Watch Out, Viagra: FDA Approves a Fast-Acting Erectile Dysfunction Drug

If you take Cialis, there’s a chance of limb pain. This side effect is not associated with any other oral ED drugs.

FDA approves Vivus’s fast-acting Viagra rival

NEW YORK (Reuters) – Men with erectile dysfunction may not have to plan for sex as far in advance anymore after Vivus Inc won U.S. approval for avanafil, its faster acting rival to Viagra.

A box of Viagra, typically used to treat erectile dysfunction, is seen in a pharmacy in Toronto January 31, 2008. REUTERS/Mark Blinch

Avanafil, which will be sold under the brand name Stendra, is the first new drug in the category in a decade.

The drug — which will compete with Pfizer Inc’s Viagra, Eli Lilly’s Cialis and Levitra, sold by GlaxoSmithKline and Bayer — gives Vivus, which has struggled to bring a weight loss drug to market, a potentially lucrative commercial product.

The Vivus drug will have some attractive marketing claims as it goes up against established rivals sold by companies with serious marketing muscle.

“This is potentially the fastest acting of the four,” said Dr Wayne Hellstrom, professor of urology at Tulane University School of Medicine in New Orleans.

While it is recommended that patients take the new pill 30 minutes prior to sexual activity, in clinical trials it has been shown to work in as fast as 15 minutes. Viagra typically takes about an hour to start working.

Stendra belongs to the same PDE5 inhibitor class as its rivals and also works by increasing blood flow to the penis. But researchers found it to be more selective than the older drugs, meaning it could have fewer unintended effects.

“Higher selectivity should translate into fewer side effects,” said Hellstrom. “It’s going to add more excitement” to the field.

ED afflicts as many as 30 million men in the U.S., Vivus said. The Vivus drug is currently awaiting a European approval decision.

Cowen and Co analyst Simos Simeonidis, in a research note, forecast annual Stendra sales of about $300 million. Viagra had sales of about $2 billion in 2011.

Vivus shares were up about 3 percent following the expected approval by the Food and Drug Administration. Investors are far more focused on the prospects for Vivus’s obesity pill Qnexa, for which the FDA is expected to rule by mid July.

Doctors should prescribe the lowest dose of Stendra that provides benefit, the FDA said. It has been approved at doses of 50 milligrams, 100 mg and 200 mg.

“This approval expands the available treatment options to men experiencing erectile dysfunction, and enables patients, in consultation with their doctor, to choose the most appropriate treatment for their needs,” Victoria Kusiak, deputy director of the Office of Drug Evaluation in the FDA’s Center for Drug Evaluation and Research, said in a statement.

The most common side effects reported in clinical studies included headache, flushing of the face and other areas, nasal congestion, common cold-like symptoms and back pain.

The drug carries the same cautions as its rivals, including that it should not be used by men who also take nitrates due to the potential for a sudden dangerous drop in blood pressure and the now famous warning to see a doctor if an erection lasts more than four hours.

Vivus shares, which closed up 2.9 percent at $25.15 on Nasdaq, rose to $25.40 in after hours trading.

Additional reporting by David Morgan in Washington; editing by Dave Zimmerman and M.D. Golan

Watch Out, Viagra: FDA Approves a Fast-Acting Erectile Dysfunction Drug

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Last Friday, the U.S. Food and Drug Administration (FDA) approved Stendra, the first new drug in a decade to treat erectile dysfunction.

Stendra, the brand name for avanafil, is sold by Vivus Inc. and will compete with other erectile-dysfunction drugs currently on the market: Pfizer’s Viagra, Eli Lilly’s Cialis and GlaxoSmithKline and Bayer’s Levitra. Like its competitors, Stendra is among a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which work by increasing blood flow to the penis.

Based on clinical trials, Stendra may kick in faster than its counterparts — possibly in as little as 15 minutes. “This is potentially the fastest acting of the four,” Dr. Wayne Hellstrom, a professor of urology at Tulane University School of Medicine, in New Orleans, told Reuters.

In clinical trials, 77% of men with general erectile dysfunction were able to get erections after taking Stendra, compared with 54% of men taking a placebo. Intercourse was successful for 57% of the men on Stendra, compared with 27% of men on the placebo, WebMD reports.

