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There are four types of ED pills on the market, including sildenafil and tadalafil, often known by their brand names, Viagra and Cialis. We compare ED pills in terms of effectiveness, cost, side effects, and more.

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Erectile dysfunction (ED) is when you regularly have difficulty achieving or maintaining erections. ED is more than just an occasional issue with arousal. It can be an ongoing health concern.

ED affects about 30 million men in the United States. Prevalence increases with age.

Treating the underlying cause of ED is often the most important step. Doctors are also likely to suggest specific treatments for the symptoms you’re experiencing. Find out which ED pills — if any — may work best.

Safety note

ED pills are only available by prescription. They are not safe for everyone, especially if you take certain heart or blood pressure medications. Nitrates, for example, widen your blood vessels. When taken with ED pills, they may lead to a potentially serious drop in blood pressure (hypotension). Taking alpha-blockers with ED medication may also lead to sudden hypotension.

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ED pills are oral medications taken by mouth. Available by prescription, these medications — called phosphodiesterase type 5 (PDE5) inhibitors — are designed to help relax smooth muscles and increase blood flow in your penis during sex. While not a cure for ED, oral medications may help you better manage ED symptoms.

Types of ED pills

There are four PDE5 inhibitors on the market. These medications do not work the same for everyone, so a doctor may suggest that you start with one and try another type if you’re not getting the results you want.

  • Sildenafil (Viagra): This is available in 25–100 milligram (mg) doses taken once daily only as needed 30 minutes to 4 hours before sex.
  • Tadalafil (Cialis): This is a lower dose medication available in 2.5–20 mg doses. It’s taken daily, so you don’t have to worry about timing of sexual activities. It might be a good fit for people who don’t take other medications.
  • Vardenafil (Staxyn, Levitra): Also designed for daily use, this medication is available in 2.5–20 mg doses and may have fewer side effects. It’s worth noting that there is a key difference between the two branded versions of vardenafil. Staxyn is orally disintegrating, meaning it dissolves in the mouth. Levitra is swallowed as a normal tablet.
  • Avanafil (Stendra): Available in higher doses at 50, 100, and 200 mg, this pill is taken once a day as needed 15 minutes before sexual activity, which is a shorter time frame than Viagra.

PDE5 inhibitors work by protecting a certain compound called cyclic guanosine monophosphate. This compound helps hold blood in the penile tissue during sexual stimulation, encouraging an erection. Also, by inhibiting PDE5 in penile tissues, blood vessels are better able to dilate, further promoting blood flow.

Additionally, PDE5 inhibitors decrease vascular pressure, which is why they may lead to hypotension when combined with nitrates and alpha-blockers.

While there are four types of PDE5 inhibitors used in the treatment of ED, they all work similarly via slight structural differences. This is why some men may find that certain ED pills may work better than others. The results are highly individual.

The cost of your ED treatment will depend on:

  • which pill you’re taking
  • the dosage
  • where you’re purchasing from
  • how much you purchase at once

Branded pills tends to be much more expensive than generic versions.

Prices start at about $2–$4 per 20 mg pill of generic sildenafil from services such as Roman and Hims and can go up to around $70 or more per pill of branded Viagra through your local pharmacy.

One of the best ways to save money on ED pills is to use services such as Roman, Hims, and Lemonaid, which offer subscription services for a discounted price and provide both brand name and generic medications.

In general, most insurance companies do not cover name-brand Viagra, but they might cover the generic, sildenafil.

Some common side effects of these medications include:

Avoid taking PDE5 inhibitors:

In addition, if you go to the emergency room for chest pain, tell your doctor if you’ve recently taken a PDE5 inhibitor. If you’re given nitroglycerin (Nitrostat, Nitro-Dur), a nitrate, it may cause your blood pressure to drop suddenly.

How to take itHow fast it worksTypical dose
Sildenafil (Viagra)1–2 hours after eating, don’t consume with fatty foodscan start in about 10 minutes, can take 1 hour for maximum effecttypical starting dose is 50 mg, can be increased to 100 mg
Tadalafil (Cialis)when you need it, or regularly every daycan start working in about 15 minutes, can take 2 hours for maximum effect

remains effective for up to 17 hours		10–20 mg for occasional use

typical daily dose is 2.5 mg
Vardenafil (Levitra)shouldn’t be taken with food, wait 1–2 hours after eatingcan start working in about 15 minutes, can take 45 minutes to reach maximum effecttypical starting dose is 10 mg, can be decreased to 5 mg or increased to 20 mg
Avanafil (Stendra)can be taken with or without food, shouldn’t be taken more than once a dayfastest acting, starts working in as little as 15 minutestypical starting dose is 100 mg, can go up to 200 mg

ED pills aren’t the only treatment for erectile dysfunction. There are also other treatments that your doctor may recommend.

Hormone replacement therapy

Your testosterone levels naturally decrease by small amounts as you age. However, you may be a candidate for hormone replacement therapy if your testosterone levels are too low.

Testosteronereplacement therapy (TRT) helps restore testosterone blood levels, but it’s still unclear if it helps improve ED. It likely depends on what’s causing ED in the first place.

Side effects of TRT may include:

Penile suppositories

The medication alprostadil is available as both an injection (known as Caverject or Edex) and as a pill that you place into the opening at the tip of the penis. This is known as medicated urethral system for erections (MUSE). MUSE works by causing blood vessels to expand, allowing more blood flow into the penis.

However, the medication is less effective when it’s delivered this way than when it’s delivered via injection.

