The most effective erectile dysfunction (ED) pills may be sildenafil (Viagra) or tadalafil (Cialis), but it depends on your personal needs. We look at these drugs and others in more detail.
Erectile dysfunction (ED) pills are available via prescription only, so you must first speak with a licensed healthcare professional to discuss getting a prescription.
Some companies also offer telehealth consultations, in which a healthcare professional decides whether ED medication is appropriate for your needs.
Examples of ED pills include:
- sildenafil (Viagra)
- tadalafil (Cialis)
- avanafil (Stendra, Spedra)
- vardenafil (Levitra, Staxyn)
These drugs are phosphodiesterase type 5 (PDE5) inhibitor medications. They may effectively manage ED by blocking the PDE5 enzyme, which increases blood flow to the penis.
However, there are differences between the types of PDE5 inhibitor medications. These differences may help you determine which will best suit your needs.
The following characteristics may vary between types of PDE5 inhibitors:
- onset (the time it takes to work)
- duration (how long it lasts)
- the best way to take it (i.e., with food or on an empty stomach)
- dosage
- cost
A medical professional may recommend 100 milligrams (mg) of avanafil as a standard treatment. However, people who consider cost the main factor might choose medications that cost less per dose, such as sildenafil, which is the generic form of Viagra.
Not everyone will find success with the first PDE5 inhibitor medication they try. However, up to
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 safe and effective when taken as a doctor advises.
Here is a comparison table of oral ED medications:
| Sildenafil (Viagra) | Tadalafil (Cialis) | Vardenafil (Levitra or Staxyn) | Avanafil (Stendra or Spedra) | |
|---|---|---|---|---|
| Dose 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 as needed | 10 mg as needed or 2.5 mg per day | 10 mg (5 mg for people 65 years or older) | 100 mg as needed |
| Onset (when to take) | 30 to 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 |
| Duration (how long it lasts) | 4 hours | up to 36 hours | 4 to 5 hours | 6 hours |
| How to store | around room temperature, from 68°F to 77°F (20°C to 25°C) | at 77°F (25°C) | at 77°F (25°C) | around room temperature, from 68°F to 77°F (20°C to 25°C) |
Research from 2019 shows that PDE5 inhibitors can effectively improve erectile function and the outlook 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.
You need to be sexually stimulated or aroused for a PDE5 inhibitor to help with ED.
People can purchase ED medications with a valid prescription from a doctor or other licensed healthcare professional at a pharmacy.
They can also purchase ED medications 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.
Below, we look at the best places to buy ED medication online.
Medical News Today selected these telehealth services based on criteria we think are good indicators of safety, quality, and transparency.
As a part of our vetting process, we consider:
- any third-party certifications
- a company’s reputation
- any lab test results
- marketing claims
Read more about how we vet products and brands.
Sildenafil (Viagra) is a common ED treatment. 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. Healthcare professionals are more likely to prescribe Viagra or generic sildenafil for ED.
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: It lasts up to 4 hours.
- Side effects: Serious side effects are rare, though they can include allergic reactions and heart problems.
Some disadvantages include:
- Unsuitable for certain heart 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
- severely impaired autonomic blood pressure control
- Possibly unsuitable for other health conditions: People with the following conditions should speak with a doctor before taking Viagra:
- serious liver conditions
- low blood pressure
- multiple myeloma
- sickle cell anemia
- 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 drugs have similar effectiveness.
Some possible side effects of sildenafil include:
- a stuffy or runny nose
- hot flashes
- headaches
- nausea
- chest pain
- painful erections lasting several hours
- dizziness
- vision problems
Tadalafil (Cialis) works by increasing blood flow to the penis. Doctors also use the drug to treat high blood pressure in the lungs and an enlarged prostate. For ED, people take tadalafil as an oral tablet.
Some advantages of tadalafil include:
- Longest lasting: It is the longest-lasting PDE5 inhibitor drug for ED. It typically lasts up to 36 hours.
- Longer-term use: It is possible to take a low dosage of 2.5 to 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 take sildenafil.
- Multipurpose use: Tadalafil has Food and Drug Administration (FDA) approval to treat the symptoms of benign prostatic hyperplasia.
However, some disadvantages include:
- 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 medications, 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
Avanafil (Stendra) is another PDE5 inhibitor drug. It works similarly to other drugs in its class by increasing blood flow to the penis.
Some advantages of avanafil include:
- Fast-acting: A 2022 study found that avanafil can start working
15 minutesTrusted Source after taking it. - Safe: Research notes that avanafil is a safe and effective ED treatment.
- More effective: The same 2022 study above suggests that avanafil is more effective than sildenafil at improving erectile function over 12 weeks.
However, a disadvantage of the drug is that it is currently unavailable in generic form, making it more expensive than other PDE5 inhibitor drugs.
There are also some possible side effects of taking avanafil, including:
- headaches
- flushing
- nasal congestion
- back pain
Similar to other PDE5 inhibitor medications for ED, vardenafil (Levitra) works by increasing blood flow to the penis.
