Key takeaways

By age 70, nearly 70% of men in the United States will experience erectile dysfunction (the inability to achieve or maintain an erection), which is often treatable with pills like Viagra (sildenafil) or Cialis (tadalafil).
Before using erectile dysfunction medication, check with your healthcare provider about potential interactions with existing health issues or medications (such as nitrates or alpha blockers).
Erectile dysfunction pills work by improving blood flow to the penis and must be used along with sexual stimulation. Medicines in this drug class, called PDE5 inhibitors, have different onset times and durations of effect.
Other treatments for erectile dysfunction include lifestyle changes, therapy, supplements, and in some cases, testosterone replacement therapy or alprostadil, depending on the underlying cause of the dysfunction.

By age 70, nearly 70% of men in the United States will experience erectile dysfunction, also known as impotence. In other words, the inability to achieve or maintain an erection is a very common problem. Fortunately, it is often easily treatable and curable with erectile dysfunction pills.

What are the most effective pills for erectile dysfunction?

Depending on the underlying cause of the condition, the most commonly prescribed oral erectile dysfunction medications include:

Although each of these pills work using the same mechanism, they each have differences. They inhibit an enzyme called phosphodiesterase type 5. These phosphodiesterase type 5 inhibitors (PDE5 inhibitors or PDE5i) don’t cause sexual arousal; they improve blood flow to the penis allowing you to experience healthy erections.

Do erectile dysfunction pills work?

Sildenafil (Viagra), vardenafil (Levitra), avanafil (Stendra), and tadalafil (Cialis) are all considered first-line ED treatments because of their effectiveness and safety profile.

Before taking any of these ED medications, tell your doctor about any medications or supplements you’re already taking, plus other health issues, such as heart disease, low blood pressure, or diabetes. Certain drugs interact with these pills. For example, you shouldn’t use any PDE5 inhibitors if you’re also taking nitrate drugs and caution is needed if you are on alpha-blockers. Being transparent with your physician will help determine the best medication and erectile dysfunction treatment for you.

Erectile dysfunction drugs

The following FDA-approved medications are commonly prescribed to treat ED.

Sildenafil (Viagra)

Possibly the most famous brand-name ED drug recommended to treat erectile dysfunction, Viagra is a PDE5 inhibitor. Viagra is available in 25 milligram (mg) to 100 mg tablets. It’s taken orally about 30 minutes before sexual stimulation, and its effects can last four to five hours.

Although not addictive, there is risk of the following side effects when taking sildenafil:

dizziness
loss of hearing or ringing in the ears
stomach pain and nausea
headaches
warmth or redness in the face, neck, or chest
nasal congestion
diarrhea
back pain
memory problems
inability to differentiate between the colors green and blue

Sildenafil is also available as Revatio, a low dose pill or injection, but only for the treatment of pulmonary arterial hypertension (PAH), not for erectile dysfunction.

Tadalafil (Adcirca, Cialis)

Tadalafil is a PDE5i, like sildenafil, that increases blood flow to the penis to facilitate an erection. It enhances the effect of a natural chemical blood vessels produce called nitric oxide, which helps the muscles in the arteries of the penis to relax and dilate, allowing more blood to enter. It has a little different chemical structure compared to Sildenafil and can take up to two hours to reach maximum effectiveness. However, its effects can last for up to 36 hours.

If tadalafil is taken as needed, the dosage is 5 mg to 20 mg orally prior to sexual activity. However, some men prefer to take Cialis daily. The initial dose for daily use is 2.5 mg, taken once daily at the same time. Eventually, the patient will transition to a daily maintenance dose between 2.5 mg and 5 mg.

The more common possible side effects of tadalafil include:

stuffy or runny nose
flushing
headache
back pain
upset stomach
pain in the limbs

Tadalafil is also available as Adcirca, but only for the treatment of pulmonary arterial hypertension (PAH), not for erectile dysfunction.

Vardenafil (Levitra, Staxyn)

Another PDE5 inhibitor, vardenafil (Levitra, Staxyn), is an oral drug taken as needed 60 minutes before sex. You can take this erectile dysfunction drug up to once per day as recommended by your doctor.

Most patients start with a 10 mg dose of vardenafil, however it’s available as an oral medication in 2.5 mg, 5 mg, 10 mg, and 20 mg doses.