“This approval expands the available treatment options to men experiencing erectile dysfunction, and enables patients, in consultation with their doctor, to choose the most appropriate treatment for their needs,” Dr. Victoria Kusiak, the deputy director of the Office of Drug Evaluation III in the FDA’s Center for Drug Evaluation and Research, said in an agency statement.

An estimated 30 million American men are affected by erectile dysfunction.

The new pill should be taken on an as-needed basis 30 minutes before sexual activity. The potential side effects of Stendra include headache, flushing of the face and other areas, nasal congestion, common cold-like symptoms and back pain. Like other PDE5 inhibitors, Stendra should not be used by men who take nitrates to treat chest pains, since the combination can lead to sudden, dangerous drops in blood pressure.

Stendra has been approved at doses of 50 mg, 100 mg and 200 mg. The FDA recommends doctors prescribe the lowest dose needed.

New Fast Acting Viagra

(CBS News) A new erectile dysfunction drug that reportedly works in less than 15 minutes has just received approval from the U.S. Food and Drug Administration. On Friday the FDA approved Vivus Inc.’s Stendra to take as an “as-needed” pill for men before sexual activity.

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More than 30 million men in the U.S. are affected by erectile dysfunction (ED). Current ED drugs on the market include Pfizer Inc.’s Viagra, Eli Lilly’s Cialis and GlaxoSmithKline and Bayer’s drug Levitra. The new drug Stendra, the brand name for avanafil, is the first new erectile dysfunction drug in a decade for this class of drugs known as phosphodiesterase type 5 (PDE5) inhibitors.

“This approval expands the available treatment options to men experiencing erectile dysfunction, and enables patients, in consultation with their doctor, to choose the most appropriate treatment for their needs,” Dr. Victoria Kusiak, deputy director of the Office of Drug Evaluation III in the FDA’s Center for Drug Evaluation and Research, said in an FDA statement.
Similar to its counterparts, the drug works by helping increase blood flow to the penis. How does it stack up against the rest?

“This is potentially the fastest acting of the four,” Dr. Wayne Hellstrom, professor of urology at Tulane University School of Medicine in New Orleans, told Reuters. Patients taking Stendra are recommended to take the drug 30 minutes before sexual activity but clinical trials have shown the drug works as fast as 15 minutes. Viagra may take an hour to start working, Reuters reported.
In clinical trials, 77 percent of men with general ED were able to get erections after taking Stendra, compared with 54 percent of men taking a placebo pill, WebMD reported. Stendra resulted in successful intercourse for 57 percent of men with general ED, compared with 27 percent of men on placebo.
According to the FDA, the most common side effects for men taking Stendra were headache, face redness, nasal congestion, cold-like symptoms, and back pain. In rare cases men may get an erection that does not go away after four hours – a condition known as priapism. If that happens, patients should seek immediate medical care, the FDA said. As with other PDE5 inhibitors, Stendra should not be used by men who also take nitrates commonly used to treat chest pain, because the combination can cause a sudden drop in blood pressure.

Viagra vs. Cialis vs. Levitra vs. Stendra: Which Is Best?

Viagra, Cialis, Levitra, and Stendra are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names:

About 30 million American men occasionally have a problem with getting or keeping an erection, according to the Urology Care Foundation. When ED becomes a problem, many turn to these oral ED medications. They often help address the issue.

The medications work in similar ways. However, they also have some key differences, such as when you take them, how long they work, and what their side effects are.

Viagra, Cialis, Levitra, and Stendra are all in a class of medications called phosphodiesterase type 5 (PDE5) inhibitors. These drugs work by blocking the PDE5 enzyme.

They also boost a chemical in your body called nitric oxide. This action encourages the muscles in your penis to relax. Relaxed muscles allow blood to flow freely, so you can get an erection when you’re aroused. It also helps you maintain the erection long enough to have sex.

Unlike Viagra and the other PDE5 inhibitors, Cialis is also approved to treat enlarged prostate.

Both Viagra and Cialis can be taken 30 minutes before sexual activity. However, Cialis lasts much longer and is noteworthy for the amount of time it remains in your body. You may feel the effects of the drug up to 36 hours after you take it.

The fact that it comes in a low dose of 2.5 milligrams (mg) also means that you can take Cialis every day. A daily dose will ensure that the drug’s always in your system.

If you take Cialis, there’s a chance of limb pain. This side effect is not associated with any other oral ED drugs.

