What Are the Alternatives to Viagra?

What you can use to substitute Viagra when treating erectile dysfunction

What are the alternatives to Viagra?

Viagra is part of a family of medicines called PDE-5 inhibitors. The other medicines similar to Viagra include:

There are also alternatives to Viagra that are not part of the PDE-5 inhibitors family. These medicines can also be very effective for people who have erectile dysfunction (ED) related to a major pelvic surgery or an injury to the spinal cord, or who can’t use PDE5 inhibitors. However, it’s recommended that you try a medicine from the PDE-5 inhibitors family before you go on to these medicines if you can as they are not as easy to use and have a higher risk of side effects. They include:

Caverject or Viridal are medicines which you inject directly into the penis
MUSE is a medicine which you apply into the inside the opening of the penis (urethra)
Vitaros is a cream which you apply on the skin of the penis

Alternatives to Viagra that don’t involve taking medication are also available, and include:

Psychosexual therapy. This may be useful if your ED is partly or mainly caused by psychological factors. Erection problems and poor mental health can often result in a cycle of one making the other worse, so therapy is always worth considering. You can have individual therapy, therapy with your partner, or a combination
Vacuum erection devices, also known as penis pumps, that contain a cylinder part and a constriction ring part. You place your penis into the cylinder part and the vacuum device removes air from the cylinder. The vacuum causes your penis to fill with blood so that you get an erection. You then keep the constriction ring around the base of the penis so that you keep the erection
Penis implants. These are a last resort treatment for men who has tried the other options mentioned above but still can’t get and keep a satisfactory erection. The part of the penis that is responsible for producing the erection is removed and replaced by a prosthesis which can be pumped to produce an erection

Finally, there are lifestyle changes that you can put into place to improve your ED. It’s always a good idea to try to do this even if you are using other ED treatments as lifestyle changes can make your ED treatment work better. They include the following:

Eating a diet with lots of fruits and vegetables and low in saturated fats, which can improve your heart and circulation health. Because ED is caused by low blood circulation to the penis, eating a healthy diet can help
Exercising for 30 minutes a day, five times per week which also improves heart and circulation health
Losing weight to a healthy BMI which can improve ED symptoms
Stopping smoking will improve your circulation, which will have an impact on your ED symptoms
Cycling less. Cycling more than 3 hours per week might be associated with ED because of the pressure of the saddle on the nerves around your penis. Although we need more research to confirm whether this is true, it might be worth trialling reducing your cycling hours if you take part in long distance cycling to see whether this improves your ED

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What’s a good first-time treatment, other than Viagra?

Other medicines that are part of the PDE-5 inhibitors family are a good treatment to start on:

Sildenafil is the generic (unbranded) version of Viagra which contains the same active ingredient. Like Viagra, it starts working around one hour after you take a dose and lasts for around four hours
Viagra Connect also contains the same active ingredient as Viagra and is available over-the-counter. This means that you can get Viagra Connect without a prescription from your doctor
Cialis is a longer-lasting medicine which can work for up to 36 hours. This might mean that you don’t have to plan sex in advance
Cialis Daily is a version of Cialis which is taken every day. This means that you can get an erection at any time, without planning sex in advance. This might be suitable if you think you will take Cialis more than twice a week
Tadalafil is the generic version of Cialis, like Sildenafil is to Viagra
Levitra, like Viagra, lasts for around four hours
Spedra works very quickly, with some men feeling the effects as quickly as fifteen minutes after they take a dose. This means that you also don’t have to plan sex as far in advance. Like Viagra and Levitra, it lasts for around four hours

Viagra and the other medications listed above are easy to use as they come in the form of tablets. They also have a lower risk of side effects compared with other medicines which are not part of the PDE-5 inhibitor family.

What if I’ve tried Viagra and it doesn’t work?

First, make sure that you are taking Viagra exactly as your doctor or pharmacist has advised. Read the patient information leaflet that comes with the medicine if you are unsure.

