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You have many different options for treating erectile dysfunction (ED). A few common medications include tadalafil, testosterone, avanafil, and vardenafil. To get a prescription, start by consulting a licensed medical professional.
There’s certainly no shortage of medications, supplements, and herbal remedies that claim to boost testosterone levels and sex drive. Especially if you have been recently experiencing performance issues in the bedroom, you might even be considering some of these alternatives.
But there’s a lot more to sexual health than just stamina or performance. If someone experiences difficulty having an erection, many of these products (despite their spectacular claims) are rarely effective, particularly when a more direct and scientifically researched treatment is needed to treat issues like erectile dysfunction.
Here, we break down seven of the best ED medications and everything you need to know about taking them.
Language matters
Sex and gender exist on spectrums. For the purposes of this article, we use “male” and “female” to refer to a person’s sex assigned at birth. Learn more about sex and gender.
Erectile dysfunction (ED) is when someone cannot achieve a firm erection or loses their erection before or during sexual activity.
Losing an erection can happen sometimes and shouldn’t be a major cause for concern every once in a while. But if it starts occurring several times a week and over a period of four or more weeks, it may be an indicator of ED.
Contrary to popular belief, ED isn’t a condition that just affects older males. Young males can experience ED too — and it’s actually more common than some people might realize. The Urology Care Foundation estimates that this condition affects approximately 30 million men in the United States.
Erectile dysfunction can develop as the result of several different factors, both physical and psychological, that contribute to a person’s ED symptoms. Talking with your doctor can help pinpoint what’s possibly causing your ED and you can both start to build an effective treatment plan.
For many people, making changes to their daily routine can help reduce ED symptoms. This could include diet modification, talk therapy, or erectile dysfunction medications.
Not everyone with ED needs to take medications. You should be aware of the cause of your ED before starting a medication.
If you think you have ED, see your primary care doctor. They’ll do a physical exam and request certain lab tests, as well as a complete medical and psychosocial history.
They may also refer you to a mental health professional who can help you manage performance anxiety or relationship issues related to your ED.
ED caused by underlying conditions
Your ED may be caused by untreated diabetes, high blood pressure, or another issue. Treating that condition first may improve your ED symptoms.
ED caused by medications
Other medications you’re taking may cause ED. These may include drugs used to treat:
- high blood pressure
- heart disease
- depression
- seizures
- cancer
Your doctor can also review any medications you’re currently taking and make some changes that could improve your ED.
Other causes of ED
There are other things that can contribute to ED. Adopting habits that promote overall health and well-being may help improve your symptoms.
Try limiting or avoiding smoking if you smoke, maintaining a moderate weight, getting regular exercise as often as possible, and limiting alcohol intake.
ED commonly occurs when blood flow to the penis is restricted or inhibited. When aroused, if blood is unable to flow to and from the penis effectively, it can’t stiffen into an erection or be kept for the entire length of a sexual encounter.
ED medications work by reversing or limiting the impact of whatever’s inhibiting that blood flow. One of the most common ED medications is known as a PDE5 inhibitor.
PDE5 stands for phosphodiesterase type 5 and it’s an enzyme that builds up over time and prevents regular blood flow to and from the penis. Taking a PDE5 inhibitor temporarily limits the effect of PDE5 and allows a person to more easily have an erection.
Less common treatments focus on improving heart health and blood pressure as a way to minimize ED symptoms.
Your doctor may want to explore other treatment options, especially if traditional PDE5 inhibitors aren’t working for you, because ED can be an early indicator for more severe health conditions like diabetes or heart disease.
If you’re looking for options to treat your ED, we have gathered this list of the most common ED medications and how effective they are at treating ED.
1. Alprostadil
Alprostadil (Caverject, Edex, MUSE) comes as an injectable solution and as a penile suppository.
You’ll inject the solution directly into your penis 5 to 20 minutes before having sex. You can use it as needed up to three times per week. You should let at least 24 hours lapse between injections.
With MUSE (or Medicated Urethral System for Erections), the suppository should be administered 5 to 10 minutes before sex. It should not be used more than twice in a 24-hour period.
Price for alprostadil
Currently, there’s no generic version of alprostadil available on the market, just the three brand name options. This means that the price for alprostadil will be higher when compared with generic alternatives to other ED medications.
According to GoodRX, the average retail price for two cartridges of 10mcg is around $180.
Pros
studies have proven its effectiveness- FDA-approved as an injectable treatment for ED
- use as needed and works within minutes
- alternative for people who didn’t respond well to oral pills
Cons
- using it as an injectable may make some users uncomfortable
- while available as an
effective topical cream in some countries, it’s not FDA-approved in the US.
Common side effects of alprostadil
- pain in the penis and testicles
- burning in the urethra
2. Avanafil
Avanafil (Stendra) is an oral drug and a PDE5 inhibitor. You should take it about 15 minutes before having sex. Do not take it more than once per day.
You should not use any PDE5 inhibitors if you’re also taking nitrates to treat heart disease. Examples of nitrates include isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat). Taking nitrates with avanafil can cause severely low blood pressure and even death.
