Over-the-counter Viagra for erectile dysfunction: Does it work?

Erectile dysfunction (ED) is a common condition treated with prescription medication. Medical professionals do not typically recommend over-the-counter (OTC) ED supplements, and most are not approved by the Food and Drug Administration (FDA).

Erectile dysfunction (ED) is a common condition that affects at least 52% of American males aged 40–70. People with ED find it difficult to develop or maintain an erection. Different medical and psychological conditions can work together or independently to cause ED, and the American Urological Association (AUA) has clear treatment guidelines for the condition.

This article looks at various treatment options for ED, including OTC pills, natural remedies, and prescription medications such as Viagra. It also discusses the evidence and risks associated with these options.

Viagra, or sildenafil, is only available by prescription in the United States. OTC viagra refers to any supplement or herb that claims to produce similar effects to Viagra and benefit ED.

In the majority of cases, OTC Viagra products are backed up by limited research suggesting they can benefit sexual function.

OTC Viagra products are not FDA regulated for safety or effectiveness and it cannot test all products marketed for use as sexual enhancers.

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.

Although there are many natural ED treatment options available, the FDA does not offer its approval as it classifies them as supplements.

Due to this, ED supplement manufacturers are not legally allowed to state that their products treat ED. Instead, they may market products as sexual enhancers with the aim of helping people achieve or maintain an erection.

The FDA does not recommend using OTC products for ED because they are not regulated for safety and may contain a combination of ingredients or do not specify which ingredients they contain.

The following sections will look at the evidence behind common OTC ingredients marketed for treating ED.

Dehydroepiandrosterone

Dehydroepiandrosterone (DHEA) is an important hormone for sexual function. It helps create sex hormones, including testosterone and estrogen. The adrenal gland naturally produces this hormone.

Levels of DHEA in the body peak in a person’s 20s, then gradually decrease with age.

According to a 2018 review , evidence suggests that low levels of DHEA in the body can increase the chance of ED. However, studies have not convincingly shown that taking DHEA supplements can help ED or improve sexual performance.

In fact, one older 2013 review concluded that DHEA did not significantly improve male sexual function.

DHEA is also a common supplement for boosting energy, enhancing immunity, slowing aging, and improving weight loss. However, there is not enough evidence to suggest that it is effective for any of these uses.

One of its significant drawbacks is that athletes cannot take it. Another is that the lack of studies means there is no information on what is the proper form and dosage for the best results.

Since DHEA is readily available as a supplement, the premise is that people who take it do so for the long term. Unlike viagra, any potential results build up over time rather than producing an immediate erection or sexual benefit.

One DHEA product is from Spring Valley. Each bottle contains 50 tablets of 50 micrograms (mcg) of DHEA. At the time of publishing, it costs $5.94.

L-arginine

L-arginine is a common amino acid in men’s health supplements.

The body converts this amino acid into a chemical called nitric oxide. Nitric oxide may help the blood vessels open wider, improving blood flow.

Research from 2017 found that a significant number of people with ED have low levels of L-arginine.

However, the findings of this study are specific to males with poor blood flow through their arteries, which is known as arterial insufficiency. The findings did not apply to males without this condition.

Other 2022 research found that treating mild to moderate ED symptoms with supplements of 1,500–5,000 milligrams (mg) was somewhat effective.

Additionally, a small-scale clinical trial from 2020 reported that taking 2.5 grams (g) of L-arginine improved the symptoms of moderate ED.

That said, a person should be cautious when taking L-arginine or similar supplements, as side effects can include nausea, diarrhea, and slightly lower blood pressure.

As with other ingredients, the supplementation form of L-arginine means that any potential benefits arise from continuous use. However, scientists currently do not know how safe it is to take high dose arginine supplements for over 3 months.

This ingredient is relatively inexpensive. For example, this supplement bottle from Horbaach contains 30 servings of 4,000 mg each. The company writes that the formulation is free of additives or potential allergens, including gluten, wheat, lactose, and soy.

At the time of publishing, it costs $14.98.

Ginseng

Ginseng, or Panax ginseng, is a popular and widely used herbal remedy. It is available in the form of pills and creams. Manufacturers claim that it can help with fertility and improve sexual function.

Ginseng contains chemicals called ginsenosides. One action of these chemicals is to promote nitric oxide, which may help trigger an erection by relaxing the smooth muscles in areas of the penis.

A review study focusing on Korean literature suggested that ginseng could help with ED and may improve sexual performance. However, the results were mixed — two studies showed positive effects, and two showed no improvement.

The NCCIH writes that the most common side effect of ginseng is interrupted sleep or insomnia.

Other side effects of ginseng may include headaches, breast pain, issues with menstruation, fast heart rate, and changes in blood pressure. It may also affect the stomach. Ginseng can also interact with a variety of medications, such as calcium channel blockers, statins, and certain antidepressants. It is important to talk with a doctor before using ginseng.

Mason Natural offers a supplement product containing 60 daily servings of 1,000 mg ginseng. It has minimal inactive ingredients, and the company writes it is soy free. At the time of publishing, it costs $9.98.

Propionyl-L-carnitine

Propionyl-L-carnitine is one of the commercially available forms of L-carnitine. Key features include playing an essential role in metabolism and protecting the body from oxidative stress and radical damage.

Some people use a supplementation form of this ingredient for these benefits and ED.

However, there is very limited data to suggest that propionyl-L-carnitine can provide the same effects as Viagra.

These two older studies that look at this ingredient in terms of benefit for sexual function only do so to see if it aids the effectiveness of Viagra:

• A 2004 study found that propionyl-L-carnitine with sildenafil is more effective in treating ED in people with diabetes than sildenafil alone.
• This 2005 study looked at whether propionyl-L-carnitine with acetyl-L-carnitine and sildenafil work better than sildenafil alone for restoring sexual potency in people after a prostatectomy. It found that the combination of the three had significantly better results.

This means that while this ingredient can be beneficial with prescription Viagra, there is no evidence that propionyl-L-carnitine on its own would have the same beneficial effects.

Moreover, no research goes into how much to take, when to take it, and when it starts to become effective.

However, some people still prefer to add it to their diet to improve bodily function as a supplement.

In fact, a 2012 small study looked at participants taking a 3-month supplementation of propionyl-L-carnitine, l-arginine, and niacin together. 40% of the study participants found they had an improvement in their erections.

Swanson sells a propionyl-L-carnitine and glycine supplement containing 60 vegetarian capsules. Each capsule delivers 515 mg of propionyl-L-carnitine. At the time of publishing, one bottle costs $24.99.

Yohimbe

Yohimbe is an African evergreen tree. Its bark contains a compound called yohimbine, which has traditional uses as an aphrodisiac.

However, 2022 research states that scientific studies of yohimbine, taken three times daily, show that it is no more effective at controlling ED than a placebo. The NCCIH says there is not enough evidence to support the use of yohimbe for ED or any other medical condition.