Over-the-Counter Viagra for Erectile Dysfunction: Does it Work?

• Best DHEA: Spring Valley DHEA Tablets | Skip to review
• Best for L-arginine: Horbäach L-Arginine | Skip to review
• Best ginseng: Mason Natural Korean Ginseng | Skip to review

Erectile dysfunction refers to difficulty developing or maintaining an erection. It is a common condition, affecting at least 52% of American males between the ages of 40 and 70.

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 supplements, natural remedies, and prescription medications. We also discuss the evidence and risks associated with these options.

Sildenafil is the generic name for Viagra. This medication is only available via prescription in the United States (US). Therefore, viagra is not available OTC.

An OTC Viagra alternative refers to any supplement or herb that claims to produce similar effects to Viagra.

In most cases, there is insufficient research to suggest that OTC Viagra alternatives can benefit sexual function.

The US Food and Drug Administration (FDA) does not regulate OTC Viagra alternatives for their safety or effectiveness. Moreover, the FDA cannot test all products marketed for use as sexual enhancers.

Over-the-counter Viagra alternatives are a type of supplement, and the FDA does not regulate supplements for their safety or effectiveness. Supplements may contain a combination of ingredients, or product labels may not specify which ingredients the product contains. As such, the FDA does not recommend using OTC products for ED.

Since OTC Viagra alternatives are not FDA-regulated, 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.

Dehydroepiandrosterone (DHEA) is an important hormone for sexual function. It helps create sex hormones, including testosterone and estrogen.

The adrenal gland naturally produces DHEA. However, DHEA levels 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 conclusively shown that DHEA supplements can treat ED or improve sexual performance.

DHEA manufacturers also claim their supplements can boost energy, enhance immunity, and slow aging. However, there is not enough evidence to suggest that DHEA has any of these effects.

One significant drawback of DHEA is that it is not suitable for athletes. The United States Anti Doping Agency (USADA) prohibits the use of DHEA in sports, and notes that the substance falls under the category of anabolic agents on the World Anti-Doping Agency Prohibited List.

Another drawback of DHEA is the lack of studies investigating its safety, effectiveness, and dosages.

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.

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

The body converts L-arginine into the chemical “nitric oxide”. This chemical may help the blood vessels open wider, thereby improving blood flow throughout the body.

Research from 2021 found a link between L-arginine deficiency and ED. The authors noted that combining L-arginine with a prescription ED treatment such as tadalafil may improve ED. However, a person should talk to their doctor before combining supplements and medications, as doing so can cause adverse effects.

A 2022 review notes that L-arginine in doses of 1,500–5,000 milligrams (mg) shows some effectiveness in treating mild to moderate ED.

Additionally, a 2020 small-scale clinical trial reported that taking 2,500 mg of L-arginine alongside improved symptoms of mild to moderate ED.

However, a person should be cautious when taking L-arginine or similar supplements, as side effects can include:

• nausea
• diarrhea
• slightly lower blood pressure

As with other supplements, any benefits of taking L-arginine are likely to arise from continuous use. However, scientists currently do not know how safe it is to take high dose L-arginine supplements for more than 3 months.

Ginseng or “Panax ginseng” is a popular herbal remedy that 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 and around the penis.

A 2021 review found that ginseng has a trivial effect on ED in comparison to placebos. However, more research is necessary.

The National Center for Complementary and Integrative Health (NCCIH), notes that the most common side effect of ginseng is interrupted sleep or insomnia.

According to the NCCIH, other potential side effects include:

• headaches
• breast pain
• issues with menstruation
• fast heart rate
• changes in blood pressure
• digestive issues

It is important that a person talks to their doctor before taking ginseng, since this supplement can interact with a variety of medications, including:

• calcium channel blockers
• statins
• certain antidepressants

Learn more about ginseng and ED.

Best ginseng: Mason Natural Korean Ginseng

Propionyl-L-carnitine is one of the commercially available forms of L-carnitine. This chemical plays an essential role in metabolism and in helping protect the body from certain forms of free radical damage.

A 2021 systematic review states that antioxidants such as propionyl-L-carnitine may increase the effectiveness of ED medications such as tadalafil. However, further research is necessary.

It is also not clear whether propionyl-L-carnitine alone would have the same beneficial effects on ED.

Scientists also have not established safe and effective dosages for propionyl-L-carnitine.

Best propionyl-L-carnitine: Swanson Propionyl L-Carnitine with Glycine

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

According to the NCCIH, people also use yohimbe as a natural supplement for ED and other issues, including:

• weight loss
• high blood pressure
• diabetes-related nerve damage

However, a 2022 review refers to studies in which participants took yohimbine as a treatment for ED. These studies found that yohimbine was no more effective at controlling ED than a placebo.

The NCCIH states that there is not enough evidence to support the use of yohimbe for ED or any other medical condition.

The NCCIH also notes the possible side effects of yohimbe, which include:

• digestive issues
• increased blood pressure
• a fast or irregular heartbeat
• anxiety

Yohimbe has also been associated with heart attacks and seizures.

The NCCIH states that yohimbe can interact with certain medications, including a class of antidepressant medications called monoamine oxidase inhibitors (MOAs).

A person should speak with a doctor before taking yohimbe.

The table below compares all of the above OTC Viagra alternatives.

Over-the-counter products marketed for ED claim to benefit those with ED, either by increasing levels of certain sex hormones, or by widening blood vessels to facilitate an erection.

However, there is currently no evidence to suggest that OTC Viagra is safe or effective. A person should exercise caution before trying any OTC Viagra products and speak with a doctor before making a purchase.

