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Key takeaways
Sildenafil citrate, a common treatment for erectile dysfunction, may not work for everyone, leading to the exploration of alternatives such as Tadalafil, Stendra, Vardenafil, Caverject, and Muse.
Alternatives like Tadalafil offer a longer duration of action and less meal interference. At the same time, Stendra provides the quickest onset among PDE5 inhibitors, and Vardenafil is available as an oral-disintegrating tablet for convenience.
For those experiencing adverse effects from PDE5 inhibitors or seeking different treatment routes, alprostadil-based treatments like Caverject (injections) and Muse (suppositories) offer alternatives. However, they come with their own set of potential side effects.
Natural alternatives and psychological counseling are available for those hesitant about prescription medications, but caution is advised with untested supplements, and professional consultation is recommended for a tailored treatment approach.
Struggling to obtain or maintain an erection can create a host of feelings, and failure to get relief from the medication prescribed to treat it can be disappointing. Sildenafil citrate is a commonly prescribed drug for erectile dysfunction (ED). Since it is the generic version of Viagra, sildenafil is well recognized, and as a result of being generic, it can be far less expensive. While it works well for many men, sildenafil can be ineffective for others. Adverse effects of the drug can be another reason for wanting to switch to a different option. Continue reading to learn more about the alternatives to sildenafil citrate, how they work, and how they compare to sildenafil.
What can I take in place of sildenafil citrate?
Sildenafil citrate belongs to the highly popular and much-marketed phosphodiesterase-5 (PDE5) inhibitor class. Viagra is famously known as the ‘little blue pill’. Besides Viagra, Cialis is the other commonly known brand name within the category. Stendra and generic vardenafil (formerly branded as Levitra and Staxyn) are other Viagra alternatives within the group. When sexual stimulation results in nitric oxide release, cyclic guanosine monophosphate (cGMP) is activated, dilating blood vessels and an influx of blood to create an erection. More cGMP is good, and PDE5 inhibitors help stop phosphodiesterase-5 from breaking down cGMP.
Trying a different PDE5 inhibitor may be worth it if generic Viagra fails. However, if other medications within this drug class are a letdown, other treatment options exist. Alprostadil (prostaglandin E1) presents another way to increase penile blood to improve erectile function. It can be administered in a couple of different ways. These details and others might be the deciding factors in helping to choose an alternative to sildenafil.
Compare sildenafil citrate alternatives |
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| Drug name | Uses | Dosage | Savings options |
| Sildenafil citrate | Erectile dysfunction, pulmonary hypertension | 25-100 mg taken one-half to four hours prior to sexual activity or 20 mg three times daily for pulmonary hypertension | Sildenafil citrate coupons |
| Viagra (sildenafil) | Erectile dysfunction | 25-100 mg taken one-half to four hours prior to sexual activity | Viagra coupons |
| Tadalafil | Erectile dysfunction, benign prostatic hypertrophy (BPH), pulmonary hypertension | 5-20 mg taken prior to sexual activity or 2.5 to 5 mg once daily without regard to sexual activity, 5 mg once daily for BPH, 40 mg once daily for pulmonary hypertension | Tadalafil coupons |
| Cialis (tadalafil) | Erectile dysfunction, BPH | 5-20 mg taken prior to sexual activity or 2.5 to 5 mg once daily without regard to sexual activity, 5 mg once daily for BPH | Cialis coupons |
| Vardenafil | Erectile dysfunction | 5-20 mg taken 1 hour prior to sexual activity | Vardenafil coupons |
| Stendra (avanafil) | Erectile dysfunction | 50-200 mg taken 15 minutes prior to sexual activity | Stendra coupons |
| Caverject (alprostadil) | Erectile dysfunction | Individualized dose delivered by intracavernous injection into penis | Caverject coupons |
| Caverject Impulse (alprostadil) | Erectile dysfunction | Individualized dose delivered by intracavernous injection into penis | Caverject Impulse coupons |
| Edex (alprostadil) | Erectile dysfunction | Individualized dose delivered by intracavernous injection into penis | Edex coupons |
| Muse (alprostadil) | Erectile dysfunction | 250-1000 mcg intraurethral suppository | Muse coupons |
Top 5 sildenafil citrate alternatives
The following are some of the most common alternatives to sildenafil citrate.
1. Tadalafil
There are a number of reasons why tadalafil may be chosen instead of sildenafil. Tadalafil, the generic version of Cialis, can assist with attaining an adequate erection for up to 36 hours after a dose, compared to only 4 hours with sildenafil. Knowing its effect on sexual function is present for 36 hours might be an appealing feature. Unlike sildenafil, the absorption of tadalafil is not affected by taking it after a meal, so that is one less thing to worry about.
