Compare erectile dysfunction pills
Choose among the types of erectile dysfunction pills by timing, regimen, cost and side effects. The most effective erectile dysfunction pill for an individual also has to fit their health history; a timing estimate alone can't select it.
The timing and response windows below are secondary educational estimates. An onset estimate describes when a response may begin; administration timing describes when to take a tablet.
A response window gives an opportunity for an erection with arousal, rather than a continuous erection.
| Medicine and brand | Onset or administration timing | Reported response window | What it tells you | Limit |
|---|---|---|---|---|
| Sildenafil — Viagra | May start in about 30 minutes | About 1–4 hours | A shorter window for planned activity | Food can delay onset |
| Tadalafil — Cialis | As needed: at least 30 minutes before sex | Up to 36 hours | Allows a wider opportunity for sex | Daily treatment is a separate regimen |
| Vardenafil — Levitra; Staxyn dissolving form | Taken about 60 minutes before sex | About 5–7 hours | Needs advance dose timing | Tablet forms are not interchangeable |
| Avanafil — Stendra | May work in about 15–30 minutes | Up to 6 hours | A reported shorter wait before activity | Educational estimates vary by person |
For sildenafil vs tadalafil, the scheduling difference is useful: sildenafil fits a more defined occasion, while tadalafil can leave a wider opportunity. These estimates answer how quickly ED pills work and how long they may last without promising a particular result.
Side effects and the prescription still shape which schedule is workable.
How erectile dysfunction pills work
During sexual stimulation, erectile dysfunction pills help increase blood flow into the penis. They inhibit PDE5, an enzyme involved in that blood-flow response. Sexual arousal is still needed, so swallowing a tablet alone doesn't produce the intended response.
These medicines manage erection symptoms while the cause may still need attention. A successful response can help with sexual activity even when diabetes, cardiovascular disease or another contributor needs its own treatment.
Healthline reports a 2009 synthesis in which successful penetrative sex occurred in 65%–80% of users of sildenafil, tadalafil or vardenafil, versus 30% with placebo. Those historical, three-drug findings support discussing oral treatment, but they are neither a personal forecast nor an effectiveness estimate for avanafil.
When describing a response to your prescriber, separate getting an erection from keeping it long enough for sex. That gives the conversation a concrete outcome, alongside whether the timing and unwanted effects were acceptable.
Taking erectile dysfunction pills
A daily schedule and an as-needed schedule give different instructions for taking erectile dysfunction pills. Daily tadalafil is taken independently of sexual activity; as-needed treatment ties the dose to a planned occasion.
Tadalafil tablets come in 2.5 mg, 5 mg, 10 mg and 20 mg strengths. Those strengths are available products, not directions for choosing a dose yourself.
The prescription sets the amount and frequency; take sildenafil and tadalafil exactly as prescribed, without taking more, less or extra doses.
Form matters as well as schedule. Conventional vardenafil and its rapidly dissolving tablet have different handling instructions, so the medicine name alone isn't enough to identify how a dose is taken.
Sildenafil timing and meals
About 1 hour before sexual activity is the usual timing for sildenafil for erectile dysfunction, with a supported administration interval from 30 minutes to 4 hours beforehand. This is the time for taking the tablet, rather than a promise that an erection will begin on schedule.
A high-fat meal delays the start of sildenafil’s effect. If sex is planned after a high-fat dinner, allow for that slower start instead of expecting the same timing as a dose taken without that meal.
Taking another tablet to hurry the response would conflict with the usual frequency limit.
Sildenafil usually should not be taken more than once every 24 hours. The US label allows a clinician to adjust the dose down to 25 mg or up to a maximum recommended 100 mg according to effectiveness and tolerability.
A disappointing response and troublesome effects therefore give the prescriber different reasons to adjust treatment; the upper end of the range isn't a starting-dose instruction.
Daily vs as-needed tadalafil
Daily tadalafil lets you take erectile dysfunction pills on a regular schedule without timing each dose around sex. As-needed tadalafil is usually taken at least 30 minutes before sexual activity and no more often than once every 24 hours.
The practical question is how much you want to plan around a dose.
A regular schedule may fit someone who prefers to separate taking medicine from anticipated activity; an as-needed schedule keeps the dose connected to the occasion. Discuss those preferences before choosing a regimen.
A longer opportunity for response can reduce the pressure to fit sex into a narrow interval. Sexual stimulation remains necessary during that opportunity.
Daily treatment still follows its own prescription, rather than being an instruction to repeat an as-needed tablet whenever the earlier window ends.
Vardenafil tablet forms
Conventional vardenafil and orally disintegrating vardenafil are different tablet forms, and Staxyn isn't interchangeable with conventional Levitra or generic tablets. Receive the form your doctor prescribed; a tablet that dissolves on the tongue has its own handling directions.
Vardenafil is reported to be taken about 60 minutes before sex and usually should not be taken more often than once every 24 hours. That advance timing applies to planning the dose, while the dissolving form changes how you remove and take it.
- Do not use medication from a pack if any blister is torn, broken or missing a tablet.