According to findings from placebo-controlled clinical trials, some people experience penile pain when taking MUSE. However, of those who were able to tolerate the medication, 7 out of 10 men were able to go through successful intercourse after using MUSE.

Side effects may include pain and burning in the genital region.

Yohimbe supplements aren’t recommended

Yohimbe herbal supplements are derived from yohimbe bark and are available over the counter. Chemically speaking, they’re different from yohimbine hydrochloride, which was approved by the Food and Drug Administration (FDA) as a prescription treatment for ED in the late 1980s.

Some scientists believe yohimbe works by stimulating blood flow to the penis. Studies on yohimbe have seen mixed results. It isn’t known whether the supplemental extract form of yohimbe is safe or effective due to a lack of clinical trials on the substance.

Note that the FDA does not regulate or test over-the-counter dietary supplements. So when purchasing supplements like these, there is no guarantee that you are getting exactly what is listed on the label.

In fact, while yohimbe is easily accessible, a 2015 study on yohimbine products in the United States found that only 4% of products contained what was listed on the label in terms of quantity.

There aren’t enough studies to support the claim that yohimbe works, and some experts are adamant that it does not.

Yohimbine hydrochloride can also cause dangerous side effects, including:

Do not use it if you have a heart disease, a mental health condition, or kidney disease.

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ED can be uncomfortable to discuss with your doctor at first, but keep in mind that it’s a common medical issue.

Since ED is often related to other health issues, it’s best to get a complete checkup as well as laboratory tests and a psychological exam. Treating any underlying cause will often help improve ED as well.

The landmark Massachusetts Male Aging Study found that depression and ED are often related.

ED may also be associated with the following:

The better your overall health, the lower the risk of ED. Discuss any of these issues with your doctor thoroughly, as well as any medications you may be taking.

In some cases, ED may be related to an underlying health condition that requires specific treatment. However, if your ED is not caused by a medical issue, a doctor may recommend preventive measures to complement oral medications. Keep in mind that ED may not be entirely preventable, but medications and lifestyle changes may help you manage it.

Talk with a doctor about the following nutrition and lifestyle changes:

  • Stop smoking, if you currently smoke: Smoking adversely affects your blood vessels and heart, which can also increase your risk of ED. If you need help stopping, talk with your doctor. They may be able to recommend smoking cessation programs or medications to help you.
  • Exercise to promote blood flow: Regular exercise of at least 30 minutes each day can help increase blood flow throughout your body, including penile blood flow. If you’re new to exercise, start off slow with moderate activities, such as walking. Talk with a doctor about how you can gradually increase physical activity.
  • Limit alcohol: According to a 2021 review of 46 studies, regular alcohol consumption was found to increase ED and possibly damage blood vessels. Try to limit the amount of alcohol you drink, and talk with a doctor if you need help.
  • Eat a healthy diet: A diet that focuses on lean meats, low fat dairy products, whole grains, fruits, and vegetables may also help prevent ED. Some studies suggest that following a plant-based diet may promote overall cardiovascular health while also decreasing your risk of ED.
  • Maintain a moderate weight: Having more weight may also increase your risk of ED due to increased inflammation and lower testosterone levels. In addition, some cases of ED are caused by stress, relationship issues, and low self-esteem. By losing or maintaining your weight, you may boost your testosterone levels and increase your overall self-esteem — two factors that can influence ED symptoms.

For people with more weight, losing weight may help prevent high blood pressure and diabetes, which are two conditions that may cause ED.

If you’re considering setting a weight goal for yourself, talk with your doctor before getting started. They can help determine if that goal is right for you, as well as strategies to help you safely achieve it.

Though ED is relatively common, if you’re bothered by the quality, firmness, or duration of your erection, talk with a doctor.

ED can point to signs of a more serious health condition, such as high blood pressure, diabetes, or heart disease.

Depending on the cause, your doctor will analyze your symptoms and determine a proper treatment.

What causes ED?

There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include:

ED can be caused by one or several of these factors. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions. Learn more about the causes of ED.

What ED pill is best for me?

The truth is the best ED pill is the one that works best for you.

They’re all equally safe and effective, but the main differences between them are:

  • how they’re taken
  • how long they last
  • their side effects
  • cost

For occasional use, most people start with sildenafil (Viagra). For regular use, tadalafil (Cialis) can be a better fit.

Some people prefer to alternate between medications, depending on their lifestyle and relationship status.

How effective are ED pills?

Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) all have studies that back how well they work.

Currently, there are no studies that directly compare them against each other, but research from 2009 found that all three medications result in successful penetrative sex in 65–80% of users with ED, compared with 30% with a placebo.

How quickly do ED pills work?

How quickly an ED pill begins to work will depend on the medication. Usually, ED pills begin to work in as little as 10–15 minutes. Some may take up to 1–2 hours to take full effect.

How long do ED pills last?

How long your ED pill lasts will depend on the medication, dosage, and your body’s metabolism.

On average, branded Viagra and its generic form sildenafil will last between 2 and 3 hours before the effects start to diminish. The pills can last up to 12 hours depending on your dosage, metabolism, and other factors. Avanafil has a similar average duration, lasting up to 6 hours. Vardenafil can remain effective for up to 12 hours.

Tadalafil has the longest duration of these common ED pills. It can remain effective for up to 36 hours.

ED pills are promising, but the results vary. PDE5 inhibitors continue to be the first line of treatment, and they have high rates of patient satisfaction. Your doctor might recommend another option if such medications do not help you or if they cause side effects.

If you’re interested in natural ED remedies, consult your doctor first. Never self-treat ED with OTC herbs and supplements.