Price for avanafil
Avanafil is currently only available as the brand name drug, Stendra. Like with most brand-name medications, the overall cost will likely be higher when compared with other generic alternatives.
The price for avanafil can vary widely based on the pharmacy filling the prescription. Retail prices generally range from $320 to $405 for six 200mg tablets, according to GoodRX.
Pros
- classified as a PDE5 inhibitor, one of the most common ED treatments
- FDA-approved medication
- effective in 15 to 30 minutes
- minimal side effects
Cons
- might be too expensive for some budgets
- can have very severe interactions with nitrates
Common side effects of avanafil
- headache
- flushing, or the reddening and warming of your face
- stuffy or runny nose
- back pain
- sore throat
3. Sildenafil
Introduced in 1998 as the first PDE5 inhibitor, sildenafil (Viagra) is probably the most widely known ED treatment.
Viagra is only available as an oral tablet and there are also several generic versions of the drug available at a lower price. It should only be taken once per day, as needed. It can take about 30 minutes to start working and should be taken about an hour or so before sex to lower the chances of ED.
Price for sildenafil
Sildenafil can be a very budget-friendly erectile dysfunction medication and thanks to several online prescriber services like Roman and Hims, the price is very affordable even without insurance.
Generic sildenafil can cost as little as $2 per pill from some providers.
Pros
- as the first PDE5 inhibitor, several studies have proven its effectiveness, even from as far back as
2002 - FDA-approved medication
- only needs to be taken as needed
- very affordable price for generic sildenafil
Cons
- may have more minor side effects, like upset stomach or vision changes, compared to newer medications
- still requires a prescription, despite how long it has been on the market
Common side effects of sildenafil
- headache
- flushing
- stuffy or runny nose
- back pain
- upset stomach
- muscle aches
- vision changes, like blurry vision and changes in how certain colors look
4. Tadalafil
Tadalafil (Cialis) is an oral drug that increases blood flow throughout your body.
You can take this PDE5 inhibitor at a higher dose about 30 minutes before sex — no more than once per day — or at a lower dose every day so you’re always ready for sex and don’t need to plan ahead. It may work for up to 36 hours.
Price for tadalafil
Tadalafil is available as brand name Cialis or as generic tadalafil.
Depending on your needs, you may consider taking a higher dose that’ll be taken as needed but at a higher price per pill. Or, consider taking a lower dose every day, which costs less per pill, but the overall cost can add up quickly when buying a full month’s supply of pills.
As of September 2022, Generic daily 5mg tadalafil can cost around $8 per dose and higher doses of generic tadalafil — 10mg and 20mg — can start around $44 per pill.
Pros
- can be taken as needed at a higher dose or daily at a lower dose
- FDA-approved medication
- very affordable price for generic tadalafil
- can be effective for up to 36 hours at a higher dosage
Cons
- daily brand name Cialis can be too expensive for some budgets
- some users experience discomfort from specific side effects and explore other options
- requires a prescription, regardless of dosage
Common side effects of tadalafil
- headache
- flushing
- stuffy or runny nose
- back pain
- upset stomach
- pain in the limbs
5. Testosterone
Testosterone is the primary sex hormone in the male body. It plays many roles in overall health.
Testosterone levels naturally drop with age. This change can lead to ED and other issues, like:
- fatigue
- low sex drive
- reduced sperm count
- weight gain
Doctors sometimes prescribe testosterone to treat ED. In fact, PDE5 inhibitors are most effective when used alongside testosterone therapy in people with a testosterone deficiency. But the drug does come with risks.
Testosterone can increase your chance of a heart attack or stroke. Because of these risks, the
Your doctor will watch you closely if they prescribe testosterone. They’ll test the levels of testosterone in your body before and during your treatment with this drug. If your testosterone levels are too high, your doctor will stop your treatment or lower your dosage.
Price for testosterone
Testosterone therapy and testosterone treatment options can come in many forms, including:
- gels
- creams
- capsules
- implants
As a result, it’s difficult to establish a price range that’s all-inclusive and doesn’t vary widely across all the different types. If you or your doctor are considering testosterone as a treatment for ED, it’s worth also discussing with them the overall cost to you and which treatments best fit into your budget.
Pros
- can have additional health benefits beyond ED treatment
- several different delivery methods to match your daily routine
- effective ED treatment when used alongside PDE5 inhibitors
Cons
- may require frequent testing of testosterone levels
- some types, like gels and creams, can be very potent and require very careful application
- side effects can be very extreme compared to other ED treatments
Possible side effects of testosterone
- acne
- male breasts
- prostate growth
- fluid retention that causes swelling
- moodiness
- sleep apnea, or interrupted breathing during your sleep
Testosterone for ED comes in many forms. The table below lists the forms of testosterone and their brand-name versions. Some forms may also be available as generic drugs.
| Testosterone form | Brand names |
|---|---|
| transdermal cream | First Testosterone Cream 2% |
| transdermal gel | AndroGel, Fortesta, Testim, and Vogelxo |
| transdermal patch | Androderm |
| transdermal solution | None (only available as generic) |
| topical gel | AndroGel and Natesto |
| nasal gel | Natesto |
| oral capsule | Testred |
| oral tablet | Android 25 |
| mucoadhesive film that dissolves under your gums | Striant |
| pellet implant | Testopel |
| solution for intramuscular injection | Depo-Testosterone and Aveed |
6. Vardenafil
Vardenafil (Levitra, Staxyn) is an oral drug and PDE5 inhibitor. It’s also available only with a prescription.
