Key takeaways
- The most common ED medications are PDE5 inhibitors. These work by enhancing nitric oxide effects to relax muscles in the penis, increase blood flow, and facilitate erections in response to sexual stimulation.
- ED medications are available in several forms, including pills, tablets, injectable solutions, and penile suppositories. Depending on the medication you take, they may take between 5 and 60 minutes to start working, with effects lasting up to 5 hours.
- Generic versions of medications like sildenafil can be much more affordable than brand names, with generic sildenafil costing as little as $2 per pill compared to brand-name Viagra at around $90 per pill.
- alprostadil
- avanafil
- sildenafil
- tadalafil
- testosterone
- vardenafil
- vitamins and supplements
There’s certainly no shortage of supplements and herbal remedies that claim to boost testosterone levels and sex drive. If you’ve been experiencing performance issues in the bedroom, you might 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 are rarely effective despite their claims, particularly when a more direct and scientifically researched treatment is needed to treat ED.
ED overview
ED is when you have difficulty getting a firm erection or when you lose an erection before or during sexual activity. It can develop as a result of several physical and psychological factors.
Talking with your doctor can help pinpoint what may be contributing to your ED, and you can work together to build an effective treatment plan.
Blen Tesfu, MD, a general practitioner, agrees. “It’s understandable why someone might turn to natural or herbal supplements when facing ED,” she said.
“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.”
Linda Khoshaba, NMD, FABNE, founder of Natural Endocrinology Specialists, has seen a variety of factors that can contribute to ED, including diabetes, heart disease, hormonal imbalances, and psychological issues.
Losing an erection can happen sometimes and shouldn’t be a significant cause for concern every once in a while. However, if it starts occurring several times a week and over a period of 4 or more weeks, it may be an indicator of ED.
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.
We break down seven of the best ED medications and everything you need to know about them.
Language matters
Sex and gender exist on spectrums. For the purpose of this article, we use “male” and “female” to refer to a person’s sex assigned at birth. Learn more about sex and gender.
Alprostadil
Alprostadil (Caverject, Edex, MUSE) comes as an injectable solution and a penile suppository.
You’ll inject the solution directly into your penis 5–20 minutes before having sex. You can use it as needed up to three times per week. Once your doctor has you on a dose that works well for you, allow at least 24 hours between injections..
With MUSE (Medicated Urethral System for Erections), the suppository should be administered 5–10 minutes before sex. It should not be used more than twice in 24 hours.
Price for alprostadil
Currently, there is 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 than for generic alternatives to other ED medications.
The price for one Caverject package of one 10-microgram cartridge, using a discount card, can range from $115 to $135.
Common side effects of alprostadil
- pain in the penis and testicles
- burning in the urethra
Pros
Studies have proven its effectiveness.- It’s approved by the Food and Drug Administration (FDA) as an injectable treatment for ED.
- This medication can be used as needed and works within minutes.
- It’s an alternative for people who didn’t respond well to oral pills.
Cons
- The injectable form may make some people uncomfortable.
- Although it’s available as an
effective topical cream in some countries, this form of alprostadil isn’t FDA-approved in the United States.
Avanafil
Avanafil (Stendra) is an oral drug and a PDE5 inhibitor. You take it about 15 minutes before having sex. Don’t take it more than once per day.
Don’t 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 available in either generic form or as the brand-name drug Stendra. The price of avanafil can vary widely depending on the pharmacy that fills the prescription.
Retail prices for generic avanafil, using a discount card, range from $82.52–$206 for six 200-milligram (mg) tablets.
Common side effects of avanafil
- headache
- flushing, or the reddening and warming of your face
- stuffy or runny nose
- back pain
- sore throat
Pros
- It’s classified as a PDE5 inhibitor, one of the most common ED treatments.
- Avanafil is an FDA-approved medication.
- It’s effective in 15–30 minutes.
- This medication has minimal side effects.
Cons
- It might be too expensive for some budgets.
- It can have very severe interactions with nitrates.
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. With online prescribers like Roman and Hims, the price can also be affordable even without insurance.
Generic sildenafil can cost as little as $2 per pill. Using a discount card, 6 pills of 100-mg generic sildenafil range from $8.97 to $97.22 depending on the pharmacy, while the brand-name Viagra can range from $517 to $560 for the same 6 pills at 100 mg.
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
Pros
- Sildenafil is the first PDE5 inhibitor, and several studies have proven its effectiveness, even from as far back as
2002 . - It’s an FDA-approved medication.
- It only needs to be taken as needed.
- Generic sildenafil has an affordable price.
Cons
- Sildenafil can produce more minor side effects, like upset stomach or vision changes, compared with newer medications.
- It may have dangerous interactions with drugs that contain nitrate.
Tadalafil
You can take this PDE5 inhibitor at a higher dose about 30 minutes before sex and no more than once per day. You can also take it at a lower dose every day, so you’re ready for sex and don’t need to plan ahead. It may work for up to 36 hours.
Price for tadalafil
Tadalafil is available under the brand name Cialis or as generic tadalafil.
Depending on your needs, you may consider taking a higher dose as needed. A higher dose means a higher price per pill. You can also consider taking a lower dose every day, which costs less per pill, but the overall cost can add up when buying a whole month’s supply of pills.
