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Men's Health August 9, 2022
Erectile dysfunction pills have some differences, but price can limit your ED medicine choices.
 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. 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. 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. What erectile dysfunction pills are available?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. 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. Cost of erectile dysfunction pillsThe 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:
How well do ED pills work?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. 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 quickly do ED pills work?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. How to use ED pills properlyDr. 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. 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. It's not like that." How long do ED pills last?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. "Will it last through another cycle? It's not guaranteed," Dr. Liou says. To have sex more than once a day, Cialis is your best bet. What are the side effects of ED pills?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. 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. Heart health and erectile dysfunctionED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis). "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.
Looking for natural solutions to ED? Read 5 natural ways to overcome erectile dysfunction. Image: Goodboy Picture Company/Getty Images Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. 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. Related ContentFree Healthbeat SignupGet the latest in health news delivered to your inbox! What is the drug of choice for patients with erectile dysfunction?Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) are oral medications that reverse erectile dysfunction by enhancing the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis.
What is the most effective treatment for ED?The best treatment for ED is the one that is best for you. Sildenafil (Viagra) and tadalafil (Cialis) are the most commonly prescribed medications for ED, and are equally safe and effective. In most cases, lifestyle and cost will help you decide between them.
How can I get erectile dysfunction pills?The safest, most effective way to get erectile dysfunction pills is at a licensed pharmacy with a prescription from a medical provider. With a prescription, you can be confident you're getting a drug that's been tested and approved by the FDA to be safe and effective.
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Which drug will be prescribed for a patient who presents with erectile dysfunction?
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