Some advantages of vardenafil include:
- Effectiveness: Clinical trials find vardenafil is effective for ED.
- Generic available: Unlike avanafil, vardenafil is available in a more affordable, generic form.
Some disadvantages include:
- Longer onset: The drug can take comparatively longer to start working.
- Dose timing: A person needs to take it 1 hour before sexual activity.
- Not multipurpose: 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 not suitable for people taking type 1A or type I3 antiarrhythmic drugs, as it
ED may occur due to shorter-term
If you experience ED regularly, talk with a doctor. They can determine the cause of long-term ED and treat it accordingly.
Possible causes of long-term ED may
- depression
- performance anxiety
- other sexual disorders
- aging
- heart problems
- diabetes
- metabolic syndrome
- hormone changes
- priapism
- prostatic hyperplasia
- medication side effects
A doctor can determine whether your ED is due to physical or mental health factors by collecting information about your medical and sexual history. They may also conduct a physical exam or recommend tests to assess your condition.
ED pills are only available with a prescription. Each dispensing pharmacy or telehealth service may charge different amounts.
However, you can purchase ED pills in several ways to save money:
- Using telehealth websites: These websites often offer ED pill subscriptions for a lower price, with medication starting at around $2 per pill. Many offer free initial consultations with a healthcare professional.
- Pill splitting: This means that if a doctor prescribes double the usual dose, you can split the pill in half, receiving twice the amount for a lower price. A
2022 reviewTrusted Source suggests that immediate-release medications, such as PDE5 inhibitors, are typically safe to split. However, people should discuss this option with a doctor first to ensure it is safe and effective for their needs. - Using manufacturer discount programs: These programs 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 brand-name Viagra per year. It is important for people to read the terms and conditions to ensure the program suits their situation.
While ED medications are often effective, some individuals may prefer to try other methods of ED treatment,
- Lifestyle strategies: Strategies such as prioritizing physical activity, a nutritious diet, and not smoking, if you do, can all help ED.
- Psychotherapy: Managing any 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 other treatments are ineffective, a doctor may recommend a surgical implant to help get or keep an erection.
Some people may also consider using ED rings. These devices use constriction to maintain an erection. You achieve this by putting the device around the base of the penis. An example 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.
Some people should not take ED medications or should take them with caution. Some examples include:
- People avoiding sexual activity: Individuals with recommendations from a healthcare professional to avoid sexual activity due to health concerns should not take any ED drugs.
- People consuming grapefruit or grapefruit juice: You should not take PDE5 inhibitors with grapefruit or grapefruit juice because it
may affectTrusted Source how the drugs work. - People 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
Individuals taking HIV protease inhibitors, such as ritonavir (Norvir), should also not take avanafil. Its prescribing information also states that people with severe liver or kidney problems should not take avanafil.
Those who experience an erection lasting more than 4 hours should also consult their doctor.
Individuals should also stay in regular contact with their doctor if they experience prolonged ED, as an underlying health condition may need exploration.
After taking ED pills, you may experience side effects such as headaches, indigestion, dizziness, or a stuffy nose. These are common and usually subside over time.
However, consult a doctor if these side effects become severe or persistent. If you experience any more serious side effects, such as vision problems, seizures, hearing loss, or symptoms of anaphylaxis, seek immediate medical care.
To find out more about the side effects of ED medication, consult a healthcare professional.
Herbal supplements
Very little research supports the effectiveness of herbal supplements for ED. The FDA has not approved these products.
Specifically, the
ED can develop due to some emotional factors, like relationship issues or mental health conditions, including stress, anxiety, or depression.
ED also has many physical causes, such as heart disease, diabetes, reduced physical activity, and high blood pressure. Smoking, heavy alcohol use, and certain medications may also contribute to ED.
To get a pill for ED, you need a prescription from a doctor or other licensed healthcare professional. This may be via a telehealth service. Once the prescription is ready, the cost depends on whether a person has insurance and, if so, whether it covers all or some of the cost.
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 side effects.
Sexual stimulation is required for any of these medications to work.
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 ED treatment. A doctor must prescribe the medication, and it must come 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 ED medications are sildenafil (Viagra) and tadalafil (Cialis).
ED medications require a prescription from a doctor. However, you can buy ED devices, such as vacuums and rings, over the counter.
Cialis and Viagra are very comparable medications. Both are proven to help the majority of people who take them get and maintain erections.
It takes 30 to 60 minutes for Viagra to take effect and 30 minutes for Cialis to take effect. The effects of Viagra last for about 4 hours. The effects of Cialis last for up to 36 hours.
Several medications can treat ED. Many ED drugs, including those in this article, work by blocking the PDE5 enzyme, increasing blood flow to the penis.
The best choice of ED medication depends on various factors. For example, people who regularly engage in sexual activities may prefer taking tadalafil, which is available as a daily pill. Others may prefer medications they can take just before having sex, such as sildenafil, avanafil, or vardenafil.
However, it is important to consult a doctor before taking ED medication and only use it as directed to help prevent adverse side effects.
