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Prescription erectile dysfunction (ED) pills that are available from a local pharmacy are generally safe for most people. However, a person needs to avoid ED pills if they take nitrates for a heart condition.

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

Along with sexual arousal, PDE5 inhibitors help someone achieve an erection by relaxing the smooth muscle in the walls of the blood vessels. This dilation allows the penis to fill with blood.

There are four main types of ED pills with approval from the Food and Drug Administration (FDA) in the United States.

They are:

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

The safest ED pills are those you receive with a prescription from a local or online pharmacy.

Viagra

Sildenafil, more commonly known by the brand Viagra, is often the first-line treatment for ED. Doctors typically recommend Viagra before other treatments because it has been on the market for so long, so its side effects and interactions are familiar.

Many doctors prescribe a Viagra dose of 50 milligrams (mg), which a person can ideally take about 1 hour before sexual activity. However, it should be effective anywhere from 30 minutes to 4 hours before sex.

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

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

Cialis

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 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 a 5-mg Cialis dose to treat benign prostatic hyperplasia. Therefore, it is a suitable option for simultaneously treating the symptoms of an enlarged prostate and ED.

The authors of a 2017 review looking at 16 trials comparing Cialis with Viagra observed that people preferred taking Cialis due to feeling less pressure over when to take the drug, leading to an increase in sexual confidence.

Levitra

Levitra is the brand name of vardenafil. Doctors recommend 10 mg as an initial dose, which a person needs to 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 individual. A person should take Levitra no more than once daily, 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 taking no more than one per day is important.

Stendra

The FDA has 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 individuals can increase it to 200 mg or decrease it to 50 mg, depending on how they respond to treatment.

Men’s health resources

For more research-backed information and resources, visit our dedicated men’s health hub.

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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. We choose reputable and reliable brands with positive reviews and transparent business practices.
  • Product transparency: MNT selects products that state ingredients, side effects, and recommended dosage clearly.
  • Safety: MNT selects brands that require a doctor’s prescription before customers can order ED pills. This ensures that a person can safely take ED pills 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 ED pills.
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The safest way to obtain ED pills is to consult a doctor for a prescription and collect the prescription from a local or online reputable pharmacy. The doctor will discuss symptoms and prescribe the best pill according to a person’s needs.

A person may also purchase ED pills online. However, this still requires a prescription. Someone purchasing online will be subject to a virtual consultation with a doctor, usually via video or phone.

PDE5 inhibitors are some of the most heavily counterfeited medications, and they may have inaccurate ingredient amounts, which could be dangerous. Whether people visit in-person or online pharmacies, they need to take extra care and purchase only from reputable companies.

Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.

The following table compares the ED services in this article on treatments offered, delivery time, and more.

Treatments offeredDelivery timeAccepts insurancePrice per pill
Hims• Viagra
• sildenafil
• Cialis
• generic Cialis
• Hard Mints
• tadalafil
2 to 5 business daysnofrom $4
Lemonaid• generic Viagra
• generic Cialis
next day deliverynofrom $2
Roman• Viagra
• generic sildenafil
• generic tadalafil
• daily generic tadalafil
• Cialis
two daysnofrom $4
BlueChew• sildenafil
• tadalafil
• vardenafil
in as little as 48 hoursnofrom $0.37

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.

It is important not to take ED pills with nitrates such as nitroglycerin, because the drugs can interact to cause dangerously low blood pressure.

People with urinary problems need to leave 4 hours between taking alpha-blockers and ED medication. Alpha-blockers include doxazosin (Cardura) and prazosin (Minipress).

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 need to 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 sufficient 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 long enough to ejaculate.

Learn more about the best ED pills for diabetes.

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

For the most effective erection, experts recommend engaging in foreplay with a 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 suitable 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 exactly the same as its branded equivalent 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. People should not purchase if they are available online with no need for a prescription.

Illegally sold ED pills could come from an unreputable manufacturing source and may contain unknown and undeclared ingredients, which can be dangerous.

All erectile dysfunction medicines, whether prescription or over-the-counter, can cause side effects.

PDE5 inhibitors are a primary treatment for erectile dysfunction. People can discuss the side effects with a healthcare professional to determine which PDE5 inhibitor is the best for their circumstances.

All ED drugs can cause side effects.

However, sildenafil is usually the first drug doctors prescribe because it has been on the market longer and more is known about its efficacy and side effects.

There is no one ED drug that is considered the safest option. Doctors consider the four main pills — sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) — safe for most people.

Yes. A number of medications have FDA approval and are effective in treating ED. These include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra).

A healthcare professional will help a person decide the best erectile dysfunction pill for their circumstances.

Things to consider when choosing the best erectile dysfunction pill include the cost, side effects, formulation, how frequently someone needs to take the medication, and whether a person is happy using generic or brand-name drugs.

Older research suggests that the first step in treating ED in seniors is to change lifestyle factors, such as quitting smoking, losing weight if necessary, and exercising regularly.

In addition, the National Institute on Aging (NIA) says ED is more common in older adults. The NIA states this may be for various reasons, including some medications, some illnesses, surgery, and drinking too much alcohol.

PDE5 inhibitors, such as sildenafil and tadalafil, are common medications to help ease ED symptoms in older individuals. This medication is safe for older adults unless they also take nitrates or have a high risk of cardiovascular disease that requires exercise restriction.

There are several methods a person may use to have and maintain an erection.

Lifestyle changes such as exercising regularly, eating a nutritious diet, limiting alcohol consumption, and managing any conditions such as high blood pressure and diabetes may help reduce ED symptoms.

Some people may find that penis pumps help maintain erections. A 2018 study found that 77% of people and their partners were satisfied with the outcome after using these devices.

However, people always need to speak with a healthcare professional to determine whether these devices are suitable for their needs.

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 need to review all their medications with a doctor and discuss safe options if they are taking alpha-blockers or nitrates. Combining these medicines could cause an unsafe drop in blood pressure.