Tadalafil is also available as a once-a-day pill for ED treatment, which some men find to be more effective or to have fewer side effects. The daily option permits more sexual spontaneity, which might be of value. By being a generic PDE5 inhibitor like sildenafil, there also are the benefits of lower prices on tadalafil than brand name options. In fact, coupons and the discount card from SingleCare offer massive savings on tadalafil.
2. Stendra
In the brand-name-only column of erectile dysfunction medications, Stendra may overshoot the price of sildenafil. However, it has a unique attribute that could make it worth the expense for the treatment of erectile dysfunction. Stendra boasts the quickest onset of action among PDE5 inhibitors. Results can be seen in as little as 15 minutes. Once again, the opportunity for spontaneity could be a valued aspect of sexual performance.
3. Vardenafil
Vardenafil has one attractive characteristic that could warrant a change from sildenafil. An oral-disintegrating tablet (ODT) formulation is available. The ODT dissolves in the mouth to permit dosing after a meal and to have a faster onset of action. Otherwise, vardenafil shares many attributes with sildenafil, such as efficacy, duration of action, and adverse effects.
In fact, the PDE5 inhibitor family has the same side effect profile. Common ones include flushing, upset stomach, and body aches. Potential serious adverse effects of PDE5 inhibitors range from hearing and vision loss to hypotension (low blood pressure) and myocardial infarction (heart attack). No member of the class has a particular advantage regarding negative reactions, although the longer duration of action of tadalafil could be problematic in this regard.
4. Caverject
If adverse effects from PDE5-inhibitors are experienced or are unsatisfactory results, alprostadil products are an alternative category. Stepping away from sildenafil and its cousins could also help avoid drug interactions. Medications for heart disease and high blood pressure, such as nitrates, are some of the ones with potentially serious interactions with sildenafil.
Alprostadil is a prostaglandin that enhances the influx of blood to the penis to create an erection within minutes. Caverject utilizes an injection into the penile shaft to deliver the alprostadil dose. Training will need to be received from a healthcare provider on how to administer the injection. While Caverject avoids many of the common side effects and drug interactions of PDE5 inhibitors, it increases the risk of penile scarring and priapism, an erection lasting more than 4 to 6 hours. Priapism is a medical emergency due to the risk of permanent tissue damage.
5. Muse
Muse is an alprostadil product that avoids the need for injections. Muse is a suppository tablet that is inserted in the meatus, the opening at the end of the penis. Scarring from injections is avoided with Muse, but the chance for penile pain, priapism, and hypotension exists. In addition, it may not be as effective as Caverject.
RELATED: Muse side effects and how to avoid them
Natural alternatives to sildenafil citrate
If the idea of alprostadil injections or suppositories and the possibility of PDE5-inhibitor side effects create second thoughts, natural alternatives might be worth a look. Vacuum-assisted erection devices are a possibility. Known as penis pumps, they encourage blood flow into the penis and are coupled with a constricting ring placed at the base of the penis. There is a learning curve and a potential for discomfort and ejaculation disturbance with the device, though.
Another non-prescription option that steers clear of ED medication is psychological counseling. Having a professional counselor address issues like depression or anxiety and advise on lifestyle changes can be quite helpful. These mental health issues are frequently embroiled with ED, as either a cause or an effect.
Dietary supplements are another item of interest for many with ED. From the start, it should be recognized that testosterone hormone replacement is a different matter and should be addressed with a medical provider to determine if it is necessary and advisable. Herbal remedies, herbal supplements, and over-the-counter options are a whole other entity. Caution is advised with these because of the possibility of a counterfeit or dangerous active ingredient in herbal aphrodisiacs. Many of these products have not been tested or approved by the U.S. Food and Drug Administration (FDA). More straightforward herbal treatments, like red ginseng and horny goat weed, have shown promise but have insufficient proof to date.
RELATED: A guide to natural cures and treatments for erectile dysfunction
How to switch to a sildenafil citrate alternatives
There is a lot to think about when it comes to potentially switching away from sildenafil. Factors like the onset of action, duration of action, adverse effects, and drug interactions are intimidating. That is why now is the time to contact a healthcare provider for medical advice.
Get an appointment to discuss what has been learned here. Other medical conditions, the use of current prescription or over-the-counter medications, and possibilities for testing testosterone levels can all be covered in conversations with your healthcare provider. Sharing ideas will help to come to an agreement on how best to move forward with sildenafil or an alternative.