There are four types of ED pills on the market, including sildenafil and tadalafil, known by their brand names Viagra and Cialis, respectively. We compare ED pills in terms of effectiveness, cost, side effects, and more.
Erectile dysfunction (ED) occurs when you regularly have difficulty achieving or maintaining erections. ED is more than just an occasional issue with arousal. It can be an ongoing health concern.
Treating the underlying cause of ED is often the most important step. Doctors are also likely to suggest specific treatments for the symptoms you’re experiencing. Find out which ED pills, if any, may work best for you.
Safety note
ED pills are only available by prescription. They are not safe for everyone, especially if you take certain heart or blood pressure medications. Nitrates, for example, widen your blood vessels. When taken with ED pills, they
ED pills are medications taken by mouth. Available by prescription, these medications — called phosphodiesterase type 5 (PDE5) inhibitors — are designed to help relax muscles and increase blood flow in your penis during sex. While not a cure for ED, they may help you better manage ED symptoms.
Types of ED pills
There are four PDE5 inhibitors on the market. These medications do not work the same for everyone, so a doctor may suggest you start with one and try another type if you’re not getting the results you want.
- Sildenafil (Viagra): Sildenafil is available in 25- to 100-milligram (mg) doses taken once daily, only as needed, 30 minutes to 4 hours before sex.
- Tadalafil (Cialis): Tadalafil is a lower dose medication available in 2.5- to 20-mg doses. You can take it daily, so you don’t have to worry about the timing of sexual activities. You can also take it on an as-needed basis 30 minutes before sexual activity. It might be a good fit for people who don’t take other medications.
- Vardenafil: Vardenafil is available in 5- to 20-mg doses taken 1 hour before sexual activity and may have fewer side effects.
- Avanafil (Stendra): Available in higher doses of 50 mg, 100 mg, and 200 mg, you can take avanafil once a day as needed, 15 minutes before sexual activity, which is a shorter time frame than Viagra.
PDE5 inhibitors work by protecting a compound called cyclic guanosine monophosphate. This compound helps hold blood in the penile tissue during sexual stimulation, encouraging an erection. Also, by inhibiting PDE5 in penile tissues, blood vessels can better dilate, further promoting blood flow.
Additionally, PDE5 inhibitors decrease vascular pressure, which is why they may lead to hypotension when combined with nitrates and alpha-blockers.
Healthcare professionals may recommend four types of PDE5 inhibitors to help treat ED. They work similarly via slight structural differences, so some people find certain ED pills may work better than others. The results are highly individual.
The cost of your ED treatment will depend on:
- which pill you’re taking
- the dosage
- where you’re purchasing from
- how many you purchase at a time
Branded pills tend to be more expensive than generic versions.
Prices start at about $2 to $4 per 20-mg pill of generic sildenafil from services such as Roman and Hims. The cost can go up to around $70 or more per pill of branded Viagra through your local pharmacy.
One of the best ways to save money on ED pills is to use services such as Roman, Hims, and Lemonaid. They offer subscription services for a discounted price and provide both brand-name and generic medications.
In general, most insurance companies do not cover Viagra, but they might cover the generic, sildenafil. A 2021 review found that generic direct-to-consumer medications are just as effective and cost less.
Common side effects of these medications include:
Avoid taking PDE5 inhibitors if you’re taking:
- nitrate drugs for angina
- alpha-blockers to treat high blood pressure, due to the blood pressure lowering effects of the combination
- an alpha-blocker to treat benign prostatic hyperplasia
In addition, if you go to the emergency room for chest pain, tell your doctor if you’ve recently taken a PDE5 inhibitor. If you receive nitroglycerin (Nitrostat, Nitro-Dur), a nitrate, it may cause your blood pressure to drop suddenly.
| How to take it | How fast it works | Typical dose | |
|---|---|---|---|
| Sildenafil (Viagra) | 1 to 2 hours after eating, do not consume with fatty foods | can start in about 10 minutes and take up to 1 hour for maximum effect | typical starting dose is 50 mg, can increase to 100 mg |
| Tadalafil (Cialis) | when you need it or regularly every day | can start working in about 15 minutes and take up to 2 hours for maximum effect remains effective for up to 17 hours | 10 to 20 mg for occasional use typical daily dose is 2.5 mg |
| Vardenafil (generic) | should not take with food, wait 1 to 2 hours after eating | can start working in about 15 minutes and take 45 minutes to reach maximum effect | typical starting dose is 10 mg, can decrease to 5 mg or increase to 20 mg |
| Avanafil (Stendra) | can take with or without food, should not take more than once a day | fastest acting, starts working in as little as 15 minutes | typical starting dose is 100 mg, can go up to 200 mg |
ED pills aren’t the only treatment for ED. There are also other treatments that your doctor may recommend.
Hormone replacement therapy
Your testosterone levels naturally decrease by small amounts as you age. However, hormone replacement therapy may work for you if your testosterone levels are too low.
Testosterone replacement therapy (TRT) helps restore testosterone blood levels, but it’s still unclear whether it helps improve ED. It likely depends on the cause of ED.
Side effects of TRT may include:
Penile suppositories
The medication alprostadil is available as an injection known as Caverject or Edex and as a pill that you place into the opening at the tip of the penis. This is known as medicated urethral system for erections (MUSE). MUSE works by causing blood vessels to expand, allowing more blood to flow into the penis.
However, the medication is less effective when delivered this way than when delivered via injection.
