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Erectile dysfunction (ED) affects a person’s ability to get or keep an erection. While many companies advertise “natural” male enhancement pills online, these are often more dangerous than prescription alternatives.

Male enhancement pills are over-the-counter (OTC) pills that claim to help people get and maintain an erection. Instead of prescription medications, these products use herbs with very little scientific evidence of their effectiveness.

Some common ingredients in OTC pills include ashwagandha, saw palmetto, and horny goat weed. Many manufacturers use proprietary blends, meaning they do not disclose the exact herbs or amount they use in the ingredients list.

While OTC male enhancement supplements are available online and in some stores, people should avoid using them unless they have discussed this with a healthcare professional. The Food and Drug Administration (FDA) warns that these pills can often contain undisclosed sildenafil, the main ingredient in Viagra. Sildenafil can interact with prescription medication and supplements, causing unintentional and potentially dangerous side effects.

A 2021 study found that some common ingredients, such as ginseng and tribulus terrestris, show promise and require more research.

However, there is little evidence that the other ingredients in the products are effective. One analysis states that there are limited human studies on the effects of supplements on ED.

Additionally, another 2021 study found that all of the OTC products the researchers examined contained undisclosed sildenafil. This ingredient can interact with other medications and cause side effects such as dangerously low blood pressure.

The researchers recommended that OTC products containing undisclosed sildenafil should be withdrawn from the market immediately due to health concerns.

The FDA does not regulate OTC male enhancement supplements.

The organization has tested many male enhancement products purchasable online and found nearly 430 contained hidden prescription ingredients such as sildenafil.

Taking products that contain undisclosed ingredients may cause unintentional side effects and interact with other medications. Sildenafil belongs to a class of medications known as phosphodiesterase-5 (PDE-5) inhibitors.

When a person takes a PDE-5 inhibitor alongside nitrates, such as nitroglycerine, it can cause dangerously low blood pressure. Some eye conditions, such as ischemic optic neuropathy, can worsen when taking sildenafil.

FDA-tainted sexual enhancement pill database

It is important to inform the FDA if a person has an adverse reaction to male enhancement pills, especially if they are available over the counter.

The FDA maintains a database of warnings about companies selling pills containing undisclosed ingredients that may harm human health.

People can help the FDA keep this data current by reporting any adverse reactions to MedWatch, the organization’s adverse event reporting program.

FDA-approved prescription medication is available for ED.

Sildenafil received Food and Drug Administration (FDA) approval in 1998. Since then, more PDE-5 inhibitors, such as tadalafil (Cialis), have also received FDA approval.

PDE-5 inhibitors are common drugs that are widely used in managing ED.

When a person becomes aroused, their body releases enzymes that cause the smooth muscle in the blood vessels to relax. This allows blood to flow through these vessels and into the penis, causing an erection.

When these enzymes degrade, they cause blood flow to decrease. PDE-5 inhibitors block the degradation of these enzymes, enabling increased blood flow and an erection.

A person must experience arousal for the drugs to produce the desired effect.

Learn more about buying ED pills online safely.

Below, we compare the ED medication providers described in this article.

PricePills availablePrescription needed?Shipping
Roman$4–$90branded and generic sildenafil, branded and generic tadalafilyesfree
Hims$4 per dose or $958 per month branded and generic sildenafil, branded and generic tadalafil, hard mintsyesfree
Lemonaid$2–$80 per dosebranded and generic sildenafil, branded and generic tadalafilyesfree
REX MD $10–$90 per dose branded and generic sildenafil, branded and generic tadalafilyesfree
Blink Health$10–$21 per dose, $9.95 monthly subscription feegeneric sildenafil, generic tadalafil, generic vardenafilyesfree
Optum Perks$3.55–$987branded and generic sildenafil, branded and generic tadalafil, branded and generic vardenafil,
Stendra (brand only)
yesin-person shopping only

Medical News Today chooses ED products that meet the following criteria:

  • Company reputation: MNT selects products from brands that have undergone internal vetting of medical and business standards. The brands we choose are reputable and reliable, with positive reviews and transparent business practices.
  • Product transparency: MNT selects products that clearly state ingredients, side effects, and recommended dosage.
  • Safety: MNT selects brands that require a doctor’s prescription before customers can order ED pills. This ensures that a person can safely take the medication and that the provider is responsible.
  • Price: MNT selects products that suit a range of budgets, including choosing brands that offer both brand-name and generic drugs.

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

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Pills that contain sildenafil citrate are generally safe to use. However, some side effects may occur, including:

A person should avoid taking ED pills while taking specific medications. These include:

  • nitrates for chest pain
  • riociguat for pulmonary hypertension
  • recreational drugs that contain nitrates such as amyl nitrite

Below are answers to common questions about male enhancement pills:

Pills for male enhancement typically claim to help people get and maintain erections.

No research has confirmed that male enhancement pills improve sexual performance or increase penis size. However, some prescription products, such as Viagra, may help treat ED.

Viagra (sildenafil) works for around 4 hours, whereas Cialis (tadalafil) can work for up to 36 hours.

Nonprescription medication, such as delaying wipes, contain de-sensitizing ingredients that help keep people harder for longer.

The best medications to help improve sexual performance are ones that doctors prescribe or pharmacies provide and contain ingredients that the FDA has approved.

Examples include PDE-5 inhibitors. These prescription drugs include sildenafil, Viagra, Cialis, and tadalafil, and can help people maintain an erection for longer.

No, Rhino pills are not safe. The Food and Drug Administration (FDA) states that these pills contain undeclared and hidden prescription medication, including PDE-5 inhibitors.

The FDA states people have been hospitalized and had to have surgery after using these pills due to side effects such as prolonged erections and extreme drops in blood pressure.

Male enhancement pills are over-the-counter pills that people can purchase online and in-store. However, there is little evidence that these products can help with erectile dysfunction (ED). Rather, they can be dangerous, as they often contain undisclosed prescription medication that can interact with other drugs.

FDA-approved ED treatment is a safer way to get and maintain an erection. These treatments are only available via a prescription from a healthcare professional. Several telehealth companies make accessing ED treatment safe, quick, and affordable.