- Peel the foil to remove the tablet; do not push it through the foil.
- Immediately place the removed tablet on your tongue and close your mouth.
- Take the rapidly disintegrating tablet without water or other liquids.
The dissolving tablet is swallowed after it dissolves in the mouth. Keep the packaging intact until taking it so the blister can be inspected before removal, and ask the pharmacist about an unexpected change in tablet form.
Avanafil use
With or without food, avanafil can be taken no more than once a day. Secondary educational estimates describe a possible start in about 15–30 minutes.
Meal flexibility may make dose planning simpler when sexual activity follows a meal. The onset remains an estimate, so allow room for your own response when discussing whether the medicine fits your schedule.
A reported shorter wait says nothing about whether avanafil will work better for you than sildenafil, tadalafil or vardenafil. Your prescription provides the dose and product instructions.
Prescription and health review
In the United States, erectile dysfunction pills require a prescription and a health assessment before selection. Bring a current medicine list and describe the erection difficulty so the clinician can consider both treatment and its possible causes.
Cardiovascular disease, diabetes, hypertension, hormonal problems and psychological factors can contribute to erectile dysfunction. Some medicines contribute too. Antidepressants and antihypertensives deserve review with the clinician; don't stop them independently because of erection problems.
A checkup may include laboratory tests or a psychological assessment, depending on the history. These can help the clinician decide whether the problem needs more than symptom treatment and whether an oral medicine is appropriate.
Some exclusions are specific to the product. Tadalafil is contraindicated after a known serious hypersensitivity reaction to tadalafil.
Sildenafil isn't used in children for erectile dysfunction. Mention a previous serious reaction by medicine name so the prescriber can act on the relevant product history.
The visit is also the place to explain whether a planned occasion or a daily schedule better fits your life. That preference can guide selection once health and medicine concerns have been considered.
How much do the pills cost?
Choosing generic erectile dysfunction pills can make a substantial difference to cost. FDA-approved generics work in the same way and provide the same clinical benefit and risks as their brand counterparts; lower development costs help explain their lower prices.
With discount cards at participating pharmacies, the reported prices vary by product, strength and quantity. Each row keeps its own medicine, strength and quantity; the figures are coupon prices, rather than insured copays or delivered totals.
| Product | Strength | Quantity | Reported coupon range | Doses or conditional supply | Price basis |
|---|---|---|---|---|---|
| Generic sildenafil | 100 mg | 6 tablets | About $8–$98 | 6 as-needed doses | With a discount card |
| Viagra | 100 mg | 6 tablets | About $510–$560 | 6 as-needed doses | With a discount card |
| Tadalafil | 5 mg | 10 tablets | About $10–$35 | 10 days only if prescribed one daily | With a discount card |
| Vardenafil | 20 mg | 10 tablets | About $35–$130 | 10 as-needed doses | With a discount card |
Six or ten as-needed doses can be used across different calendar periods. The tadalafil row becomes a ten-day supply only under a one-tablet-daily prescription.
Milligram amounts across different medicines don't measure equivalent treatment value, so a higher number on the box is no reason to prefer a product.
For a useful budget, request the whole prescribed-fill quote and add any consultation, delivery, tax or subscription charge. Keep the same strength and quantity when comparing pharmacies.
Ask your plan whether erectile dysfunction pills are covered by insurance for your prescription, and what you would pay; coverage depends on the plan’s answer.
Getting pills from a pharmacy
Licensed local and online pharmacies can dispense prescription erectile dysfunction pills. A consultation addresses whether treatment should be prescribed; the dispensing pharmacy provides the medicine. If you buy erectile dysfunction pills online, identify who will actually fill the prescription.
The four medicines require a prescription in the United States, so a product sold over the counter as a sexual-enhancement supplement belongs to a different category. The word “natural” is not a substitute for knowing what a product contains.
Online pharmacy checks
- ☐ Find the pharmacy’s license in the state board of pharmacy database using FDA BeSafeRx.
- ☐ Avoid an online pharmacy that is not listed in that database.
- ☐ Confirm that a licensed pharmacist is available to answer medicine questions.
FDA warns that unsafe internet pharmacies may sell unapproved, counterfeit or otherwise unsafe medicines outside licensed safeguards. Natural ED supplements can also contain undisclosed drugs that cause adverse effects or interact with other medicines.
Choosing a licensed dispenser and a prescribed product helps avoid replacing a known medicine with an uncertain ingredient list.
Blood pressure and interactions
The US Viagra label contraindicates sildenafil administration in patients who use nitric oxide donors, including organic nitrates or organic nitrites in any form, because Viagra potentiates their hypotensive effects: the combination can lower blood pressure dangerously. The specific heart or blood-pressure medicines a person takes therefore affect whether sildenafil is suitable.
Alpha-blockers require a different precaution. The sildenafil label says patients should be stable on alpha-blocker treatment before starting sildenafil, with sildenafil initiated at 25 mg. That is a clinician-managed starting precaution for this combination, rather than a general dose for anyone with high blood pressure.