Similarities	Differences
They’re both PDE5 inhibitors.	Cialis lasts up to 36 hours in the body, while Viagra lasts 4–6 hours in the body.
Both are taken 30 minutes before sex.	Cialis can cause limb pain, while Viagra can cause vision change, rash, and dizziness.
Side effects include flushing, back pain, headaches, muscle pain, and upset stomach.

Pros of Cialis

Cons of Cialis

Pros of Viagra

Cons of Viagra

Viagra can take 30 to 60 minutes to work in the body, while Levitra takes 60 minutes. The effects of both drugs last for about 4 hours.

Levitra does have fewer common side effects than Viagra, and it’s not associated with rash or muscle aches. Vision color changes are considered side effects of both Viagra and Levitra.

Similarities	Differences
They’re both PDE5 inhibitors.	Viagra can be taken 30 minutes before sex, while Levitra should be taken 1 hour before.
Side effects include stuffy or runny nose, headaches, vision changes, dizziness, flushing, and back pain.	Levitra may increase creatine kinase levels, a sign of possible muscle injury, but is not associated with rash or muscle aches that may occur with Viagra.

Pros of Levitra

Cons of Levitra

Pros of Viagra

Cons of Viagra

Stendra is the newest drug on the market. No generic version is available for sale yet.

A hallmark of Stendra is its fast-acting nature. You can take the 100-mg and 200-mg doses as shortly as 15 minutes before sexual activity.

As a second-generation medication, Stendra also seems to have milder side effects than Viagra and the other PDE5 inhibitors that came before it. Side effects commonly caused by Viagra — but not Stendra — include vision changes, nausea, and muscle aches.

The only common side effect caused by Stendra — but not Viagra — is a sore throat.

Similarities	Differences
They’re both PDE5 inhibitors.	Stendra can be taken 15 minutes before sex, while Viagra should be taken at least 30 minutes beforehand.
Side effects include stuffy or runny nose, headaches, flushing, and back pain.	Viagra can cause side effects including nausea, muscle aches, vision changes, and rashes.

Pros of Stendra

Cons of Stendra

Pros of Viagra

Cons of Viagra

As mentioned earlier, Cialis can be used as a daily medication to treat enlarged prostate, unlike Levitra, which is strictly used as a treatment for erectile dysfunction.

Cialis is also faster acting than Levitra. You can take it 30 minutes before sexual activity, while you should take Levitra at least 1 hour in advance.

Cialis and Levitra both have similar side effects, but some side effects unique to Cialis include muscle aches and pain in the limbs.

Similarities	Differences
They’re both PDE5 inhibitors.	Cialis can be taken 30 minutes before sex, while Levitra should be taken at least 60 minutes beforehand.
Side effects include stuffy or runny nose, headaches, flushing, upset stomach, indigestion, and back pain.	Cialis can cause muscle aches and pain in the limbs, while Levitra does not.

Pros of Levitra

Cons of Levitra

Pros of Cialis

Cons of Cialis

Here are the basic features of each of these drugs:

Viagra	Cialis	Levitra	Stendra
What’s the generic name?	sildenafil	tadalafil	vardenafil	avanafil
Is a generic version available?	yes	yes	yes	no
What form does it come in?	oral tablet	oral tablet	oral tablet	oral tablet
What strengths does it come in?	25 mg, 50 mg, 100 mg	2.5 mg, 5 mg, 10 mg, 20 mg	5 mg, 10 mg, 20 mg	50 mg, 100 mg, 200 mg
What’s the typical dosage?	50 mg	10 mg as needed or 2.5 mg daily	10 mg (5 mg if you’re 65 years or older)	100 mg
When do I take it?	30–60 minutes before sex	30 minutes before sex	60 minutes before sex	15 minutes before sex for 100 mg and 200 mg, 30 minutes before sex for 50 mg
How long does it work?	4 hours	up to 36 hours	4–5 hours	6 hours
How do I store it?	around room temperature, between 68–77°F (20–25°C)	at 77°F (25°C)	at 77°F (25°C)	around room temperature, between 68–77°F (20–25°C)

These medications are available in a variety of doses, ranging from 2.5 mg to 200 mg. You can take all of them with or without food. However, taking Viagra, Levitra, or Stendra after eating a high fat meal does slow the rate of absorption.

Most of them stay in your bloodstream for about 4 to 5 hours. Cialis is the exception, as it remains in your bloodstream for up to 36 hours. The length of time a drug stays in your system may be important if you’re taking other medications.