It has very similar possible side effects as other PDE5i drugs, including:

headache
dizziness
upset stomach

Like all PDE5 inhibitors, Vardenafil may interact with other drugs. It should not be prescribed to patients taking potent CYP3A4 inhibitors like ketoconazole and ritonavir, or to patients with severe cardiovascular disease, who are taking nitrates like nitroglycerin, which is prescribed to prevent chest pain.

Avanafil (Stendra)

The most rapidly absorbed PDE5 inhibitor available, Avanafil (Stendra) can reach maximum concentrations after only 30-45 minutes. It is taken orally 30 minutes before sex and can work for 6-12 hours.

Common adverse effects of avanafil include:

headache
flushing
stuffy nose
sore throat

How long do ED pills last? A PDE5i Comparison

Is Stendra more effective than Viagra?

Stendra (avanafil) and Viagra (sildenafil) are both effective PDE5 inhibitors used to treat erectile dysfunction. Like all PDE5 inhibitors, they work by relaxing smooth muscle and increasing blood flow to the penis.

The main difference between the two erectile dysfunction medicines is not their effectiveness, but their onset and duration.

Stendra works quickly and can possibly be effective as soon as 15 minutes before sexual activity. It can last for up to 12 hours. Comparatively, Viagra should be taken 30 to 60 minutes before sex, and lasts for about 5 hours.

Which is better: Viagra or Cialis or Levitra?

The key differences between all PDE5 inhibitors are the onset and duration time of the drugs.

Levitra (vardenafil) and Viagra (sildenafil) are especially similar.

Levitra should be taken one hour before sexual activity, whereas sildenafil has a larger window. It can be taken anywhere from 30 minutes to 4 hours before sexual activity. The time it takes to work varies by individual.

When you compare Cialis to Viagra and Levitra, there are two key differences:

Cialis can be taken either as needed, or daily. Viagra and Levitra are taken no more than once a day, only as needed.
Cialis lasts much longer than Viagra or Levitra, anywhere from 24 to 36 hours (or continuously if taken daily) compared to 4 to 5 hours.

Other treatments for ED

Because there are many causes of sexual dysfunction, there are a variety of other treatment methods many people use to improve the condition and their sexual health. These include:

Acupuncture
Talk therapy (counseling)
Food and diet changes
Meditation
Exercise
Penile implants and pumps

Or, over-the-counter supplements and vitamins that some people report as effective for men’s health. Some popular options include:

L-arginine
Ginseng
Yohimbe

As there is a risk that these remedies may interact with other drugs, you should always seek medical advice from your doctor before starting any over-the-counter or natural treatments.

Your doctor may also recommend the following erectile dysfunction treatments.

Alprostadil (Caverject, Viridal, MUSE)

Alprostadil is a second-line therapy for erectile dysfunction. This drug is available as an injection (Caverject, Viridal) or a urethral suppository (MUSE). It is a vasodilator that dilates blood vessels to increase blood flow to the penis and allow an erection.

Testosterone replacement

If you have low levels of the male sex hormone, testosterone, your doctor may suggest testosterone replacement therapy to improve sexual dysfunction. This can be used alone or in combination with other medications and therapies.

Your testosterone levels can be checked with a simple blood test. Beyond erection problems, symptoms of low testosterone, an essential hormone for normal erections, include:

Reduced sex drive
Breast growth
Loss of body hair
Increased body fat
Drop in muscle strength and size

If you do begin hormone therapy, these are some potential side effects:

Fluid retention
Acne
Enlarged breasts and prostate
Decreased fertility
Increase in red blood cells
Worsened sleep apnea symptoms

How to choose the right option for you

Erectile dysfunction is treatable and often curable. It can also serve as a warning sign, a first indicator of underlying conditions such as cardiovascular disease, high blood pressure, kidney disease, high cholesterol, diabetes, obesity, alcohol abuse, or neurologic disorders. When you tell your doctor about ED, it can help with early diagnosis.

It’s best to speak openly to your doctor or a specialist in urology about your experience to figure out which treatment options will work best for your symptoms, needs, and lifestyle. If you decide to purchase any prescription medications or supplements online, always ensure your are buying from a trusted and reputable website. Look for pharmacy credentials to avoid counterfeit or diluted products, and never buy them without a prescription.