Viagra alternatives: Pills, natural remedies, and over-the-counter options

Viagra is a well-known treatment for erectile dysfunction, but many other medications and approaches can help achieve and maintain erections.

Research indicates that erectile dysfunction (ED) affects over 12 million men in the United States each year. Although the prevalence of this issue increases with age, it does not just affect older adults.

However, a range of treatments and strategies can improve or reverse ED. Options include drugs and other medical treatments, lifestyle changes, and alternative approaches.

In this article, we look into various alternatives to Viagra, answer some frequently asked questions, and discuss when to contact a doctor.

The table below offers a quick comparison of Viagra to its alternatives:

Why use it?	Price	Lasts for	Pros	Cons
Viagra (sildenafil)	starts working in 30–60 minutes	depends on insurance, location, and pharmacy	4 hours	different doses available

can take them with or without food

may cause side effects

Beyond Viagra, several medications can help with having and keeping erections.

Oral medications

Oral drugs, including Viagra, may be the first approach to treating ED.

Viagra is effective because it slows the action of phosphodiesterase type 5 (PDE5), an enzyme in the blood vessel walls.

Other prescription-only PDE5 inhibitors include:

• Vardenafil: Available under the brand names Levitra and Staxyn, this drug is available in regular and disintegrating tablet forms. A person takes it 1 hour before sex, and it can be effective for up to 7 hours.
• Tadalafil: Available under the brand names Adcirca and Cialis, a person takes this 1–2 hours before sex. Each dose can last up to 36 hours.
• Avanafil: Available in the U.S. as Stendra, a person takes this drug 15–30 minutes before sex, and the effects can last up to 6 hours.

There are various telehealth companies that stock ED medications, including:

• Roman: This company offers sildenafil or tadalafil and requires people to schedule an online appointment with its doctors. A person can benefit from personalized treatment, free delivery, and ongoing follow-ups. The platform also offers treatment for those with concerns about hair loss, premature ejaculation, and allergies. Learn more about Roman.
• Hims: This company addresses men’s health concerns. First, people complete an online form so that a physician can learn more about their symptoms. Once a person receives a treatment plan, they can have a follow-up appointment with Hims doctors. Learn more about Hims.
• Lemonaid Health: This brand offers medication for various health conditions. People can access ED medication starting from $2 per pill after scheduling an online appointment with a doctor.

Nonoral drugs

Alternatives to pills and tablets include :

Penile self-injections

Certain medications, such as alprostadil (Caverject), papaverine, and phentolamine (Regitine), are available as an injection directly into the side or base of the penis.

This method generally works very quickly and is highly effective. However, this approach may cause side effects, including swelling, pain, and stinging. It may also cause permanent damage with improper use.

Urethral suppositories

A person can use a special applicator to insert very small alprostadil suppositories into the urethra, a method that can help stimulate erections.

This method generally works quickly, and a person can also self-administer this treatment.

However, these suppositories could affect a fetus if a sexual partner is pregnant. It could also cause side effects and not be as effective as other methods.

Testosterone replacements

A doctor may recommend this approach if they believe that ED is due to low levels of testosterone. A person can take synthetic testosterone via pills, patches, and injections.

Pros:

• increased energy
• increased muscle mass
• increased libido

Cons:

• unwanted physical changes, such as swollen breast tissue
• risk of prostate health issues
• risk of reducing sperm count

Other medical treatments

In some people, drug treatments may be unsuitable, perhaps due to other health issues. In these cases, a doctor may recommend:

Vacuum erection devices

These are hollow tubes, also known as penis pumps. They attach to a hand- or battery-operated pump and work by drawing blood into the penis. The person can then maintain the erection using a tension ring.

Pros:

• no known side effects
• generally safe to use
• effective

Cons:

• risk of injury with improper use
• can be bulky
• can be inconvenient

Wearable devices

One example is Eddie by Giddy, a nonprescription, Class II medical device to help treat ED. The maker states that it uses constriction and tension to help maintain erections.

The Food and Drug Administration (FDA) has registered the device, but no scientific studies have evaluated its effectiveness.

Pros:

• the treatment is typically long term
• no known side effects
• a cost-efficient treatment

Cons:

• helps with maintaining an erection but not getting one
• must be properly sized
• can be tricky to use and uncomfortable

Penis implants

Implants are inflatable or bendable rods that a surgeon implants into the erection chambers of the penis. However, doctors typically only recommend this approach as a last resort .