Viagra can be taken with or without food, but some men find that taking it with food means that it takes longer to work for them.

Alcohol can worsen symptoms of your ED. Make sure that you don’t drink alcohol heavily before taking Viagra to get the most out of your medicine.

It’s important to remember that Viagra doesn’t cause an erection on its own, but needs sexual stimulation for it to work. Make sure you’re aroused or Viagra won’t help you get an erection..

Sometimes, it takes your body a while to get used to Viagra. We recommend that you give this medication a few tries before going back to your doctor. Viagra also comes in three different dose strengths, so as long as you’ve had no side effects, your doctor might suggest that you take a higher dose before moving on to trying a different medicine.

You can try another medication from the PDE-5 inhibitor family to see whether your body responds better to it. Although these medications come from the same family, the PDE5 inhibitors available in the UK include 4 different active ingredients to try out. So, your body might respond differently to them.

If medications from the PDE-5 inhibitor family don’t work, then your GP can refer you to a urologist. Or, if you have diabetes your GP might refer you to a diabetes clinic. Doctors specialising in these areas can then assess you and offer alternative treatments, such as non-tablet medicines, devices, or even surgery. These are more difficult to use and carries a higher risk of side effects, so it’s best to start them under supervision of a specialist.

I’m looking for options that are cheaper than Viagra

Generic versions of medicines such as Sildenafil exist because patents for the branded versions have run out. The generic medicines are often cheaper than the branded versions, but contain the same active ingredient. The generic versions of branded medicines are:

Sildenafil (Viagra, Viagra Connect)
Tadalafil (Cialis)

Levitra and Spedra are still under patent, so the active ingredients, vardenafil and avanafil, aren’t available as generics just yet.

Some non-medication treatments can also be cheaper. Devices have a high one-time cost but may turn out to be cheaper over time. Lifestyle changes are also potentially free.

I want something like Viagra but I don’t want to see a doctor

You can use Zava’s Online Doctor Service to order treatment without a face-to-face appointment. To do this, follow these steps:

Complete the short online questionnaire
Select the treatment of your choice
A doctor will review your questionnaire to see whether you are eligible
If so, your treatment will be sent by post to the address of your choice

You can also get Viagra Connect without making an appointment with your doctor. However, you will still be assessed by the pharmacist.

I want a natural alternative to medicines like Viagra

The UK’s regulator of medicines, the Medicines and Healthcare Regulatory Agency, don’t recommend using herbal remedies to treat erectile dysfunction (ED). However, if you would still like to use these type of medications, we recommend that you look for registered and licenced products which can be identified by the Traditional Herbal Registration (THR) logo.

Lifestyle changes are also a natural way to improve ED.

I want treatment, but I don’t think I’m eligible for Viagra

If you’re not sure whether or not you’re eligible for Viagra, you can use our Online Consultation Service or make a face-to-face appointment with your GP for an assessment.

Your GP might be able to suggest an alternative method of treatment if you’re not eligible for Viagra.

Dr Kathryn Basford is a qualified GP who works as a GP in London, as well as with Zava. She graduated from the University of Manchester and completed her GP training through Whipps Cross Hospital in London.

Reviewed by: Dr Kathryn Basford on 26 Nov 2018

British Association of Urological Surgeons (2017). Vacuum Erection Assistance Devices. [online]. Available at: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/VEDs.pdf [accessed 3rd November 2018].

Clinical Knowledge Summaries (2017). Erectile dysfunction. [online]. NICE. Available at: https://cks.nice.org.uk/erectile-dysfunction#!scenario [accessed 3rd November 2018].

EMC. Viagra: patient information leaflet. [online]. Available at: https://www.medicines.org.uk/emc/files/pil.1072.pdf [accessed 3rd November 2018].

Zava offers a convenient and discreet service to help men improve their erectile dysfunction. There are a number of treatments you can consider. Continue to our erectile dysfunction service page to learn about the treatment options available.