Do not take any of these medications more than once in a 24-hour period.

The side effects of these medications are mostly similar, and they’re usually mild. Tell your doctor if you have any side effects that linger and do not go away on their own.

Below are the most common side effects, according to their manufacturers:

Side effect	Viagra	Cialis	Levitra	Stendra
stuffy or runny nose	x	x	x	x
headache	x	x	x	x
dizziness	x	x
upset stomach	x	x	x
nausea	x
indigestion	x	x	x
vision changes	x	x
rash	x
flushing	x	x	x	x
back pain	x	x	x	x
pain in the limbs	x
muscle aches	x	x
sore throat	x

Priapism warning

If you have an erection that lasts longer than 4 hours, contact your doctor right away. This condition, known as priapism, is a risk associated with all of these ED drugs.

To get any ED medication, you’ll need a prescription. You can get a prescription through your primary care doctor or online through telehealth companies.

Unless prescribed by a doctor, online ED medications are not FDA-approved. They may contain ineffective or harmful ingredients.

Usually, you’ll go to the pharmacy to pick up your Viagra, Cialis, Levitra, or Stendra prescription. If you have health insurance, keep in mind that most insurance companies will not cover the cost of your prescription. But if you have certain medical conditions, your insurance plan may pay for the drug with prior authorization.

The exact price you pay for any drug will depend on your insurance plan, if you have one, and your pharmacy.

If you’re on a tighter budget, it’s also worth considering generic versions of ED medications like Viagra, Cialis, and Levitra. They can be just as effective at treating ED and are available at a fraction of the cost.

If your insurance company covers brand-name ED medications, they’re very likely to cover generics, too, which will bring down the price even further.

If your insurance plan doesn’t cover ED medication or you don’t have insurance, you can still get FDA-approved medication through a reputable source — but the price will be higher.

Online ED treatment companies, like Roman, Hims, and Lemonaid, all offer ED medication (brand name and generic) even without insurance.

Because these medications require a doctor’s prescription, you’ll need to meet with a doctor first. Most of these online providers allow you to meet with a licensed doctor in your state virtually.

These prices can vary based on your state, subscription package discounts, and whether you have the prescription mailed to you or filled through a pharmacy.

Here’s a quick look at what you can generally expect to pay, as of September 2022, through these services:

Viagra	Generic Viagra (sildenafil)	Daily Cialis	Generic daily Cialis (tadalafil)
Roman	$70 per dose	$2 per dose	$13 per dose	$8 per dose
Hims	$139 per dose	$3 per dose	$958 per month	$82 per month
Lemonaid	—	$2 per dose	—	$8 per dose

Each drug comes with the risk of drug interactions. Since PDE5 inhibitors work on the body in similar ways, Viagra, Cialis, Levitra, and Stendra lead to similar interactions.

• nitrates, such as isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat)
• certain blood pressure drugs, such as calcium channel blockers
• alpha-blockers, which can treat high blood pressure or an enlarged prostate
• certain pulmonary hypertension drugs, such as riociguat (Adempas)
• protease inhibitors, a class of HIV medications
• antifungal drugs, such as ketoconazole and itraconazole (Onmel, Sporanox)
• antibacterial drugs, such as clarithromycin (Biaxin)

Avoid drinking alcohol excessively while on any PDE5 inhibitor. Do not combine them with different ED drugs.

Cialis may also be less effective if used alongside antiseizure medications such as carbamazepine (Tegretol) and phenobarbital.

For specifics on which medications are safe for you to use, it’s best to consult your doctor or pharmacist.

In some cases, using these medications may mean you need to completely avoid PDE5 inhibitors. In other cases, your doctor or a healthcare professional may adjust your medication dosage, which can help lower the possibility of drug interactions while using PDE5 inhibitors.

It’s normal to lose your erection sometimes. Several factors can cause short-term erection issues, from anxiety and stress to just simply not being aroused or interested in a sexual encounter.

But if you’re having difficulties becoming erect or maintaining an erection throughout sex several times a week for longer than 4 weeks, it may be worth talking with a doctor to see whether you may be experiencing ED.

While ED can be more common as someone ages, it can affect males at almost any age. Talk with your doctor about what you have been experiencing. Ask them about what treatments they recommend.

Sometimes, just making lifestyle changes, like to your nutrition, work routine, or home life, can improve ED symptoms.

