Newer FDA-Approved Medications for Erectile Health

Does it make any difference which of the four drugs for erectile dysfunction you take? "Yes, there can be differences," says Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston. "For new patients, I have them try different ones to see what works best." Sildenafil (Viagra) is often the first drug your doctor offers.

Key Points

Make sure you get the right prescription and dose. When you order medicines and when you receive them in the mail, make sure they're the exact dose and type prescribed by your doctor or other health care professional. The dose is the amount of medicine you take. Don't be fooled into buying "herbal viagra." Never take any medicines that claim to be the "herbal" or nonprescription version of an oral medicine for ED. These tadapox tablets aren't an effective option, and some contain harmful substances.

Can you use baking soda for erectile dysfunction treatment?

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men's Health to get started. What are the differences between erectile dysfunction drugs? About half of men ages 40 to 70 have erectile dysfunction (ED) to some degree, although only one in 10 report a complete inability to have erections. Taking an ED drug produces an erection sufficient to start intercourse in about 70% of otherwise healthy men. It's been on the market longest and its side effects and the medications and foods it interacts with are well known. But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It's a common practice among insurers to limit the number of pills you can obtain per month.

After you hit your limit, the out-of-pocket cost for a single pill can be very high.

"The main obstacle in my practice is the cost," Dr. Liou says. You'll need to work with your doctor to get the pill you need at a price you can afford. In addition to Viagra, other ED drugs available in the United States include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse.

What Treatments Might Not Work for Erectile Dysfunction?

Called priapism, this rare condition can be painful. You need to get treatment for it as soon as possible to help prevent damage to your penis. If you have an erection that lasts more than four hours, call your care team right away. Treatments for erectile dysfunction are big business, and online scams abound. If you do buy medicines over the internet: Check to see if an online pharmacy is legitimate.

Erectile dysfunction

Never order medicines from an online pharmacy that doesn't list its phone number and physical address, has prices that seem too good to be true, or tells you that no prescription is needed. Also stay away from ones that don't have a licensed pharmacist on staff to answer your questions. Some illegal businesses sell fake versions of real medicines, which can be dangerous or might not work. In the United States, the National Association of Boards of Pharmacy can tell you whether an online pharmacy is licensed and in good standing. If you live in another country, check to see if pharmacy association or regulation agencies offer services like these. There is also a fast-dissolving form of Levitra, called Staxyn, that you put under your tongue. One ED drug, Cialis, is FDA-approved for use daily in a dose of 2.5 or 5 milligrams. This helps to produce erections on demand and may also help relieve urinary problems, like difficulty starting urination, that result from an enlarged prostate. The cost to you for ED drug therapy varies considerably, depending on the pharmacy price, prescription co-pays, and your level of health plan coverage. Even if private insurance covers it, you may be limited to four doses per month. Here are a few things you can do to contain costs: Various web-based tools can help you compare prices easily. Ask your doctor about pill splitting, where you get the pills at a higher dose than you need and divide them. These allow you to obtain a limited supply of medications not covered by your insurance. ED drugs produce an erection sufficient for intercourse in about 70% of men. But the results vary quite a bit from one individual to another.

• First-line treatment: Usually oral PDE5 inhibitors due to efficacy and ease of use.
• Second-line treatment: Includes intracavernosal injections or intraurethral suppositories.
• Third-line treatment: Includes vacuum devices and surgical penile implants.
• Step-care model: Progressing from least invasive to more invasive treatments.
• Treatment goals: To achieve erections sufficient for satisfactory sexual intercourse.
• Success rates: Vary by treatment; PDE5 inhibitors work for about 60-80% of men.
• Treatment adherence: Side effects, cost, and psychological factors affect continued use.
• Combination approaches: Using psychological therapy alongside medical treatment.
• Follow-up care: Important to assess effectiveness and adjust treatment as needed.
• Treatment discontinuation: Reasons include cost, side effects, or loss of a partner.

A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs. "There are some men in whom none of these drugs work," Dr. Liou says. How soon the drugs start working ranges from 15 to 60 minutes. Neither Viagra nor Levitra will work if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an "on demand" erectile drug; using the others requires more planning. Dr. Liou says that some men come to him after getting a prescription from their primary care doctors, claiming that the drug doesn't work. Sometimes it's because they used it incorrectly. "The biggest misconception is that these drugs are an on/off switch for erections," Dr. Liou says.

Growth & innovations in the pharmaceutical industry for the manufacturing of erectile dysfunction drugs, owing to rise in incidences of erectile dysfunction, increase in the geriatric population which are more susceptible to developing erectile dysfunction are the primary factors that drives Erectile Dysfunction Drugs Market Growth. In addition, an increase in demand for erectile dysfunction drugs, rise in R&D activities, and an increase in the prevalence of chronic diseases such as diabetes, hypertension, and obesity further contribute to the market growth.

