Choosing the Right Pill to Treat ED

GoodRx can help make your prescription more affordable. GoodRx for ED can also deliver generic Viagra or generic Cialis directly to your door. You’ve likely heard of Viagra, Cialis, vardenafil (previously sold as Staxyn and Levitra), and Stendra. These are commonly-prescribed treatments for erectile dysfunction (ED) — when a person has regular difficulties getting or maintaining an erection for satisfying sexual intercourse.

More men than ever before use erectile dysfunction medication to give their sex life a boost. But do you use it the right way?

It might work longer if you have mild to moderate erectile dysfunction. This medicine also works best when you take it an hour before sex on an empty stomach. As with sildenafil, a high-fat meal or alcohol keep the body from absorbing it as quickly. Vardenafil usually works for 4 to 5 hours. Its effects might last longer if you have mild to moderate ED.

ED drugs can keep you erect even after you’ve climaxed: FALSE.

A newer form of the medicine that dissolves on the tongue might work faster than the pill that you swallow. This medication is taken with or without food an hour before sex. It works for up to 36 hours. You can take it in a small dose daily or in a larger dose as needed. You can take this medicine with or without food 30 minutes before sex, depending on the dose.

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It lasts 4 to 5 hours, or longer if you have mild to moderate ED. These medicines all work well for ED. When choosing one, tell your doctor or other health care professional what your preferences are, such as cost, ease of use, how long the drug's effects last and side effects. Generic versions of sildenafil, vardenafil and tadalafil are available. Check with your health care team before you take any medicine for erectile dysfunction. With all of these choices, is there one best ED medication?

Below, we’ll discuss some key differences between ED medications to help you navigate your treatment options. There’s no single best ED medication. But there are some differences between them that may make one treatment a better fit for you than another.

What if I like sex to be spontaneous?

Oral ED medicines might not work or might be dangerous if you also take any of the following: Often, these are prescribed for chest pain called angina. Some examples of nitrates are nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Bidil). These are commonly prescribed for an enlarged prostate or male pattern baldness. They include dutasteride (Avodart, Jalyn) and finasteride (Propecia, Proscar). Medicines that block an enzyme called CYP3A4.

4 Commonly Used ED Medications

Oral medicine for ED also might not be safe or work well if you have: Very low blood pressure, called hypotension, or uncontrolled high blood pressure, called hypertension. Kidney disease that needs to be treated with dialysis. These include a heart attack, stroke or a serious heart rhythm disorder in the past six months. An inherited eye disease that affects the retina. Side effects of oral ED medicines are often mild.

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Visual changes, such as blue tinge to vision, sensitivity to light or blurred sight. Rarely, more-serious side effects can happen, including: Some people have suddenly lost some of their hearing or vision after taking one of these medicines. But it isn't clear whether these side effects were caused by the medicine or by health conditions that the people already had. Get medical care right away if you take oral ED medicine and have sudden loss of hearing or vision. An erection that doesn't go away on its own. Sildenafil (Viagra), tadalafil (Cialis), vardenafil (formerly sold under the brand names Levitra and Staxyn), and avanafil (Stendra) belong to a class of drugs known as phosphodiesterase 5 (PDE5) inhibitors. PDE5 inhibitors increase the amount of blood that fills the penis, helping an erection last long enough for satisfying sex. They don’t affect arousal or libido. All of these medications have been proven to be safe and effective for ED treatment. And some people even prefer to alternate between PDE5 inhibitors, depending on their lifestyle and relationship status. The main differences between these medications have to do with: How you take them (with or without food) How you take them (with or without food) How long they last (4 to 36 hours, though an erection should not last that long) How long they last (4 to 36 hours, though an erection should not last that long) How often you plan to use it How often you plan to use it Your healthcare professional might also recommend one over another depending on whether your ED is mild or more severe. Viagra was the first major medication the FDA approved for ED. It’s been available in the U.S. since 1998. It’s often prescribed for mild or moderate symptoms. How to take it: You should take Viagra on an empty stomach. If you really need to eat, then try waiting at least 1-2 hours after your meal before you take Viagra. It’s best to choose a light, low-fat meal since fatty meals and alcohol can slow down the time it takes Viagra to kick in by about 1 hour.

2. Dehydroepiandrosterone (DHEA)

Does it ever happen when you masturbate? Are the problems associated with stress or alcohol? Asking yourself these types of questions can help identify if your ED may be more psychological than physical. You might benefit from sex therapy with your partner, or you may need treatment for a specific condition that affects your desire and sexual arousal, like post-traumatic stress disorder, depression, or anxiety. Medicines that you take by mouth are called oral medicines.

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They're often the first line of treatment for trouble getting or keeping an erection, called erectile dysfunction (ED). Oral medicines for ED usually work well and cause few side effects. The four main medicines taken by mouth for erectile dysfunction are: They enhance the effects of a chemical the body makes that relaxes muscles in the penis, called nitric oxide. This boosts blood flow and helps you get an erection from sexual activity. Each oral medicine for ED has a slightly different chemical makeup.