If your doctor believes you could benefit from ED medication, they can discuss your treatment options and prescribe the best ED medication for you.

Additionally, your doctor can check in with you if you start to experience any side effects from using Viagra or a similar ED medication.

Are Cialis and Viagra the same?

No. Although Cialis and Viagra are both PDE5 inhibitors that boost nitric oxide in your body to help with ED, they’re different medications.

Cialis comes in a lower dose than Viagra and can be taken daily. Also, the effects of Cialis last longer than the effects of Viagra.

How long does it take for Cialis to peak?

It depends on the individual and the level of arousal. It’s recommended that you take Cialis 30 minutes before engaging in sexual activity, but it may take as long as 2 hours to take effect. Cialis also requires sexual stimulation in order to work, so arousal also factors into this equation.

Do ED medications make you last longer?

These medications are meant to help you have an erection long enough to have sex. However, medications like Viagra aren’t approved to treat premature ejaculation.

Can Viagra and Cialis be taken together?

It’s unnecessary to take Viagra and Cialis together. They’re both PDE5 inhibitors that help achieve the same goal. Your doctor can help you decide which would be best for you, but there’s no need to take both.

Is there a generic of Stendra?

No, there is currently no generic of Stendra available in the United States.

Which ED medication is best?

It depends on the individual. While all ED medications help achieve the same goal, they differ in dosage, length of effects, and potential side effects. Consider all of these factors when determining which ED medication might work best for you.

Which ED medication causes the fewest side effects?

Stendra has the fewest side effects. Viagra, although the most well-known, has the most side effects.

If you have ED, talk with your doctor about Viagra, Cialis, Levitra, and Stendra. Tell your doctor if you take other over-the-counter or prescription drugs or supplements. Be sure to mention all other health conditions you have.

When used correctly, each of these drugs has been shown to help people with ED. Take them exactly as your doctor prescribes. If you have questions or concerns, talk with your doctor.

All of these medications have been shown to lead to good results, but it may take a little time and patience to find the right one for your needs. If one drug does not work or produces unpleasant side effects, you can try another one.

It may also take some trial and error to find the dosage that works best for you. If you’re not sure that using ED medication is right for you, you can also give natural ED treatments a try.

If you’re considering natural ED treatments, talk with your doctor or a healthcare professional first to learn more about risks, benefits, and potential drug interactions.

Last medically reviewed on August 31, 2022

ED medication: Which pills are the most effective?

Erectile dysfunction (ED) is a treatable condition, and various medications can help, such as sildenafil and tadalafil. The pills that people find most effective will depend on their individual needs and lifestyles.

All ED pills are available via prescription only, so a person must first speak with a doctor or healthcare professional to discuss symptoms. Some companies offer telehealth consultations. The medical professional will then decide whether ED medication is appropriate.

Research shows that phosphodiesterase type 5 (PDE5) inhibitors can effectively treat ED, together with other medications, such as injections.

These drugs impede the functioning of PDE5, an enzyme within the blood vessel walls that helps control blood flow.

Following arousal, the body releases enzymes that cause blood vessels in the smooth muscles to relax, allowing for more blood flow. PDE5 inhibitors block the degradation of these enzymes, increasing blood flow and resulting in an erection.

It is important to note that a person needs to be aroused for a PDE5 inhibitor to help with ED.

This article focuses on PDE5 inhibitors. It discusses what erectile dysfunction is and what may cause it and looks at the common PDE5 medications for ED in detail.

Below is a comparison table of these oral ED treatments.

Sildenafil (Viagra)	Tadalafil (Cialis)	Vardenafil (Levitra or Staxyn)	Avanafil (Stendra or Spedra)
Dosage options	25 mg, 50 mg, 100 mg	2.5 mg, 5 mg, 10 mg, 20 mg	2.5 mg, 5 mg, 10 mg, 20 mg	50 mg, 100 mg, 200 mg
Typical dosage	50 mg	10 mg as needed or 2.5 mg per day	10 mg (5 mg for people 65 years or older)	100 mg
When to take (onset)	30–60 minutes before sex	30 minutes before sex	60 minutes before sex	15 minutes before sex for 100 mg and 200 mg, 30 minutes before sex for 50 mg
How long it lasts (duration)	4 hours	up to 36 hours	4–5 hours	6 hours
How to store	around room temperature, from 68–77°F (20–25°C)	at 77°F (25°C)	at 77°F (25°C)	around room temperature, from 68–77°F (20–25°C)

Erectile dysfunction occurs when a person cannot develop or maintain an erection firm enough for sexual intercourse.