Oral medicine for ED also might not be safe or work well if you have: Very low blood pressure, called hypotension, or uncontrolled high blood pressure, called hypertension. Kidney disease that needs to be treated with dialysis. These include a heart attack, stroke or a serious heart rhythm disorder in the past six months. An inherited eye disease that affects the retina. Side effects of oral ED medicines are often mild.

ED drugs can keep you erect even after you’ve climaxed: FALSE.

Visual changes, such as blue tinge to vision, sensitivity to light or blurred sight. Rarely, more-serious side effects can happen, including: Some people have suddenly lost some of their hearing or vision after taking one of these medicines. But it isn't clear whether these side effects were caused by the medicine or by health conditions that the people already had. Get medical care right away if you take oral ED medicine and have sudden loss of hearing or vision. An erection that doesn't go away on its own. But the drugs don't work well without sexual stimulation. "During that time, you need to be with your partner and have foreplay," Dr. Liou says. "Don't take it, do the taxes or the dishes, and then meet at the bedroom thinking you'll be ready to go. The ED drugs break down at different rates in the body. The durations of action range from four hours to more than a day (for Cialis in the higher doses). Each dose should be sufficient to provide a full cycle of intercourse, from erection to climax. To have sex more than once a day, Cialis is your best bet. The most common side effects of ED drugs, in order of most to least common are headache, flushing, upset stomach, nasal congestion, vision problems, diarrhea, dizziness, and rash. A man who has an erection that lasts four hours or more needs to get to a hospital or risk permanent damage.

Treatment of Erectile Dysfunction

It lasts 4 to 5 hours, or longer if you have mild to moderate ED. These medicines all work well for ED. When choosing one, tell your doctor or other health care professional what your preferences are, such as cost, ease of use, how long the drug's effects last and side effects. Generic versions of sildenafil, vardenafil and tadalafil are available. Check with your health care team before you take any medicine for erectile dysfunction.

Nerve disorders

Oral ED medicines might not work or might be dangerous if you also take any of the following: Often, these are prescribed for chest pain called angina. Some examples of nitrates are nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Bidil). These are commonly prescribed for an enlarged prostate or male pattern baldness. They include dutasteride (Avodart, Jalyn) and finasteride (Propecia, Proscar). Medicines that block an enzyme called CYP3A4. None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker or may recommend the alpha blocker tamsulosin (Flomax), which affects blood pressure less. ED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis).

• Age-related ED: Natural decline in erectile function is common with aging.
• Diabetes management: Tight glycemic control can help prevent or improve ED.
• Hypertension management: Controlling high blood pressure improves vascular health.
• Statin medications: Used for cholesterol, may improve endothelial function and ED.
• Metformin: A diabetes drug that may have a positive effect on erectile function.
• The impact of recreational drugs: Cocaine, marijuana, and opioids can cause ED.
• Anabolic steroid abuse: Can shut down natural testosterone production, causing ED.
• Performance anxiety: A common psychological cause of situational ED.
• Sensate focus exercises: A therapy technique to reduce anxiety and increase intimacy.
• Dilators for ED: Used in physical therapy to address pelvic floor muscle tension.

"It can predate a diagnosis of cardiovascular disease by at least a few years," Dr. Liou says. We don't have strong proof yet that starting to live a healthier lifestyle can reverse erectile problems, but it can't hurt.

• Priapism: A medical emergency; an erection lasting more than 4 hours.
• Fibrosis: Scar tissue formation inside the penis from repeated injections.
• Hypotension: A severe drop in blood pressure, especially with drug interactions.
• Cardiovascular events: Risk of heart attack or stroke, especially in at-risk men.
• Hearing loss: Sudden decrease or loss of hearing, sometimes accompanied by tinnitus.
• Vision loss: Non-arteritic anterior ischemic optic neuropathy (NAION).
• Testosterone therapy risks: Acne, sleep apnea, erythrocytosis, prostate growth.
• Allergic reactions: Rash, itching, or swelling, though rare.
• Injection site reactions: Bruising, bleeding, or infection.
• Device-related risks: Infection or mechanical failure with implants or pumps.

Read 5 natural ways to overcome erectile dysfunction. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.

Lifestyle and home remedies

It might work longer if you have mild to moderate erectile dysfunction. This medicine also works best when you take it an hour before sex on an empty stomach. As with sildenafil, a high-fat meal or alcohol keep the body from absorbing it as quickly. Vardenafil usually works for 4 to 5 hours. Its effects might last longer if you have mild to moderate ED.

Does Cialis Make You “Harder” Than Viagra?

A newer form of the medicine that dissolves on the tongue might work faster than the pill that you swallow. This medication is taken with or without food an hour before sex. It works for up to 36 hours. You can take it in a small dose daily or in a larger dose as needed. You can take this medicine with or without food 30 minutes before sex, depending on the dose. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Erectile dysfunction (ED) is the inability to get or maintain an erection long enough to have sexual intercourse. There are many different causes, which may include conditions that affect your blood vessels, neurological conditions, mental health conditions and injuries.