PDE5 Inhibitors

These small differences affect the way each medication works, such as how quickly it takes effect and wears off, and the possible side effects. Your doctor or other health care professional can recommend one for you based on these factors, other health conditions you have and any other medicines you take. This medicine works best when you take it on an empty stomach an hour before sex. The body takes longer to absorb it after a high-fat meal or alcohol. Its effects often last for 4 to 5 hours. How fast it works: Viagra can start to take effect in as little as 30 minutes. But usually you’ll have to wait 45 to 60 minutes before it reaches maximum effect.

• Natural remedies like ginseng may offer mild benefits for ED.
• Acupuncture has shown mixed results for ED treatment.
• Pelvic exercises can improve blood flow and erectile function.
• Psychological counseling can help if ED has a mental component.
• Regular cardiovascular checkups are essential if ED persists.
• Smoking cessation improves blood flow and overall ED outcomes.
• Managing stress and anxiety benefits erectile performance.
• Monitor blood pressure and cholesterol levels to improve ED.
• Avoid excessive caffeine and sugar intake for better vascular health.
• Ensure adequate hydration and sleep to support sexual health.
• Some herbal supplements may interact with ED medications—consult doctor.
• Open communication with your partner enhances understanding and support.

Then it keeps working for up to 8 hours. Typical dose: The typical starting Viagra dosage is one 50 mg tablet as needed.

• Cialis for Daily Use: 2.5mg or 5mg taken daily, maintains steady medication levels in the bloodstream.
• Levitra 20mg: Higher strength for patients needing a more potent vardenafil effect.
• Kamagra (Unofficial Sildenafil): Not FDA-approved, often sold online, carries significant safety risks.
• Heart Health Assessment: Essential first step, ED can be an early sign of cardiovascular disease.
• Drug Interaction Review: Crucial before starting any ED pill, especially with nitrates or alpha-blockers.

If you’re getting side effects, it can be cut down to 25 mg. If it’s not fully working, it can be increased to 100 mg. Cialis is different from Viagra and other ED medications because it lasts much longer. You can also take it on a daily basis. For this reason, Cialis may be a better fit than Viagra for regular use.

Get the timing right.

Some people prefer to alternate between medications. All ED meds are equally safe and effective. In most cases, your unique relationship needs, lifestyle, and insurance coverage will help you decide between them. There are ways to save on ED medications. Many are available as lower-cost generics or have other copay savings opportunities. It’s especially helpful for men who don’t respond as well to medications that are only taken “on demand.” Here’s an overview: How to take it: Food doesn’t affect Cialis.

What is Erectile Dysfunction?

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men's Health to get started. The best treatment for erectile dysfunction (ED) is the one that is best for you. Sildenafil (Viagra) and tadalafil (Cialis) are the most commonly-prescribed medications for ED, and they have the longest track record. For occasional use, most people start with sildenafil. You can take it just when you need it or regularly — every day — if needed.

• ED medications are not an instant cure; they assist during sexual activity.
• Always follow dosage instructions provided by your doctor.
• Avoid mixing ED pills with recreational drugs or nitrates.
• Monitoring side effects can help determine the right medication.
• Some men may need multiple tries to find optimal treatment.
• Communicate openly with your partner about ED treatment options.
• Remember that age and health status influence medication choice.
• In some cases, underlying health issues need addressing first.
• Explore alternative therapies if medications are ineffective or unsuitable.
• Use medications as part of a broader approach to sexual health.
• Consider psychological factors that may contribute to ED.
• Keep regular medical appointments for ongoing evaluation.

How to take it: Food doesn’t affect Cialis. How fast it works: Cialis can start working in as quickly as 30 minutes, but you may have to wait up to 2 hours for it to reach the point when it’s most effective. The effects of Cialis can last for up to 36 hours, helping you with erections at any point in that time period.

Change your sex routine

Called priapism, this rare condition can be painful. You need to get treatment for it as soon as possible to help prevent damage to your penis. If you have an erection that lasts more than four hours, call your care team right away. Treatments for erectile dysfunction are big business, and online scams abound. If you do erectile dysfunction pills over the counter buy medicines over the internet: Check to see if an online pharmacy is legitimate.

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Never order medicines from an online pharmacy that doesn't list its phone number and physical address, has prices that seem too good to be true, or tells you that no prescription is needed. Also stay away from ones that don't have a licensed pharmacist on staff to answer your questions. Some illegal businesses sell fake versions of real medicines, which can be dangerous or might not work. In the United States, the National Association of Boards of Pharmacy can tell you whether an online pharmacy is licensed and in good standing. If you live in another country, check to see if pharmacy association or regulation agencies offer services like these.

How can I regain erectile strength?

Make sure you get the right prescription and dose. When you order medicines and when you receive them in the mail, make sure they're the exact dose and type prescribed by your doctor or other health care professional. The dose is the amount of medicine you take. Don't be fooled into buying "herbal viagra." Never take any medicines that claim to be the "herbal" or nonprescription version of an oral medicine for ED. These aren't an effective option, and some contain harmful substances. Typical dose: The typical starting dosage of Cialis for occasional use is one 10 mg tablet. It can be dropped to 5 mg or increased to 20 mg depending on how you respond. The daily dose for regular use is 2.5 mg to 5 mg.