According to a 2022 overview of the condition, ED is common in individuals over 40 years of age.

ED can differ from one person to another. While some people can get an erection, they may not be able to maintain it, and they may not be able to get one every time they want to have sex. Others may not be able to get an erection at all.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) writes that ED can be a short- or long-term health concern.

The National Health Service (NHS) in the United Kingdom reports that ED occurs due to factors such as fatigue, stress, anxiety, or alcohol consumption. However, someone who experiences ED regularly should talk with a doctor.

• depression
• performance anxiety
• other sexual disorders
• aging
• heart problems
• high blood pressure
• diabetes
• metabolic syndrome
• neurological disorders, such as multiple sclerosis
• hormone changes
• traumatic injuries
• stroke
• sleep apnea
• chronic obstructive pulmonary disease
• glaucoma
• priapism
• prostatic hyperplasia
• medication side effects

Below is detailed information about the PDE5 inhibitor drugs available.

Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.

Medical News Today follows a strict product selection and vetting process. Learn more here.

Sildenafil (Viagra)

Sildenafil (Viagra) is common in the treatment of ED. It can also treat conditions such as pulmonary hypertension, a type of high blood pressure in the lungs.

The pills come in 25 mg, 50 mg, or 100 mg.

Some advantages of taking sildenafil for ED include:

• Fast-acting: It starts working around 30 minutes after taking the pill.
• Research: Clinical trials and studies confirm its effectiveness.
• Lasting effects: Up to 4 hours.
• Side effects: Serious side effects are rare, though they can include allergic reactions and heart problems.

• Short-term use: It may only be a short-term option, as 20–50% of people who take sildenafil do so temporarily.
• Unsuitable for some health conditions: Viagra’s prescribing information states people with cardiovascular diseases that make sexual activity unsafe should take Viagra with caution. This also applies to people with aortic stenosis, idiopathic hypertrophic subaortic stenosis, or those with severely impaired autonomic blood pressure control. The NHS states those with serious liver conditions, low blood pressure, multiple myeloma, or sickle cell anemia should speak with a doctor before taking Viagra.
• Drug interactions: It can interact with other drugs, including some heart disease and blood pressure medications.
• Preference: People seem to prefer an alternative drug called tadalafil, though the two drugs are equally effective, according to 2017 research.

There are also some possible side effects of sildenafil, including:

• a stuffy or runny nose
• hot flashes
• headaches
• a fever
• nausea
• chest pains
• painful erections lasting several hours
• dizziness
• vision problems
• indigestion

Where to buy sildenafil (Viagra)

The following companies offer sildenafil:

Roman	Lemonaid	Blink Health	GoodRx	Optum Perks
Cost	starting from $2 per dose	starting at $2 per pill	initial cost of $10, then starting from around $17 per month	dependent on pharmacy	dependent on pharmacy
Available dosage	20–100 mg, according to a doctor’s recommendation	20 mg — doctors may recommend taking multiple pills to create a 40 mg, 60 mg, 80 mg, or 100 mg dose	20 mg, 25 mg, 50 mg, 100 mg	20 mg, 25 mg, 50 mg, 100 mg	20–100 mg, according to a doctor’s recommendation

Optum Perks is a sister site of Medical News Today. It offers discounts to help you find the lowest cost pharmacy for your prescriptions.

Tadalafil (Cialis)

Tadalafil (Cialis) works by increasing blood flow to the penis. Doctors also use the drug to treat high blood pressure in the lungs and enlargement of the prostate. For ED, people take it as an oral tablet.

Some advantages of tadalafil include the following:

• Longest lasting: It is the longest lasting PDE5 drug for ED, typically lasting up to 36 hours, though some reports suggest it can last up to 72 hours.
• Longer-term use: It is possible to take a low dose of 2.5–5 mg once per day for a longer-term solution.
• Daily use: People who regularly engage in sexual activities may prefer taking a daily pill.
• Increased confidence:Research suggests that people who take tadalafil experience more sexual confidence than those who do not.

