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When you think of erectile dysfunction (ED), you probably think of Viagra. That’s because Viagra was the first oral pill to treat ED. It was approved by the Food and Drug Administration (FDA) in 1998.

Viagra can be very effective in treating ED, but there are lots of alternatives to Viagra. Because it can be expensive, or if you’d like to avoid taking a medication, you may want to try other options. Continue reading to learn about other ED drugs, as well as some alternative methods of treating ED.

Although Viagra is considered to be the most common prescription medication for ED, quite a few are on the market. They all work by improving blood flow to the penis so that you can get and maintain an erection long enough to have sex.

Because of each medication’s unique chemical makeup, you may react differently to each of them. It may take a little trial and error to determine which one works best for you.

Taking oral medications isn’t enough to provide an erection. These medications are designed to work alongside physical or emotional sexual stimulation to prompt an erection.

Other prescription medications used to treat ED include:

Tadalafil (Cialis)

Cialis is an oral tablet that starts to work about 30 minutes after you take it. It can improve erectile function for up to 36 hours. The starting daily dose range is 2.5 milligrams to 5 milligrams, but it can be increased or decreased as necessary. You take it as needed, but never more than once per day. You can take Cialis with or without food.

There’s also a once-per-day version. These 2.5-milligram tablets must be taken at the same time every day.

Vardenafil (Levitra)

Take Levitra about 1 hour before sexual activity. The starting dose is usually 10 milligrams. Don’t take it more than once per day. You can take these oral tablets with or without food.

Vardenafil (Staxyn)

Staxyn is different from the other ED drugs because you don’t swallow it with water. Instead, you place the tablet on your tongue and allow it to dissolve. Do this about 1 hour before sexual activity.

Don’t crush or split the tablet. You can take it with or without meals, but not with liquids. The tablets contain 10 milligrams of medication. Don’t take Staxyn more than once per day.

Avanafil (Stendra)

Stendra comes in 50-, 100-, and 200-milligram tablets. You take it about 15 to 30 minutes before sexual activity, but never more than once per day. You can take it with or without food.

Risk factors and side effects

Before taking any ED medication, tell your doctor about any preexisting health conditions you have. Also, discuss any other drugs or supplements you’re currently taking. Some ED medications can interact with other medications and cause serious side effects.

Don’t take ED medications if you:

  • take nitrates, which are usually prescribed for chest pain, or angina
  • have low blood pressure, or hypotension

Additionally, your doctor may advise against taking ED medications if you:

  • take certain other medications that may interact with the ED medication
  • have uncontrolled high blood pressure, or hypertension
  • have liver disease
  • are on dialysis due to kidney disease

The most common side effects of ED drugs are temporary. They include:

  • headache
  • indigestion or upset stomach
  • back pain
  • muscle aches
  • flushing
  • stuffy or runny nose

Although it’s uncommon, some ED drugs can cause a painful erection that won’t go away. This is known as priapism. If an erection lasts too long, it can damage your penis. If your erection lasts more than 4 hours, seek immediate medical attention.

Other uncommon symptoms of ED medication are changes to hearing and vision, including color vision.

If you take medication for other health conditions, you may not be able to take an oral medication for ED. Although a few natural remedies may work to relieve your symptoms, more research is needed to determine their effectiveness. Many products claim to cure ED, but there isn’t always enough research that backs up those claims.

Whatever alternatives you choose, it’s best to discuss them with your doctor before use. A doctor can help you decide whether this is the best option for you.

L-arginine

L-arginine is an amino acid. One small 1999 study found that oral L-arginine was no better than a placebo in treating ED, but another small study found some evidence that high doses of L-arginine can improve blood flow and help ED. Potential side effects of use include nausea, cramps, and diarrhea. Don’t take this if you take Viagra.

Learn more about L-arginine supplements and erectile dysfunction.

Red ginseng

Red ginseng is an herbal supplement. A 2008 systemic review of 7 studies found that red ginseng may be effective in treating ED. Researchers cautioned that more high quality studies are needed to better determine the potential benefits and risks of this supplement.

If you plan on trying ginseng, speak with your doctor about dosing. Side effects may include headaches, sleep problems, and gastrointestinal problems.

Tell your doctor if you’re taking other medications because they can interact with the supplement and lead to harmful side effects. Ginseng may lower blood sugar levels, so use it with caution if you take medication for diabetes.

Acupuncture

Acupuncture is an ancient healing practice used for a variety of conditions. Although it’s been suggested that acupuncture can treat ED, there’s little evidence regarding its effectiveness.

A 2016 systemic review failed to prove that acupuncture alone was effective in treating ED. The authors did note the small sample size and poor quality of the studies involved. More research is needed.

If you’re considering acupuncture, search for a qualified and certified practitioner.

Check out melatonin as a treatment for erectile dysfunction.

There are several options to treat erectile dysfunction aside from oral medications like Cialis, including:

Make an appointment with a doctor or other healthcare professional if you’re frequently:

  • concerned about the overall firmness of your erection
  • unable to get or maintain an erection
  • stressed or concerned about your sexual performance

These could be symptoms of ED.

ED may be a symptom of an underlying medical condition, so it’s important to meet with your doctor. Also mention to your doctor any other symptoms you may be experiencing. They can help you determine whether your ED is isolated or related to something else. Treating the underlying condition may resolve the problem.

Other tips to keep in mind while treating ED:

  • Always take ED medications exactly as directed. Talk with your doctor before increasing the dose, and report any troubling side effects.
  • Don’t mix treatments. Taking an oral medication while using a natural remedy may cause harmful side effects.
  • Natural doesn’t always mean safe. Herbal or other dietary supplements can interact with medications. When considering something new, consult with your doctor or pharmacist, and be sure to report side effects.

Aside from drugs and herbal remedies, certain lifestyle factors can contribute to ED. Whatever treatment you choose, it may help if you also:

  • Avoid or limit alcohol use.
  • Quit smoking, if you smoke.
  • Maintain a moderate weight.
  • Get sufficient sleep every night.
  • Engage in regular exercise, including aerobic exercise.
  • Try pelvic floor exercises. A small 2005 study concluded that pelvic floor exercises should be a first-line approach in treating ED.

If you’ve reviewed the suggestions we’ve made and you’re still having erection issues, contact your doctor.

Other methods to treat ED include blood vessel surgery, vacuum pumps, and penile implants. If the problem persists, talk with your doctor about these and other alternatives.

Keep reading about effective over-the-counter treatments for erectile dysfunction.