These trials have uniformly demonstrated that ED medications are safe and effective for the vast majority of men. Learn more in our guide to the safest drug for erectile dysfunction.Our guide on how to know if you have ED goes more into detail about common signs that you’re affected by erectile dysfunction. Most ED medications take 15 min to 1 hour to “kick in” and start producing a noticeable effect on your ability to develop and maintain an erection, so make sure you’re timing your specific dosage accordingly. While you may experience side effects from your medication, most are mild and temporary. Your body may just need some time to get used to the effects of ED medication, so give it a few tries before making any adjustments.

Interacting Drug/Class	Effect on ED Medication	Clinical Concern	Recommended Action
Nitrates	Potentiate hypotension	Risk of dangerous blood pressure drop	Avoid concurrent use
Alpha-blockers	Additive blood pressure lowering	Dizziness, fainting	Dose adjustment, monitoring
CYP3A4 inhibitors	Increase ED medication levels	Increased side effects	Dose reduction, careful monitoring
Grapefruit juice	Inhibits CYP3A4 enzyme	Raises drug plasma levels	Avoid consuming with ED meds

Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing Since the 1990s, erectile dysfunction (ED) drugs have helped millions of men continue to enjoy an active sex life. "While not much has changed in how they work or the types of drugs available, there still are things men should consider when choosing which one to try," says Dr. Michael O'Leary, a urologist and former director of men's health at Harvard-affiliated Brigham and Women's Hospital's Department of Urology. There are four main FDA-approved ED drugs: sildenafil (Viagra), tadalafil (Cialis), vardenafil, and avanafil (Stendra).

Viagra vs. Cialis: What's the Difference?

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.

Be physically active

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 vardenafil pills another country, check to see if pharmacy association or regulation agencies offer services like these. All of these come as pills; vardenafil also is made in a dissolvable version you place under your tongue. Chewable ED drugs are available that contain the same active ingredients of sildenafil, tadalafil, and vardenafil. However, they are made to order in compounding pharmacies and may include other ingredients. Dr.

Product	Dosage	Quantity + Bonus	Price
Cialis Generic	20mg	60 + 6 Pills	117.76€ 112.15€
Kamagra	100mg	20 Pills	86.09€ 81.99€
Cialis Original	20mg	34 + 2 Pills	183.99€ 175.23€
Levitra Original	20mg	34 + 2 Pills	188.51€ 179.53€
Kamagra Gold	50 mg	84 + 6 Pills	224.77€ 214.07€
Kamagra Effervescent Tablets	100 mg	84 + 7 Pills	202.91€ 193.25€
Viagra Original	100mg	8 Pills	59.84€ 56.99€
Viagra Super Active	100mg	270 + 30 Pills	390.61€ 372.01€
Viagra Generic	150mg	180 + 10 Pills	236.46€ 225.20€
Cialis Professional	20mg	270 + 6 Pills	623.07€ 593.40€
Viagra Soft Tabs	100mg	180 + 10 Pills	314.95€ 299.95€
Cialis Professional	20mg	20 Pills	78.33€ 74.60€

O'Leary advises against using these custom-made products since they are not regulated or approved by the FDA.

4 of the Best Erectile Dysfunction Medications

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 medications

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. The four ED drugs - known medically as PDE5 inhibitors - work similarly to increase blood flow into the penis, which helps men reach and maintain an erection. They do this by inhibiting phosphodiesterase type 5 (PDE5), an enzyme in blood vessel walls that controls blood flow. When a man is aroused, his body releases molecules that relax the smooth muscles in the blood vessels, allowing more blood to flow in. ED drugs prevent PDE5 fildena 150 mg tablet from breaking down these substances, thus keeping the blood flowing. ED drugs are effective in about 70% of men, according to Dr. O'Leary, but the results can vary. "A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs," he says. Also, while ED drugs can help men achieve and maintain an erection, they don't help with other sexual issues, such as low libido, premature ejaculation, or the inability to reach orgasm. The main differences between ED drugs are how quickly they act and how long the effect lasts. Avanafil takes about 15 to 30 minutes to work and lasts six to 12 hours.

Role of L-Arginine as a Supplement

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.

Sildenafil Citrate

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. Sildenafil and vardenafil take effect in 30 minutes to an hour and last four to five hours. Tadalafil kicks in after 30 to 45 minutes and can last 24 to 36 hours. "Many doctors first prescribe sildenafil because it has been around the longest and has a high success rate," says Dr.