According to findings from placebo-controlled clinical trials, some people experience penile pain when using MUSE. However, of those who could tolerate the medication, 7 out of 10 men were able to have successful intercourse after using MUSE.
Side effects may include pain and burning in the genital region.
Yohimbe supplements are not approved for ED
Yohimbe herbal supplements are derived from yohimbe bark and are available over the counter (OTC). Chemically speaking, they’re different from yohimbine hydrochloride, which the Food and Drug Administration (FDA) no longer approves as a prescription treatment for ED.
Note that the FDA does not regulate or test OTC dietary supplements. When purchasing supplements like these, there is no guarantee of getting exactly what the label contains or that the product is safe or effective.
There aren’t enough studies to support the claim that yohimbe works, and some experts are adamant that it does not.
Yohimbine hydrochloride can also cause dangerous side effects, including:
- anxiety
- dizziness
- headaches
- heart attack
- increased heart rate
- increased blood pressure
- seizures
- tremors
- vomiting
Do not use it if you have a heart disease, a mental health condition, or kidney disease.
ED can be uncomfortable to discuss with your doctor at first, but keep in mind that it’s a common medical issue.
Since ED is often related to other health issues, it’s best to get a complete checkup as well as laboratory tests and a psychological exam. Treating any underlying cause will often help improve ED as well.
The landmark
ED may also be associated with the following:
The better your overall health, the lower the risk of ED. Discuss any of these issues with your doctor thoroughly, as well as any medications you may be taking.
In some cases, ED may relate to an underlying health condition that requires specific treatment. However, if your ED is not due to a medical issue, a doctor may recommend preventive measures to complement oral medications. Keep in mind that ED may not be entirely preventable, but medications and lifestyle changes may help you manage it.
Speak with a doctor about the following nutrition and lifestyle changes:
- Stop smoking, if you currently smoke: Smoking adversely affects your blood vessels and heart, which can also increase your risk of ED. If you need help stopping, speak with a doctor. They may be able to recommend smoking cessation programs or medications to help you.
- Exercise to promote blood flow: Regular exercise of at least 30 minutes each day can help increase blood flow throughout your body, including penile blood flow. If you’re new to exercise, start slowly with moderate activities, such as walking. Speak with a doctor about how you can gradually increase physical activity.
- Limit alcohol: According to a
2021 review of 46 studiesTrusted Source , regular alcohol consumption was found to increase ED and possibly damage blood vessels. If you drink alcohol, try to limit the amount you drink, and talk with a doctor if you need help. - Eat a healthy diet: A diet that focuses on lean meats, low fat dairy products, whole grains, fruits, and vegetables may also help prevent ED. Some
studiesTrusted Source suggest that following a plant-based diet may promote overall cardiovascular health while also decreasing your risk of ED. - Maintain a moderate weight: Having more weight may also increase your risk of ED due to increased inflammation and lower testosterone levels. In addition, some cases of ED are due to stress, relationship issues, and low self-esteem. By losing or maintaining your weight, you may boost your testosterone levels and increase your overall self-esteem — two factors that can influence ED symptoms.
If you’re considering setting a weight goal for yourself, speak with your doctor before getting started. They can help determine whether that goal is right for you and discuss strategies to help you safely achieve it.
Though ED is relatively common, if you’re bothered by the quality, firmness, or duration of your erection, speak with a doctor.
ED can point to signs of a more serious health condition, such as high blood pressure, diabetes, or heart disease.
Depending on the cause, your doctor will analyze your symptoms and determine a proper treatment.
What causes ED?
There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include:
- cardiovascular disease
- diabetes
- hypertension, or high blood pressure
- high cholesterol
- obesity
- low testosterone levels or other hormone imbalances
- kidney disease
- increased age
- stress
- anxiety
- depression
ED can be due to one or several of these factors. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions.
What ED pill is best for me?
The best ED pill is the one that works best for you.
They’re all equally safe and effective, but the main differences between them are:
- how they’re taken
- how long they last
- their side effects
- cost
For occasional use, most people start with sildenafil (Viagra). For regular use, tadalafil (Cialis) can be a better fit.
Some people prefer to alternate between medications, depending on their lifestyle and relationship status.
How effective are ED pills?
Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) all have studies that back how well they work.
Currently, there are no studies that directly compare them with each other, but research from 2009 found that all three medications result in successful penetrative sex in 65% to 80% of users with ED, compared with 30% with a placebo.
How quickly do ED pills work?
How quickly an ED pill begins to work will depend on the medication. Usually, ED pills begin to work in as little as 10 to 15 minutes. Some may take up to 1 to 2 hours to take full effect.
How long do ED pills last?
How long your ED pill lasts will depend on the medication, dosage, and your body’s metabolism.
On average, branded Viagra and its generic form, sildenafil, will last between 2 and 3 hours before the effects start to diminish. The pills can last up to 12 hours depending on your dosage, metabolism, and other factors. Avanafil has a similar average duration, lasting up to 6 hours. Vardenafil can remain effective for up to 12 hours.
Tadalafil has the longest duration of these common ED pills. It can remain effective for up to 36 hours.
Four types of ED pills are available on the market, but the results vary.
PDE5 inhibitors continue to be the first line of treatment. Your doctor might recommend another option if ED pills do not help you or cause side effects.
If you’re interested in natural ED remedies, talk with a doctor first. Do not self-treat ED with OTC herbs and supplements.