Erectile dysfunction (ED) is a common problem for people with diabetes, but several treatments can help.

ED involves difficulty developing and maintaining an erection for sexual activity. The cause may be psychological or physical.

Keep reading to learn more about how ED pills work, and which options are most suitable for people with diabetes.

During sexual arousal in males, the brain signals for more blood to flow into the penis, causing an erection. Erectile dysfunction (ED) occurs when a physical or psychological factor impedes this process.

For people with diabetes, ED can occur as a result of persistently high blood sugar levels causing damage to the nerves and blood vessels. Damage to certain nerves can reduce sensations in the genitals, while damage to blood vessels in the penis can reduce blood flow to this area. Either type of damage can cause ED.

Pills for ED typically contain phosphodiesterase type 5 (PDE5) inhibitors. These substances block the PDE5 enzyme, which regulates the contraction and relaxation of smooth muscles, such as those within the artery walls. Disrupting this enzyme causes the smooth muscles to relax, dilating the arteries and increasing blood flow. Meanwhile, the veins constrict, causing a blood pressure difference that leads to penile rigidity.

Diabetes can lead to physical or psychological disruption of normal sexual function in both men and women.

A person with diabetes may experience high blood sugar levels that damage the nerves or blood vessels, causing ED. People with diabetes are also more likely to have high blood pressure or cardiovascular disease, and the treatments for these conditions may further increase the risk of ED.

Most people with diabetes can take ED pills. However, it is essential to talk with a doctor first, as these medications can affect a person’s heart rate and vision. They may also interact dangerously with other medications.

Learn more about the connection between ED and diabetes here.

Below are some of the best ED pills available on the market.

Best overall: Viagra

Viagra (generic name; sildenafil) is a PDE5 inhibitor. It helps increase blood flow to the penis during sexual arousal.

Viagra starts working after about 30 minutes to an hour, and the effects last for up to 4 hours.

A doctor can prescribe Viagra in dosages of 25, 50, or 100 mg a day.

Features

  • PDE5 inhibitor
  • low dosages can also treat pulmonary arterial hypertension

Side effects

Some potential side effects of Viagra include:

In rare cases, Viagra can cause serious side effects, such as chest pain, and painful erections lasting several hours.

Price and availability

In the United States (U.S.), Viagra is only available via prescription. Some online retailers include:

  • Get Roman (starting at $2 a dose for sildenafil)
  • Lemonaid Health (starting at $2 a pill for sildenafil)
  • BlueChew (starting at $20 a month for six 30 mg sildenafil chews)

Pros and cons

Pros

  • available in various forms
  • generally fast response following ingestion
  • relatively affordable

Cons

  • side effects that can last longer than some other ED pills

Best for daily use: Cialis

Cialis (generic name; tadalafil) is another PDE5 inhibitor for ED. It is available in tablet form, and the effects can last for up to 36 hours.

Some people take this medication daily to treat both ED and urinary problems associated with prostate enlargement.

Features

  • PDE5 inhibitor
  • for use once a day, or as needed
  • takes an average of 2 hours to reach its peak potential

Side effects

Cialis can cause side effects, including:

  • hot flashes
  • headaches
  • a stuffy or runny nose
  • cough
  • indigestion
  • arm and leg pain
  • muscle pain

Price

Cialis is available via prescription only. Costs vary, depending on the supplier. For example, the company “Forhims” charges $570 for a one-pill-a-day monthly prescription.

Pros and cons

Pros

  • long-lasting
  • relatively fast-acting
  • suitable for daily use

Cons

  • costly when compared to alternatives
  • only available in pill form

Best for a coated tablet: Levitra

Levitra (generic name; vardenafil) is another PDE5 inhibitor for ED. People take Levitra 25 – 60 minutes before sexual activity, and the effects can last up to 5 hours.

A 10-mg dose of Levitra is equivalent to 50 mg of sildenafil. The medication is available as a coated tablet, which a person can take with food.

