7 Effective Erectile Dysfunction Medications and How They Work

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There’s certainly no shortage of medications, supplements, and herbal remedies that claim to boost testosterone levels and sex drive. Especially if you’ve 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.

Blen Tesfu, MD, and general practitioner, agrees. “It’s understandable why someone might turn to natural or herbal supplements when facing ED,” she says. “However, it’s critical to remember that such supplements are not regulated by the Food and Drug Administration (FDA) to the same extent as prescription medications, which means their safety, efficacy, and the truthfulness of their labeling cannot be guaranteed. Additionally, some supplements may interact negatively with other medications.”

Here, we break down seven of the best ED medications and everything you need to know about taking them.

These are the seven most common types of ED medications:

• alprostadil
• avanafil
• sildenafil
• tadalafil
• testosterone
• vardenafil
• vitamins and supplements

Erectile dysfunction (ED) is when someone cannot achieve a firm erection or loses their erection before or during sexual activity.

Linda Khoshaba, NMD, FABNE, and founder of Natural Endocrinology Specialists (NES), defines ED as “the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.”

During her experience as a naturopathic endocrinologist, Khoshaba has seen a variety of factors that can contribute to ED, including diabetes, heart diseases, hormonal imbalances, and psychological issues.

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 4 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, visit your primary care doctor. They’ll do a physical exam and request certain lab tests, as well as a complete medical and psychosocial history.

“ED can be caused by a variety of factors, both physical and psychological,” Tesfu says. “Some of the most common physical causes include heart disease, high cholesterol, high blood pressure, diabetes, obesity, tobacco use, alcohol, and certain types of prescription medications.”

Based on your physical exam and health evaluation, a doctor 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.

“Maintaining a healthy weight, engaging in regular physical activity, limiting alcohol, avoiding tobacco and illicit substances, and managing stress can all contribute to better erectile function,” Tesfu says.

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 effect 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.

“These medications work by enhancing the effects of nitric oxide, a natural chemical the body produces to relax muscles in the penis, increase blood flow, and facilitate an erection in response to sexual stimulation,” Khoshaba explains.

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 10 mcg is around $180.

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. Don’t 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 200 mg tablets, according to GoodRx.

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 a 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.

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 5 mg tadalafil can cost around $8 per dose, and higher doses of generic tadalafil — 10 mg and 20 mg — can start around $44 per pill.

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, such as:

• 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 FDA says that only people who have low testosterone due to certain health issues should use testosterone.

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.

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.

6. Vardenafil

Vardenafil (Levitra, Staxyn) is an oral drug and PDE5 inhibitor. Levitra is taken as an oral tablet that’s swallowed, while Staxyn is a disintegrating tablet that should be placed under the tongue while it dissolves. This type of disintegrating medication means that Staxyn has higher systemic exposure compared with Levitra. Vardenafil, in both forms, is 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 20 mg tablets, according to GoodRx.

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 don’t 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 brand name 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? Can I regain erectile strength?

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.

Also, Khoshaba notes that medication isn’t required for all cases of ED. “In some cases, psychotherapy and/or behavioral therapy can be extremely effective, especially when the ED is due to psychological factors, such as stress, anxiety, or depression,” she says.

How quickly do ED pills work?

Most ED medications take about 15 to 45 minutes on average to work.

Sildenafil takes between 30 minutes and 1 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.

What is the most effective medication for ED? 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.

What is better than Viagra for ED?

Viagra is usually the first ED medication prescribed, Tesfu says. “It has been available for over 20 years and is often very effective,” she says. However, it’s important to know that one ED medication may not work the same for everyone.

Also, your choice of medication may depend on your lifestyle and preferences. Tesfu explains that Cialis may last longer than Viagra, while newer medications like Stendra may carry fewer side effects than older classes of ED drugs. Additionally, “men who take nitrate medications for heart disease cannot use ED pills,” Tesfu cautions.

It’s important to discuss all ED treatment options with a doctor. Aside from oral medications like Viagra, other options may include injections or testosterone replacement therapy, as well as behavioral or psychotherapies to address underlying mental health considerations, Khoshaba says.

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’re experiencing symptoms of ED, such as persistent trouble getting or keeping an erection, reduced sexual desire, or concerns about your erections or sexual performance that cause stress or relationship tension, it’s a good idea to consult with a healthcare provider,” Tesfu says.

“It’s especially important to seek help if your ED symptoms are associated with other worrying symptoms like chest pain, shortness of breath, or changes in physical health,” she adds. “The earlier you address the issue, the better the outcomes tend to be.”

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.

“It’s also important to understand that while these medications can help manage the symptoms of ED, they do not generally address the underlying causes,” Khoshaba cautions. “Therefore, lifestyle changes like quitting smoking, regular exercise, a healthy diet, limiting alcohol consumption, and stress management are key for the long-term management of ED.”