Generic daily 5-mg tadalafil can cost from $10.15 to $34.29 for 10 tablets when using a discount card, depending on which pharmacy you use. In contrast, higher doses of generic tadalafil — 10 mg and 20 mg — can start around $21 for 10 pills.
Common side effects of tadalafil
- headache
- flushing
- stuffy or runny nose
- back pain
- upset stomach
- pain in the limbs
Pros
- It can be taken as needed at a higher dose or daily at a lower dose.
- Tadalafil is an FDA-approved medication.
- Generic tadalafil is affordable.
- It can be effective for up to 36 hours at a higher dose.
Cons
- The daily brand-name Cialis may be too expensive for some budgets.
- Some users experience discomfort from specific side effects.
- It may have dangerous interactions with drugs that contain nitrate.
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 have been shown to be most effective when used alongside testosterone therapy in people with a testosterone deficiency. But the drug does come with risks.
Testosterone can increase your risk 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 an all-inclusive price range that doesn’t vary widely across different types.
If you’re considering testosterone as a treatment for ED, it’s worth discussing with your doctor 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
Pros
- It can have additional health benefits beyond ED treatment.
- It comes in several different delivery methods to match your daily routine.
- It’s an effective ED treatment when used alongside PDE5 inhibitors.
Cons
- It may require frequent testing of testosterone levels.
- Some types, like gels and creams, can be very potent and require very careful application.
- The side effects can be very extreme compared with other ED treatments.
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 Pump, Testim, and Vogelxo |
| transdermal solution | None (only available as generic) |
| topical gel | AndroGel Pump and Natesto |
| nasal gel | Natesto |
| mucoadhesive film that dissolves under your gums | Striant |
| oral capsule | Jatenzo |
| pellet implant | Testopel |
| solution for intramuscular injection | Depo-Testosterone and Aveed |
Vardenafil
Vardenafil (Levitra, Staxyn) is an oral drug and a PDE5 inhibitor. Levitra is an oral tablet that you swallow, while Staxyn is a disintegrating tablet that you place under the tongue while it dissolves. Staxyn is not interchangeable with Levitra brand or generic (vardenafil) tablets.
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 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 5–7 hours.
Price for vardenafil
The price of Vardenafil can vary depending on the pharmacy you use. But generally speaking, it can range from around $35.79 to $128 for ten 20-mg tablets with a discount card.
Common side effects of vardenafil
- headache
- flushing
- stuffy or runny nose
- back pain
- upset stomach
- dizziness
Pros
- Vardenafil is very popular because it’s one of the fastest-acting PDE5 inhibitors.
- It’s an FDA-approved medication.
- Strong side effects are uncommon. The most common side effect is a headache.
- It’s available in generic form at a lower price than brand-name Levitra and Staxyn.
Cons
- If taken with nitrates, alpha-blockers, or certain other heart and blood pressure medications, it can lead to potentially severe side effects.
Vitamins and supplements for ED
There are many vitamins and supplements on the market that claim to help with ED. Some promise improved sexual function as well as increased energy and vitality. But these supplements usually don’t work. They may also be unsafe.
Some supplements 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
The best place to get ED medications is from your doctor or a licensed healthcare professional. Although some online pharmacies may sell or deliver ED medications, these are often unregulated and may contain ineffective or harmful ingredients.
ED may be caused by untreated diabetes, high blood pressure, or other health conditions. In some cases, it can also be caused by certain prescription medications.
Your doctor can review any medications you’re currently taking and make changes that could improve your ED symptoms.
ED commonly occurs when blood flow to the penis is restricted or inhibited.
When aroused, if blood is unable to flow to and from your penis effectively, you won’t be able to get or maintain an erection firm enough for sexual intercourse.
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. 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 have an erection more easily.
“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 explained.
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. This is because ED can be an early indicator for more severe health conditions like diabetes or heart disease.
Prices for ED medications can vary, even if you’re getting these medications at a pharmacy with insurance. Some coupons can be found online if you search for the medication you’re trying to get.
If you’re participating in a subscription service or don’t have insurance, 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, can cost as low as $9 per pill. Many services sell these therapies, so be sure to do your research before making a purchase.
You can sign up for a subscription service, like Hims or Roman, and save money by purchasing multiple-month shipments.
Keep in mind that ED is often caused by other medications you may be taking or an underlying health condition. Getting treatment for the underlying health condition 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 professional,” Tesfu said.
“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 added. “The earlier you address the issue, the better the outcomes tend to be.”
If you do need ED treatments, there are many options. They come in different forms and work in unique ways. They can also cause side effects that are specific to the medication.
Together, you and your doctor can find the best ED medication for you.
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. How long 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 said.
Most ED pills take about 15–45 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.
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 avoid taking ED medications or consult your physician for guidance.
Some of these conditions include liver disease, kidney disease, and low or unmanaged high blood pressure. Nitrate drugs and ED treatments should not be used at the same time because this combination could have serious health implications.
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, avanafil, and tadalafil available, and you can get these medications via subscription services like Hims or Roman.
Viagra is usually the first ED medication prescribed, Tesfu says. “It has been available for over 20 years and is often very effective,” she said. 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 have fewer side effects than older classes of ED drugs. Additionally, “men who take nitrate medications for heart disease cannot use ED pills,” Tesfu cautioned.
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.
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 regular part of the aging process. Fortunately, there are many approved treatments to treat it.
There is a wide variety of ED medications, 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 doctor 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 cautioned.
“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.”