Features

  • PDE5 inhibitor
  • fast-acting
  • lasts up to 5 hours
  • available in coated tablet form

Side effects

Potential side effects of Levitra include:

  • hot flashes
  • headaches
  • a stuffy or runny nose
  • vision problems
  • stomach problems
  • muscle and back pain

Price and availability

Levitra is available via prescription only. Some insurance policies may cover the costs.

Levitra can cost $390 to $1,623 for ten to thirty 10 mg tablets. Factors that may affect the cost include the location of the pharmacy, and whether a person buys a brand name or generic label.

Pros and cons

Pros

  • fast-acting
  • a smaller dosage can have the same effect as a larger dose of another type of ED pill

Cons

  • more costly than other ED pills
  • effects do not last as long compared to other ED pills
  • only available in pill form

Best for fast action: Stendra

Stendra (generic name; avanafil) works more quickly than most other PDE5 inhibitors, taking effect within 15 – 30 minutes. The effects can last 3 – 6 hours.

Stendra is available as a tablet that people can take once daily, with or without food. A doctor will determine the appropriate dosage on a case-by-case basis.

Features

  • PDE5 inhibitor
  • fast-acting, taking effect within 15 – 30 minutes
  • effects can last 3 – 6 hours

Side effects

Stendra can cause side effects, including:

  • hot flashes
  • headaches
  • a stuffy or runny nose
  • vision problems
  • nausea
  • back and muscle pain

Price

Stendra costs $53 per 100 mg tablet. Some insurance providers may be able to cover the cost.

Pros and cons

Pros:

  • fast-acting

Cons:

  • very costly when compared to alternatives
  • effects do not last very long for the cost
  • only available in pill form

Best for a chewable alternative: BlueChew

Blue Chew is an online licensed medical provider. It provides ED tablets in a chewable form.

In order to receive the medication, a person must either have an existing prescription, or must complete a medical profile and digital consultation allowing BlueChew medical practitioners to provide the prescription. A person can then opt to receive a monthly order of either 30 or 45 mg of sildenafil, or 6 or 9 mg of tadalafil.

BlueChew notes that people should not take Sildenafil or Tadalafil if they take medication containing nitrates or guanylate cyclase stimulators for pulmonary hypertension.

BlueChew ED pills contain the same active ingredients as those in FDA-approved Viagra and Cialis. However, the chewable components are not FDA-approved.

Features

  • available in chewable tablet form
  • available via monthly prescription
  • sildenafil or tadalafil available

Price

BlueChew ED pills are available through the BlueChew website. Monthly subscriptions start at $20.

Pros and cons

Pros

  • choice of two active ingredients
  • flexibility with prescription
  • ease-of-use, with regular prescription deliveries to a person’s home
  • affordable

Cons

  • does not state if the pill is allergen-friendly

Best injectable alternative: TriMix injection

TriMix Injections are an alternative to PDE5 treatments, combining the active ingredients papaverine, phentolamine, and prostaglandin E1.

A person injects TriMix into the penis, after which an erection can appear within 5 – 20 minutes and may last up to an hour. A person cannot use the medication more than two times per week.

Features

  • injectable medication
  • fast-acting, causing an erection 5 – 20 minutes after use
  • results can last up to an hour

Side effects

Side effects of TriMix injection can include:

  • moderate pain during injection
  • a small amount of bleeding at the injection site
  • a painful sensation during erection
  • in rare cases, an erection lasting more than 2 hours

Price

TriMix injections are available via prescription only. A vial providing around 25 injections costs around $175.

Pros and cons

Pros

  • alternative for those unable to use PDE5 medication
  • fast-acting
  • self-administered
  • a single vial can offer up to 25 injections
  • some insurance plans may cover the costs

Cons

  • results do not last as long as other alternatives
  • not suitable for those with an aversion to needles
  • only suitable for use twice per week

Below is a summary table comparing the six best ED pills available for purchase.