The FDA does not test or regulate OTC Viagra alternatives, and there is insufficient research to determine whether these supplements are safe or effective.

The FDA recommends being particularly cautious with ED pills that:

• claim to produce fast results, such as within 30–40 minutes
• are available in single servings
• are labeled as alternatives to prescription drugs
• are marketed through unsolicited emails
• have labels in a different language without trusted translation
• contain warnings and directions that mimic those of prescription products

In addition, the FDA has a database of over 300 products marketed for ED that contain excessively high doses or undisclosed ingredients. These ingredients may interact with other medications a person is taking, potentially resulting in harmful consequences.

For example, these products may interact with drugs that contain nitrates, such as:

• nitroglycerin, which helps treat angina and coronary heart disease
• isosorbide or nitroprusside, which helps treat high blood pressure
• amyl nitrate, which helps treat angina

Given the above, it is best to speak with a doctor before taking any supplement.

Potential risks of using OTC treatments for ED include:

• Drug interactions: Some supplements may cause unsafe interactions with other medications or supplements that an individual is taking.
• Undisclosed ingredients: Inaccurate reporting of ingredients could lead to a person consuming harmful ingredients or consuming a harmful dose of ingredients.
• Quality control: A lack of quality control and FDA regulation can lead to dangerously different levels of active ingredients in the same product.

It is important not to purchase products that advertise themselves as “herbal Viagra” or over-the-counter (OTC) Viagra. The FDA does not regulate these supplements and warns that these product may contain active drugs that the manufacturers do no list on the label.

A recent study found that three out of the 12 herbal ED products they investigated contained undisclosed sildenafil. This is particularly dangerous for people who take nitrates, as their blood pressure can become dangerously low.

In addition to sildenafil, these products can contain other ingredients that interact with medications or supplements a person takes. Some of these OTC supplements may even contain ingredients that have not undergone any safety evaluation in the United States.

A doctor may prescribe medications that stimulate blood flow to the penis, thereby causing an erection.

These drugs are known as PDE-5 inhibitors. They extend the effects of nitric oxide, which the body produces to relax muscles and increase blood flow.

The four main FDA-approved oral drugs for ED are:

• Sildenafil (Viagra): Individuals typically take sildenafil around 1 hour before sex, up to once daily. Hims offers generic sildenafil at around $4 per dose. Branded Viagra starts from $139 per dose.
• Avanafil (Stendra): Individuals taking avanafil in doses of 100 mg or 200 mg should take the medication up to 15 minutes before sex, whereas those taking a 50 mg dose should take the medication around 30 minutes before sex. In both cases, a person should not take more than one dose in a 24-hour period. This product is unsuitable for smaller budgets, with six tablets costing $414.33 at Blink Health.
• Tadalafil (Cialis): Depending on the doctor’s instructions, individuals can take tadalafil daily, or as they need around 30 minutes before sex. However, they should not exceed more than one dose within a 24-hour period. Hims offers a generic version for around $6 per dose.
• Vardenafil (Levitra): Individuals can take vardenafil around 60 minutes before sexual activity, and should not exceed more than one dose per day. The generic version of vardenafil costs around $126 for six tablets at Blink Health.

Learn more about which is best out of Viagra, Cialis, Levitra, and Stendra.

Side effects

Different drugs vary in dose, how long they work, and possible side effects. Roughly 40% of those who take PDE-5 inhibitors for ED experience side effects, although these symptoms are usually mild.

Below is a table featuring the four main PDE-5 inhibitors and some of their more common side effects.

Interactions

Sildenafil, the active ingredient in Viagra, can interact with medications for the following conditions:

• high blood pressure
• high cholesterol
• diabetes
• heart disease

People with any of the above conditions should consult a doctor before taking ED medications or supplements, whether prescription or OTC.

Medications for ED may also not be suitable for people with certain underlying medical conditions, including:

• heart problems
• very low blood pressure or uncontrolled high blood pressure
• liver disease
• kidney disease

A person’s doctor can determine which medication is the best fit for them.

There are several other treatment options for ED. These include vacuum devices and ED rings.

Vaccum devices are mechanical pumps that create an erection by drawing blood into the penis. Around 77% of people who use vacuum devices or penis pumps for ED were satisfied with the results.

ED rings are bands that go around the base of the penis to help maintain an erection. A 2022 case report states that ED rings can be effective in improving ED.

Learn more about the various treatment options for ED here.

However, there are some risks involved with penis pumps and rings, including:

• bruising
• pain, including painful erections
• numbness and tingling
• burst blood vessels

A person should always speak with a doctor before trying a new ED treatment to ensure it is safe.

Certain lifestyle factors can increase a person’s chance of erectile problems. Controlling these factors may help improve their symptoms.

The following may help naturally treat erectile problems and boost the person’s overall health:

• not smoking
• exercising regularly
• maintaining a moderate weight
• eating a healthy diet
• reducing stress or anxiety

Prescription medications can help people manage ED symptoms, but they require a consultation with a physician. Research reports that males are less likely than females to seek preventive or immediate medical care.

As an alternative, some businesses offer telehealth services that include ED diagnostic and treatment options. The ability to access evaluation and treatment online can help people save money, time, and preserve anonymity, which may make it more likely that they can get the safe and professional help they need.

Learn more about the benefits of telemedicine.

However, telehealth should not replace in-person exams since ED can be associated with other health issues, such as cardiovascular disease.

Learn more about prescription drugs for ED here.