However, disadvantages include the factors below:

• Cost: Taking it every day can have a higher cost.
• Hidden underlying ED causes: Taking it long term may prevent or delay treatment for the underlying cause of ED, which may be psychological.
• Drug interactions: Tadalafil can interact with several types of medication, including common blood pressure drugs.

There are also possible side effects from tadalafil, including:

Where to buy tadalafil (Cialis)

Tadalafil is available to purchase from the following companies:

Roman	Lemonaid	Blink Health	GoodRx	Optum Perks
Cost	$11–44	$65 per pill	initial cost of $10, then starting from around $17 per month	dependent on pharmacy	dependent on pharmacy
Available dosage	2.5, 5 mg, 10 mg, 20 mg	5 mg, 10 mg, 20 mg	2.5 mg, 5 mg, 10 mg, 20 mg	2.5 mg, 5 mg, 10 mg, 20 mg	2.5, 5 mg, 10 mg, 20 mg

Avanafil (Stendra)

Avanafil (Stendra) is another PDE5 drug. It works similar to other drugs in its class by increasing blood flow to the penis.

• Fast-acting: Avanafil can start working 15–30 minutes after taking the drug.
• Safe:Research has found that avanafil is a safe and effective ED treatment.
• Longer lasting: Its effects can last up to 6 hours .
• Popular with older and younger adults: An older review from 2014 found that older and younger adults both preferred taking avanafil to other PDE5 drugs due to its quick effects.

However, a disadvantage of the drug is that it is currently unavailable in generic form, making it more expensive than other PDE5 drugs.

There are also some possible side effects of taking avanafil, including:

Where to buy avanafil (Stendra)

The following companies offer avanafil (Stendra).

GoodRx	Blink Health	Optum Perks
Cost	dependent on pharmacy	starting from around $415 for six tablets	dependent on pharmacy
Available dosage	50 mg, 100 mg, 200 mg	50 mg, 100 mg, 200 mg	50 mg, 100 mg, 200 mg

Vardenafil (Levitra)

Similar to other PDE5 medications for ED, vardenafil (Levitra) works by increasing blood flow to the penis.

Some advantages of vardenafil include clinical trials finding it to be effective. In addition, unlike avanafil, vardenafil is available in a more affordable, generic form.

Its disadvantages are that the drug can take comparatively longer to start working, and a person needs to take it 1 hour before sexual activity. In addition, compared with tadalafil and sildenafil, vardenafil has no unique advantages.

Some possible side effects of vardenafil include:

Where to purchase vardenafil (Levitra)

Levitra and its generic version, vardenafil, are only available to purchase once a doctor has prescribed them.

At the time of publication, four 2.5-mg tablets cost between $29 and $178, while thirty 20-mg tablets can cost up to $442.

People can purchase ED medications at a pharmacy, provided they have a valid prescription from a doctor or healthcare professional.

Alternatively, they can purchase them online, usually after completing an online questionnaire reviewed by a doctor or healthcare team.

Individuals should check reviews of the health company before purchasing a product and consult a doctor or pharmacist if they have any concerns.

Research suggests that ED pills are safe and effective when someone takes them under a doctor’s supervision.

Results may vary between individuals, but a 2021 review found that 50 mg and 100 mg sildenafil pills were most effective compared to a placebo. However, there is currently insufficient data to compare the different PDE5 inhibitor pills.

ED pills are typically taken around 1 hour before sex. However, instructions may vary between medications.

Some pills require people to take them with food, and other pills on an empty stomach.

A person should always follow the instructions before taking any prescription medication.

While ED medications are often effective, some individuals may prefer to try other methods of ED treatment, including :

• Diet, exercise, and healthy habits: This involves staying active, following a nutritious diet, and avoiding smoking.
• Psychotherapy: Dealing with underlying emotional or psychological issues may help ease ED.
• Vacuum devices: These devices use suction to bring blood into the penis to achieve an erection.
• ED rings: These devices use constriction to maintain an erection. A person puts this device around the base of their penis. An example of this is Eddie by Giddy. The product comes in different sizes, and the website provides full instructions. Learn more about the Eddie product here.
• Surgery: When all other treatments are ineffective, a doctor may recommend a surgical implant to help a person achieve or maintain their erections.

Individuals should keep regular contact with their doctor if they experience prolonged ED, as there may be an underlying health condition that needs exploration.

After taking ED pills, a person may experience side effects such as headaches, indigestion, dizziness, or a stuffy nose. These are common and usually subside over time.