You should take it as needed about 60 minutes before sex but for some people, it can start working in about 30 minutes. You can take this drug up to once per day and it’s effective for about 5 to 7 hours.
Price for vardenafil
Depending on the pharmacy and even the state you’ll be buying it from, can cause the price for vardenafil to really vary. But generally speaking, the price can range from around $78 to $150 for ten 20mg tablets according to GoodRX.
Pros
- very popular because it’s one of the fastest-acting PDE5 inhibitors
- FDA-approved medication
- strong side effects are uncommon (the most common side effect is headache)
- available in generic form at a lower price than brand-name Levitra and Staxyn
Cons
- potentially severe side effects if taken with nitrates, alpha-blockers, or certain other heart and blood pressure medications
Common side effects of vardenafil
- headache
- flushing
- stuffy or runny nose
- back pain
- upset stomach
- dizziness
7. Vitamins and supplements for ED
There are many vitamins and supplements on the market that claim to help ED. Some promise better sexual function as well as increased energy and vitality. But these supplements usually do not work. They may also be unsafe.
Some supplements that are marketed as “natural” may even contain drugs. ED supplements can still interact with other medications you’re taking. They may also cause side effects.
Talk with your doctor before trying any vitamins or supplements for ED.
The best place to get medications for ED is from your doctor or a licensed medical professional. Although some online pharmacies may sell or deliver ED medications, these are often unregulated and may contain ineffective or harmful ingredients.
ED medications vary in price. You can sign up for a subscription service, like Hims or Roman, and save money by purchasing multiple-month shipments.
If you’re getting these medications at a pharmacy with insurance, the cost will vary, too. Some coupons can be found online if you search for the medication you’re trying to get.
Without insurance or participating in one of these subscription services, the prices of ED medications — especially the name-brand versions — are quite expensive.
The average cost per pill of Viagra, for example, is $70. But sildenafil, the generic version of Viagra, costs as low as $9 per pill. Many services sell these therapies, so a bit of research should help you keep some money in your wallet.
How well do ED pills work?
The ED pills mentioned above have differences, including price points. Sildenafil has been on the market the longest, and its side effects are well known. It’s often the first erectile dysfunction medication that doctors turn to.
While medication for ED works often, sometimes addressing the underlying causes can be helpful too. Some ED drugs can have unpleasant side effects, like headaches, that cause discomfort.
It’s worth noting that some ED medications have different onset times in different people. The time these medications are effective also varies in individuals.
How quickly do ED pills work?
Most ED medications take about 15-45 minutes on average to work.
Sildenafil takes between 30 minutes and an hour to work, and it works for between 1 and 4 hours. Cialis can take up to 2 hours and last for 36 hours. There’s also a Cialis regimen that’s taken daily.
What are the side effects of ED pills?
Side effects of ED pills can range from headaches to nausea and diarrhea. Other mild side effects include warmness in the chest, neck or face, and a stuffy nose.
Some of the more serious side effects include back pain, loss of hearing, ringing in the ears, and the inability to see the differences between green and blue.
If you have underlying health conditions, you’ll want to abstain from ED meds or consult your physician for guidance.
Some of these conditions include liver disease, kidney disease, and low or uncontrolled high blood pressure. Nitrate drugs and ED medications should not be used at the same time because this combination could have serious health implications.
How do I choose the best medication for me?
These drugs are similar in their efficacy, so personal preference is important. Consider cost, ease of use, how long the drug lasts, and if you want a medication for one-time use or ongoing therapy.
There are generic versions of sildenafil, vardenafil, and tadalafil available, and you can get these medications via subscription services like Hims or Roman.
If you have signs of ED, keep in mind that the condition is often caused by another medication you’re taking or a health condition. Getting treatment for the underlying health issue or having your doctor adjust your drug regimen may be all that’s needed to ease your symptoms.
If you do need ED medications, there are many options. They come in different forms and work in unique ways. They also can cause side effects that are specific to the medication.
Together, you and your doctor can find the best ED medication for you.
ED is a common condition that can affect a person’s self-esteem and relationships. ED can be caused by underlying health issues or occur as a normal part of the aging process. Fortunately, there are many approved treatments to treat it.
There are a wide variety of ED meds, so choosing one based on cost and ease of use is usually the best place to start.
As always, if you have any health conditions or are on medications, be sure to speak with a physician first. These medications can have rare but sometimes serious, life threatening side effects.