Pros:

• allows for control over erections
• typically a long lasting solution
• typically effective, even when other methods are not

Cons:

• invasive and requires recovery time
• risk of injury
• risk of infection

Natural remedies

Many companies sell dietary supplements, herbal preparations, and food products as remedies for ED.

Some alternative herbal treatments, including the following, are also marketed for this purpose:

• Dehydroepiandrosterone (DHEA): A 2018 article states that aging causes a decline in DHEA, which leads to symptoms of depression, aggressive behavior, and low libido, among others. The research also notes that some trials suggest DHEA supplements may help improve a person’s well-being.
• Ginseng: According to a 2021 study , ginseng may improve an individual’s ability to have intercourse. In an older study , participants who took red ginseng experienced a decrease in premature ejaculation and improvement in sexual performance.
• L-arginine: Researchers of a 2017 study wrote that L-arginine is a safe ingredient but may not be effective in restoring erectile function. However, if individuals combine it with other supplements, they may experience different results. For example, an older study from 2003 found that taking L-arginine with pycnogenol may help improve sexual function in persons with ED without causing any side effects.
• Propionyl-L-carnitine:An older study found that acetyl-L-carnitine and propionyl-L-carnitine can be safe and help improve the effectiveness of sildenafil and restore sexual potency.

However, as the FDA reports, nearly 300 supplements and foods that supposedly enhance sexual function contain undisclosed drug ingredients. These supplements do not undergo analysis by the FDA for quality or purity.

With this in mind, it is vital to consult a healthcare professional before starting a supplement. Additionally, people should choose a brand that engages in third-party testing and certification.

Certain lifestyle changes may help improve erectile function:

• Eating a balanced diet: Flavonoid-rich foods, such as blueberries, strawberries, blackberries, and citrus fruits, may reduce ED for some people.
• Maintaining a moderate body weight: Having overweight or obesity may cause or worsen ED.
• Getting regular exercise: Physical activity can improve circulation, reduce stress, and contribute to a moderate body weight.
• Quitting smoking:Research indicates a strong link between cigarette smoking and ED.
• Avoiding heavy drinking and Illegal use of substances: Doing so may improve sexual function.
• Seeking help for mental health conditions: Addressing anxiety, depression, and sources of sustained stress, for example, may help.

The generic name for Viagra is sildenafil. The drug also has another brand name: Revatio. It works by slowing down the action of PDE5, an enzyme in the blood vessel walls.

This enzyme breaks down a substance responsible for blood flow in the penis. Inhibiting the enzyme increases blood flow to the area and helps achieve and maintain erections.

However, sildenafil can only help maintain an erection that a person also has physically stimulated.

Common side effects of the drug include headache, facial flushing, indigestion, nasal congestion, and a blue tint to an individual’s field of vision.

ED can result from physical, psychological, and emotional factors.

Medical conditions that may cause ED include :

• high blood pressure , a narrowing of the arteries due to a buildup of plaque
• kidney disease , which involves scar tissue in the penis
• injury to the penis, prostate, bladder, pelvis, or spinal cord

Mental health conditions and factors that may contribute to ED include anxiety, depression, guilt, stress, and low self-esteem.

Other factors that may play a role include:

• alcohol and illegal drug use
• overweight or obesity
• low levels of exercise
• smoking

Below are some of the most common questions and answers about Viagra alternatives.

Do I need a prescription for erectile dysfunction pills?

Viagra is available over the counter in the United Kingdom. However, a person in the U.S. usually needs a doctor’s prescription for this and similar drugs.

Do natural Viagra alternatives work?

There is not enough scientific evidence to suggest that herbs and other supplements can treat ED. However, various lifestyle changes, such as quitting smoking , may help.

Can I purchase Viagra alternatives online?

Some companies employ licensed medical professionals to help determine if someone may benefit from a Viagra alternative. If the healthcare professional approves, the company can then ship the treatment to the person’s front door.

Anyone with symptoms of ED that last for a few weeks or more should contact a healthcare professional.

This is particularly important for people who suspect that an underlying health issue, such as heart disease, may be causing their ED.

This health issue can be a side effect of certain medications, so a doctor may address the issue by changing a person’s ongoing treatment plan.

There are various options for people who cannot or do not want to take Viagra. These alternatives include other medications, medical devices, and lifestyle changes.

Individuals should speak with their doctor about treating ED safely.

Last medically reviewed on March 28, 2022

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