Viagra
(sildenafil)
Cialis
(tadalafil)
Levitra
(vardenafil)
Stendra
(avanafil)
BlueChewTriMix Injections
Pricestarting at $2 a dosevaries depending on supplier$390 to $1,623$53 per 100 mg tabletmonthly prescriptions start at $20average of $175
Featureslasts 4-6 hourslasts up to 36 hourslasts up to 5 hourslasts up to 6 hourschewable tabletslasts up to one hour
Prosavailable in liquid and pill formfast-acting and suitable for daily usefast actingfast actingsubscription servicealternative to tablets
Consside effects may last longer than other ED pillscostlyeffects do not last as long as other ED pillscostlydoes not offer all types of ED pillseffects do not last as long as other ED pills

Medications for ED can cause side effects, and people with diabetes may face additional risks.

For example, PDE5 inhibitors can interact with several other drugs, including nitrate-based medications. Doctors may prescribe these medications to treat high blood pressure, which frequently affects people with diabetes.

Any person with diabetes should speak with a doctor before taking medication for ED.

A person should talk to their doctor before trying any type of ED medication, especially if they have an underlying medical condition, or are taking medication of any kind. Some medications can interact with one another, causing dangerous effects.

A person who has begun taking ED medication should see a doctor if they experience any of the following side effects:

  • hot flashes
  • headaches
  • vision issues
  • dizziness
  • nausea
  • muscle pain

A person should also see their doctor if the ED medication they are taking does not produce the desired effects. A doctor will be able to provide alternative suggestions.

Besides medication, the following approaches may help to reduce or eliminate the incidence of ED:

  • Making lifestyle changes: Examples include:
  • Improving blood sugar control: Maintaining healthy blood sugar levels can help in the long term.
  • Receiving counseling: Psychological therapies can help to address any psychological or emotional causes of ED.
  • Changing medications: ED can be a side effect of certain medications. Where possible, a doctor may change the medication type or dosage.
  • Trying devices: Vacuum devices are an alternative to ED medications. These devices use suction to draw blood into the penis.
  • Undergoing injection therapy: This therapy involves injecting medications into the penis to cause an erection.
  • Undergoing surgery: If all other treatments are ineffective, a doctor may recommend surgery to place inflatable or flexible rods into the penis to enable an erection.

Below are some frequently asked questions about ED pills.

Do ED pills work for diabetics?

Most ED pills can help a person who has both ED and diabetes. However, a person should speak to their doctor before taking medication for ED, as these drugs can interfere with other medications the person is taking. They may also affect vision, blood pressure, and heart rate.

Is Cialis better for diabetics?

Cialis does not alter blood sugar levels in people with diabetes. People can also take the medication with insulin.

Cialis contains the active ingredient “tadalafil”. A 2019 study found that men with diabetes who took tadalafil daily showed significant improvement in their ED.

A person must speak to a doctor before trying any new medication.

Can a diabetic overcome erectile dysfunction?

Erectile dysfunction can be permanent or may happen only occasionally.

The following lifestyle changes can help to improve occasional or intermittent ED:

  • maintaining a healthy weight
  • eating a healthy, balanced diet
  • avoiding alcohol
  • getting sufficient sleep
  • quitting smoking
  • getting sufficient sleep

Permanent ED can occur as a result of irreversible blood vessel damage due to diabetes or other conditions. While there are no treatments available to reduce this damage, prescription medications can help to improve functionality. If these options are not successful, a person can ask their doctor about vacuum devices or penile implants.

A person with diabetes and ED may benefit from taking ED pills. These medications typically contain PDE5 inhibitors that help to promote blood flow to the penis to induce and maintain an erection.

However, a person should talk to their doctor before trying ED pills, as these medications can cause side effects and may interfere with other medications the person is taking.

Anyone who experiences side effects while taking an ED medication should notify their doctor immediately. A person should also see their doctor if their ED medication is not effective. A doctor can recommend alternative options, such as injectable medications, vacuum devices, or penile implants.