PDE5 inhibitors prevent the breakdown of cGMP.
ED medications are often taken on an as-needed basis.
Tadalafil's longer duration allows daily low-dose use.
Viagra's active ingredient is sildenafil citrate.
Medical evaluation is necessary before starting treatment.
Not all men respond to ED medications; alternatives exist.
Rare side effects include priapism and sudden vision loss.
Some ED drugs are available in generic form.
Patients should follow dosing instructions carefully.
Medication efficacy can be enhanced by reducing alcohol intake.

O'Leary.

Insurance Preauthorization: Often required for brand-name medications.
Step Therapy: May require trying generics before brand names are covered.
Medicare: Part D plans typically cover generic ED medications.
Medicaid: Coverage varies significantly from state to state.
Out-of-Pocket Cost: For uninsured or if medication is not covered.
Coupons and Savings Cards: Often available from manufacturers for brand drugs.
Pharmacy Choice: Costs can vary between different pharmacy retailers.

Men who want a longer-lasting effect might opt for tadalafil. Tadalafil is also available as a low-dose daily drug, so you have a constant amount of the drug in your bloodstream, which helps with spontaneous sex.

PDE5 inhibitors have different durations and onset times.
Combining ED meds with other vasodilators may cause hypotension.
ED drugs may improve self-esteem and relationships.
Use caution with recreational drugs when on ED medications.
Proper storage is necessary to maintain medication potency.
Men with kidney impairment may need dose adjustments.
ED medications are sometimes used off-label for pulmonary hypertension.
Some drugs may cause temporary vision disturbances.
Open communication with healthcare providers ensures safe use.
Lifestyle modifications can sometimes eliminate the need for medication.

(This version is also used to treat benign prostatic hyperplasia, or an enlarged prostate.) The maximum dosages for ED drugs vary from 20 milligrams (mg) for tadalafil and vardenafil to 100 mg for sildenafil and 200 mg for avanafil. Your doctor usually begins with a low dose and increases it as needed. "Once you reach the maximum dose, and the drug still doesn't work, taking more won't help," says Dr. O'Leary. "Also, switching to another ED drug usually won't make a difference." The most common side effects of ED drugs are headaches, upset stomach, nasal congestion, muscle pain, and facial flushing. But most of these are relatively mild and disappear after a few hours. "ED drugs can make blood pressure temporarily drop, so don't use them if you take nitrates for angina (chest pain) or other heart problems," says Dr. O'Leary.

How do oral ED drugs work?

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 aren't an effective option, and some contain harmful substances. However, there's no problem with nitrates found in food - for example, leafy green vegetables (spinach, kale) and root vegetables (beets, carrots).

Increase the Dose

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.

Testosterone Cypionate / DHEA Grapeseed Oil

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. You also need to be careful if you take alpha blockers such as tamsulosin (Flomax) and alfuzosin (Uroxatral), used to treat an enlarged prostate.

Oral Medications

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men's Health to get started. Although the term “ED” is often associated with a complete inability to get an erection sufficient for sex, the reality of erectile dysfunction is that it can vary hugely in severity. Can get a normal erection, but find it difficult to maintain it during sex Can get a normal erection, but find it difficult to maintain it during sex Find it difficult to get an erection every time you want to have sex Find it difficult to get an erection every time you want to have sex Can’t get an erection at all, even when you’re sexually stimulated Can’t get an erection at all, even when you’re sexually stimulated A Hims medical provider will help determine which treatment is most appropriate for you. All of the active ingredients in our treatments are approved by the FDA based on extensive, high-quality clinical trials. "Make sure to take these medications at least four hours apart from an ED drug," says Dr. O'Leary. It's also best not to take sildenafil or vardenafil soon after eating, as food can block their absorption. (Tadalafil and avanafil don't interact with food in this manner.) Matthew Solan, Former Executive Editor, Harvard Men's Health Watch Howard E.

Injection therapy involves alprostadil directly into the penis.
Vacuum erection devices can be used with or without medication.
Counseling may help if ED has psychological causes.
Lifestyle changes like weight loss can improve ED.
ED can be an early sign of cardiovascular issues.
Regular check-ups improve safety for ED medication users.
Some men may experience flushing or dizziness.
Combining ED meds with nitrate medications is dangerous.
ED medications do not increase sexual desire, only function.
Use of ED medications is contraindicated in severe liver impairment.