil, which is available as a daily pill. Meanwhile, others may prefer medications they can take just before having sex, such as sildenafil, avanafil, or vardenafil.
However, it is important for a person to consult a doctor before taking ED medication and only use it as directed to help prevent adverse side effects.