Erectile dysfunction (ED) affects nearly every man at some point in his life. Whether it happens only occasionally or has become a chronic problem—or somewhere in between—men frequently turn to erectile dysfunction drugs. While the “little blue pill” and its cousins usually come to mind first, there are other medications for erectile dysfunction that are not taken orally. It’s good to have choices, and fortunately you do./.,mnbvcxz
What’s the first thing you should do if you are experiencing erectile dysfunction? What do you know about the different erectile dysfunction drugs? What side effects can you expect? How effective are these drugs?
These and more questions are important for every man to ask before he decides to use any type of erectile dysfunction drugs. So let’s get to it.
What should men with ED do first?
If you are experiencing problems in the bedroom and they are not going away, you should seek professional help to identify the reason for your erectile dysfunction. That means making an appointment with your primary care physician or urologist and having a heart to heart talk along with providing your medical information and likely a physical exam. Once you have a better handle on why you are experiencing impotence, the what and how of treatment can begin.
You may be experiencing psychological challenges such as excessive stress or relationship problems that are interfering with your ability to get and maintain an erection. Perhaps you have one or more of dozens of underlying medical conditions, such as diabetes, high blood pressure, or heart disease, which can affect erections.
Even lifestyle habits, including tobacco use, alcohol consumption, prescription and illicit drug use, and poor diet, can play a part. Identifying the underlying reasons for your erectile dysfunction should be the first step you take, before you decide if you need erectile dysfunction drugs.
Which erectile dysfunction drugs are available?
The first erectile dysfunction drugs that most men think of are the oral drugs, which include avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxyn), all of which have been approved by the Food and Drug Administration (FDA) for this purpose. Other drug options include alprostadil as an injection, alprostadil as a suppository, and the hormone testosterone. Alprostadil is available under the brand names Caverjet, Edex, and Muse. Testosterone is available as a topical, pill, patch, injection, and implant but has limited studies on its effectiveness for ED.
How do oral erectile dysfunction drugs work?
All of the five FDA approved oral drugs for erectile dysfunction work in a similar way: they increase the flow of blood to the penis, which enables a man to get and maintain an erection. However, these drugs do not automatically result in an erection. Men must be sexually stimulated first, because this releases the nitric oxide from the penile nerves. The drugs enhance the effects of nitric oxide, which in turn relaxes the muscles surrounding the penis, resulting in improved blood flow and an erection.
Are all oral erectile dysfunction drugs alike?
Yes and no. Although they all work in a similar way, they differ in how long and how fast the medication works. For example:
- Levitra and Viagra take effect in about 30 minutes, but Levitra can be effective for about 5 hours while Viagra lasts about 4 hours
- Cialis and Stendra can both spring you into action within about 15 minutes, but Stendra lasts only up to 12 hours while Cialis can be effective for up to 36 hours
- Staxyn is an orally disintegrating form of Levitra (but is not interchangeable with it) and can be effective in less than 30 minutes
- Thus far, Cialis is the only oral erectile dysfunction drug that is also approved by the FDA to treat benign prostatic hyperplasia, which is an added benefit for men who are experiencing symptoms of this prostate condition
What are the side effects of oral erectile dysfunction drugs?
The most common side effects are back pain, dizziness, flushing, headache, nasal congestion, and runny nose. However, if you are using nitrates or blood thinners, or if you have a high blood pressure, very low blood pressure, heart problems, or have had a stroke, you should talk to your doctor before using these medications.
How effective are oral erectile dysfunction drugs?
A new (March 2015), large meta-analysis looked at the efficacy and side effects of the various oral erectile dysfunction drugs. A total of 82 trials involving 47,626 men were evaluated for drug efficacy while 72 trials (20,325 men) were analyzed for side effects. The findings were as follows:
- Sildenafil (Viagra) 50 mg was the most effective but had the highest rate of overall side effects
- Tadalafil (Cialis) 10 mg had intermediate effectiveness and the lowest overall rate of side effects
- Vardenafil 10 mg and avanafil 100 mg had markedly lower effectiveness when compared with sildenafil 50 mg and similar side effects
According to Michael Eisenberg, MD, director of male reproductive medicine and surgery at Stanford University, oral ED drugs are effective for more than two-thirds of men with erectile dysfunction. Which drug you chose should be discussed between you and your doctor.
How does alprostadil work?
Alprostadil as a self-injection (Caverject Impulse, Edex) works by enhancing blood flow to the penis. The injection, which involves using an extremely thin needle, usually produces an erection that can last about 60 minutes. Alprostadil as a urethral suppository (Muse) involves using a special applicator to place the suppository inside the penis in the urethra. An erection usually occurs within 10 minutes and lasts between 30 and 60 minutes.
What are the side effects of alprostadil?
The side effects associated with self-injections of alprostadil include bleeding from the injection side, development of fibrous tissue at the injection site, and priapism (a prolonged erection). For the suppository, side effects may include minor bleeding in the urethra, development of fibrous tissue inside the penis, and pain when urinating.
What about testosterone for erectile dysfunction?
Some doctors will prescribe testosterone replacement therapy for men who have ED and who may or may not have low T levels. However, the vast majority of men don’t need testosterone replacement therapy. The real prescription should be for lifestyle changes, such as a healthy diet, stress reduction, regular exercise, adequate sleep, and avoidance of tobacco and alcohol. These efforts can not only help boost testosterone levels (without the side effects associated with taking the hormone) but also address other possible underlying contributors to ED.
Can herbal supplements work for erectile dysfunction?
Several natural supplements have been studied, to varying extents, for treatment of erectile dysfunction. Among those that are supported by some research are the following.
- Asian ginseng (Panax ginseng), which has been shown to help men whose erectile challenges are associated with either physical or psychological issues
- Carnitine, an amino acid that has been shown to be more effective than testosterone for erectile dysfunction
- Ginkgo biloba, an herb that contains a compound shown to improve blood flow
- Horny goat weed, which contains a flavonoid called icariin. This substance seems to work in a way similar to the oral erectile dysfunction drugs.
- Maca, which has been used since ancient times by the Incans, seems to boost sexual desire and sexual function
- Muira puama, the leaves and roots of which have been shown to increase blood flow to the penis
- Tongkat ali has demonstrated an ability to raise testosterone levels, which may help with erectile dysfunction
- Tribulus terrestris is a traditional Chinese and Indian medicine remedy for erectile dysfunction, and although animal studies are more convincing (showing an increase in sexual behavior and testosterone levels), some human studies have produced positive results.
What about erectile dysfunction drugs available over the Internet?
Men who are embarrassed to speak to their doctor about their impotence or who want to find less expensive erectile dysfunction drugs may turn to the Internet or other sources that provide the drugs from foreign countries. These medications are not FDA approved. The problem with these sources is that men cannot know for sure if the drugs are counterfeit, diluted, or even what they claim to be. Not only could such drugs be dangerous themselves, they also could interact with other medications they are taking.
Read more in our Erectile Dysfunction Health Center.
Chen L et al. Phosphodiesterase 5 inhibitors for the treatment of erectile dysfunction: a trade-off network meta-analysis. European Urology 2015 Mar 26
Springen K. Do you need erectile dysfunction drugs? Mens Health 2013 Feb. 19