However, a person should consult their doctor if these side effects become severe or persistent.

Although rare, ED medications can also cause more serious side effects, including:

• chest pain
• vision problems
• hearing loss
• seizures
• skin reactions, including itchy, red, or swollen skin
• priapism, a painful erection lasting more than 4 hours

If someone experiences any of these side effects, they should discontinue using the drug immediately and seek medical advice.

Symptoms, such as wheezing, tightness in the chest or throat, difficulty breathing, and swelling of the mouth, throat, lips, or tongue, may have links with anaphylaxis, a life threatening allergic reaction.

If a person notices any symptoms of anaphylaxis, they should call 911 or go to the nearest emergency room.

Some people should not take ED medications or should take them with caution. Some examples include:

• Those avoiding sexual activity: Individuals with recommendations from a healthcare professional to avoid sexual activity due to health problems should not take any ED drugs.
• Grapefruit: A person should not take PDE5 inhibitors with grapefruit or grapefruit juice as it may affect how the drugs work.
• History of adverse reactions: People who previously experienced sudden hearing loss or vision problems should not use the drugs. If someone new to ED drugs experiences these symptoms, they should discontinue use and seek immediate medical attention.

ED medications may also interact with other drugs, including:

• nitrates
• certain blood pressure medications
• alpha-blockers
• guanylate cyclase stimulators
• certain antifungal medications and antibiotics

Additionally, individuals taking HIV protease inhibitors, such as ritonavir (Norvir), should not take avanafil. The Food and Drug Administration (FDA) advises that people with liver or kidney problems do not take avanafil.

Those who experience an erection lasting more than 4 hours should also consult their doctor.

Herbal supplements

A person should be cautious when considering herbal supplements that claim to help with ED. This is because there is very little research to prove their effectiveness, and the FDA has not approved these products.

Specifically, the FDA advises against buying “herbal Viagra” as it contains undeclared ingredients that may negatively interact with some prescription drugs.

Here are some common questions about ED and its medications.

What causes ED?

ED can develop due to several mental or emotional issues, including stress, anxiety, depression, and relationship issues.

There are also many physical causes of ED, such as heart disease, diabetes, multiple sclerosis, and high blood pressure or cholesterol levels. Smoking tobacco, consuming high amounts of alcohol, and taking certain medications could also contribute to the condition.

How do you know whether ED is physical or mental?

A doctor or healthcare professional can determine whether a person’s ED is due to physical or mental health factors by collecting information about their medical and sexual history. They may also conduct a physical exam.

Healthcare professionals may also recommend an overnight erection test, which involves placing a device around the penis overnight to measure the number of nocturnal erections. If a person can achieve a set number of erections at night, it may indicate that their ED is due to psychological problems rather than physical conditions.

A person may also undergo an intracavernosal test. During this test, doctors inject a small amount of medication into the base of the penis to cause an erection. Imaging techniques, such as an ultrasound, can also help determine whether there are any problems with blood flow.

How much do pills for ED cost?

To get a pill for ED, a person needs a prescription from a doctor or an online telehealth service. Once the prescription is ready, the cost will depend on whether an individual’s insurance plan covers all or some of the costs.

Typically, generic versions of ED pills, such as sildenafil, cost significantly less than the brand-name versions, such as Viagra.

How effective are ED medications?

Each of the medications in this article is effective in treating ED. However, according to research , avanafil may be the fastest working medication with the fewest visual side effects.

It is important to note that for any of these medications to work, a person requires sexual stimulation.

Which ED medication is best?

The type of ED medication a person should take depends on individual needs. Each medication type may have different side effects, dosage requirements, and times to work properly.

Individuals should consider these factors before trying these medications.

Which ED drug is safest?

All four of the main ED pills — sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) — are safe for most people to use. These drugs are FDA-approved for use in ED. A person must ensure their medication is doctor-prescribed and comes from a legitimate source.

Is it safe to combine ED treatments?

Health experts recommend against combining ED medications unless a doctor advises otherwise.

If one medication for ED is not working, a person should consult their doctor to determine whether alternative treatment options may work better or if other underlying factors may contribute to ED.

What is the most popular ED pill?

The most commonly prescribed erectile dysfunction medications are sildenafil (Viagra) and tadalafil (Cialis).

Can you get ED medications over the counter?

Most ED medications require a prescription from a doctor. However, people can buy ED devices such as vacuums and rings online.