Any erectile dysfunction (ED) pills that are available with a prescription at a local pharmacy are generally safe for most people. However, if a person is taking nitrates for an underlying heart condition, they should avoid ED pills.

ED pills are phosphodiesterase-5 (PDE5) inhibitors. A person could experience an unsafe drop in blood pressure if they take these alongside nitrates.

PDE5 inhibitors help a person achieve an erection by relaxing the smooth muscle in the walls of the blood vessels. This dilation allows the penis to fill with blood.

In this article, we talk about the different types of ED pills, their safety and side effects, and the differences between generic and branded options.

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There are four main types of ED pills that the Food and Drug Administration (FDA) have approved as treatments in the United States.

They are:

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Stendra)

Viagra

Sildenafil, more commonly known by the brand name Viagra, is often the first-line treatment for ED. Doctors tend to like trying Viagra before other treatments because it has been on the market for so long, which means that its side effects and interactions are well-known.

The FDA state that the recommended dose of Viagra is 50 milligrams (mg), which a person should ideally take about 1 hour before sexual activity. However, it should be effective anywhere from 30 minutes to 4 hours before sex.

A person should avoid taking Viagra with meals as this will slow down its absorption rate and delay its effect. People should also avoid taking Viagra with alcohol.

It usually takes 30–120 minutes for Viagra to start working after a person takes it.

Cialis

As per the prescribing information, the initial dose for Cilias is 10 mg, and a person can take it as necessary for sexual activity. They can decrease the dose to a minimum of 5 mg or increase it to a maximum of 20 mg, depending on what they need and tolerate.

Cialis behaves slightly differently than other ED medications. It does not break down as quickly, so it stays in the body for longer.

A doctor may prescribe Cialis at a 5-mg dose to treat benign prostatic hyperplasia. It is, therefore, a good option for treating the symptoms of both an enlarged prostate and ED at the same time.

The authors of a 2017 review that looked at 16 trials comparing Cialis with Viagra observed that people preferred taking Cialis.

Levitra

Levitra is the brand name of vardenafil. The FDA recommend 10 mg as an initial dose, which a person should take 1 hour before sexual activity. The maximum dose is 20 mg, with the minimum being 5 mg.

A doctor may adjust the dose depending on the medication’s effect on the person. A person should take Levitra no more than once per day, with or without food.

Staxyn is a dissolvable tablet that contains vardenafil. According to the FDA, it is “not interchangeable” with Levitra as it has a stronger effect on the body.

Staxyn comes in 10-mg tablets that dissolve on the tongue. A person can take the tablet with or without food about 1 hour before sexual activity, but it is important to take no more than one a day.

Stendra

The FDA have approved three doses of Stendra: 50-mg, 100-mg, and 200-mg. A person typically takes Stendra 30 minutes before sexual activity. The starting dose is often 100 mg, but a person can either increase it to 200 mg or decrease it to 50 mg, depending on how they respond to treatment.

The medical community considers ED pills generally safe for most people who are otherwise healthy enough for sexual activity.

As with any medication, there are potential side effects that a person may experience. ED pills can also interact with other medications, such as nitrates.

People living with urinary problems should leave 4 hours between taking alpha-blockers and ED medication.

Each pill for ED has a risk of mild side effects.

Common side effects include:

If a person has an erection that lasts longer than 4 hours, they should seek immediate medical attention. A long lasting erection can cause permanent damage to the penis.

Experts estimate that 70% of people taking ED medications will achieve an erection good enough for sexual intercourse.

The quality of the erection, pleasure, and sensations will vary depending on other preexisting conditions, such as nerve damage from surgery or diabetes. However, those who can achieve an erection should have one that lasts long enough for them to ejaculate.

Learn more about the best ED pills for diabetes here.

How long ED pills take to work will vary among individuals. Most manufacturers suggest that a person should take their ED treatment 15–60 minutes before sexual activity.

For the most effective erection, experts recommend that a person also engage in foreplay with their partner to help stimulate arousal.

Viagra, Levitra, Staxyn, and Stendra provide more of an on-demand sexual experience.

Cialis, on the other hand, stays in the body for longer and takes more time to reach its full effect. As a result, it is good for people who prefer the reliability of a daily-use product with longer lasting effects.

Brand name medications are better known than their generic counterparts due to advertising. They appear on the market first and tend to be more expensive than the generic equivalent. Newer medications typically do not have generic versions because the release of their patent rights takes time.

Generics are a copy of the branded equivalent. A generic form of medication works in exactly the same way as the branded drug and shares the same side effects and dosage instructions. A person’s insurance company may substitute a generic version of the branded equivalent to save money.

A person should always purchase their medications from a reputable pharmacy. ED medications are only available with a prescription. If they are available online with no need for a prescription, people should not purchase them.

Illegally sold ED pills could come from an unreputable manufacturing source and may contain a dangerous combination of ingredients.

ED medications are generally safe and have only mild side effects. The medications mostly work the same way and help a person achieve an erection for sexual activity.

People should review all their medications with a doctor and discuss safe options if they are taking alpha-blockers or nitrates. This is important because if a person combines these medicines, it could cause an unsafe drop in blood pressure.