For tadalafil used for erectile dysfunction, the US label likewise requires stability on alpha-blocker treatment first and initiation at the lowest recommended tadalafil dose. The two labels provide product-specific directions; the clinician applies them to the actual combination.
A diagnosis of hypertension alone therefore supplies less useful information than the names of the medicines and the heart history. Note nitrate use and alpha-blocker treatment explicitly on the medicine list rather than describing everything as a blood-pressure pill.
Side effects and alcohol
Headache, flushing and a stuffy or runny nose are common side effects of erectile dysfunction pills. How disruptive they are can influence whether a particular medicine remains a practical option.
Tadalafil can also cause indigestion and back or muscle pain. Reported avanafil effects include dizziness, blurred vision and nausea as well as headache. Naming the symptom and the medicine helps the prescriber consider whether a change is needed.
Alcohol can increase sildenafil-associated dizziness and fainting. When considering erectile dysfunction pills and alcohol, that sildenafil warning is a concrete reason to discuss drinking with the prescriber instead of assuming a tolerated amount applies to every medicine.
Do not drive or operate machinery until you know how sildenafil affects you. A dose taken before an evening out may therefore affect travel plans as well as sexual activity.
Sudden loss of vision or hearing calls for immediate action rather than being treated as an ordinary unwanted effect.
When symptoms need urgent help
After tadalafil, an erection lasting longer than 4 hours needs emergency medical attention, whether it hurts or not. Waiting for pain can delay the action required by the tadalafil label.
If you think it is an emergency, call 911. For a suspected overdose or accidental poisoning, call Poison Help at 1-800-222-1222.
For sildenafil, tadalafil and vardenafil, sudden vision loss requires stopping further PDE5 inhibitor doses and getting medical help immediately.
The vardenafil instructions also name a sudden decrease in vision. Call the doctor right away; tadalafil instructions also allow emergency medical treatment for sudden vision loss.
Sudden hearing loss while taking sildenafil, tadalafil or vardenafil requires an immediate call to the doctor. Ringing in the ears or dizziness may accompany it.
For sildenafil used for erectile dysfunction, take no further sildenafil, tadalafil or vardenafil until speaking with the doctor after this symptom.
The tadalafil label also directs patients who develop symptoms when sexual activity begins to stop further sexual activity and seek immediate medical attention. Do not wait to see whether continued activity feels easier.
Other unusual problems while taking sildenafil or tadalafil warrant contacting the doctor too. The urgent triggers above call for prompt action even if the medicine previously seemed well tolerated.
When pills do not work
Tell the prescriber when erectile dysfunction pills aren't working or when adverse effects make them difficult to use. Describing dose timing, sexual arousal and the actual response gives the clinician something specific to change.
A slower start after food or an underlying contributor can shape the next discussion. For ongoing sildenafil or tadalafil treatment, talk with the doctor before stopping; urgent symptoms still require the immediate actions in the medicine instructions.
- Vacuum erection device: draws blood into the penis, with a tension ring used to maintain the erection.
- Alprostadil: can be given as a penile injection or a urethral pellet when oral treatment is unsuitable.
- Inflatable penile implant: placed surgically, allowing control over erection timing.
These options change how an erection is produced or maintained, so their practical demands differ from taking a tablet. A clinician can discuss which approach fits the reason oral treatment was unsuitable or ineffective.
Testosterone replacement belongs to confirmed low testosterone, rather than routine treatment when testosterone is normal.
Physical activity, smoking cessation, reducing excessive alcohol use and stress management can complement treatment. They give the care plan ways to address contributing factors alongside an erection treatment.
FAQ
What if a daily tadalafil dose is missed?
Take a missed daily tadalafil dose when you remember, unless it is almost time for the next dose; then skip it and continue the regular schedule. Do not double up or take more than one dose per day to catch up. As-needed use has no scheduled dose to make up. Sildenafil instructions also prohibit doubling a missed scheduled dose.
What if too many pills are taken?
For suspected sildenafil overdose, contact a poison control center or emergency room at once. If too much vardenafil has been taken, call the doctor or emergency room right away. Give the medicine name when seeking help so the advice addresses the product actually taken.
How should pills be stored and discarded?
Store sildenafil at 59–86 degrees F (15–30 degrees C), out of reach of children and pets. Keep it for the prescribed patient and don't share it with someone who has similar symptoms.
For unwanted medicine, use a drug take-back location or a prepaid drug mail-back envelope. Keep vardenafil dissolving tablets in intact blisters, and don't use a pack with torn, broken or empty blisters.
Sources
- Drugs.com — ED medicines
- Cleveland Clinic — Sildenafil tablets
- MedlinePlus — Sildenafil (Viagra) (drug information)
- MedlinePlus — Tadalafil (Cialis) (drug information)
- MedlinePlus — Vardenafil (drug information)
- DailyMed — sildenafil prescribing information (FDA label)
- DailyMed — tadalafil prescribing information (FDA label)
- DailyMed — vardenafil prescribing information (FDA label)
- FDA how to buy medicines safely from an online pharmacy
- FDA disposal of unused medicines
- FDA generic drug facts
- Poison Help (HRSA)