Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Health care professionals treat the underlying cause of erectile dysfunction (ED) when possible.

Give it Time to Work

(This version is also used to treat benign prostatic hyperplasia, or an enlarged prostate.) The maximum dosages for ED drugs vary from 20 milligrams (mg) for tadalafil and vardenafil to 100 mg for sildenafil and 200 mg for avanafil. Your doctor usually begins with a low dose and increases it as needed. "Once you reach the maximum dose, and the drug still doesn't work, taking more won't help," says Dr. O'Leary. "Also, switching to another ED drug usually won't make a difference." The most common side effects of ED drugs are headaches, upset stomach, nasal congestion, muscle pain, and facial flushing.

Maintain a healthy weight

But most of these are relatively mild and disappear after a few hours. "ED drugs can make blood pressure temporarily drop, so don't use them if you take nitrates for angina (chest pain) or other heart problems," says Dr. O'Leary. However, there's no problem with nitrates found in food - for example, leafy green vegetables (spinach, kale) and root vegetables (beets, carrots). You also need to be careful if you take alpha blockers such as tamsulosin (Flomax) and alfuzosin (Uroxatral), used to treat an enlarged prostate. Sometimes, the exact cause of ED is not known.

Product	Dosage	Quantity + Bonus	Price
Viagra Original	100mg	64 + 4 Pills	264.15€ 251.57€
Apcalis SX Oral Jelly	20mg	10 Sachets	58.75€ 55.95€
Viagra Generic	200mg	30 + 2 Pills	83.07€ 79.11€
Viagra Generic	200mg	180 + 10 Pills	277.56€ 264.34€
Kamagra Polo	100mg	12 Pills	60.21€ 57.34€
Levitra Professional	20mg	60 + 2 Pills	223.11€ 212.49€
Viagra Original	100mg	14 + 2 Pills	89.03€ 84.79€
Levitra Generic	60mg	120 + 8 Pills	372.33€ 354.60€
Kamagra Gold	50 mg	12 Pills	47.30€ 45.05€
Cialis Super Active	20mg	30 + 6 Pills	128.09€ 121.99€
Viagra Generic	50mg	30 + 4 Pills	54.26€ 51.68€
Kamagra Soft Tabs	100mg	120 + 6 Pills	311.78€ 296.93€
Viagra Generic	100mg	30 + 4 Pills	60.91€ 58.01€
Kamagra Polo	100 mg	180 + 8 Pills	446.52€ 425.26€

Health care professionals will then focus on improving sexual function. Choosing an ED treatment is a personal decision. If you have a partner, you may want to talk together about treatments that work for you as a couple. Your health care professional may suggest lifestyle changes to help improve your ED symptoms, including Health care professionals may suggest counseling if mental health or emotional issues are affecting your ED.

Safety and Handling Considerations

Also stay away from ones that don't have a licensed pharmacist on staff to answer your questions. Some illegal businesses sell fake versions of real medicines, which can be dangerous or might not work. In the United States, the National Association of Boards of Pharmacy can tell you whether an online pharmacy is licensed and in good standing. If you live in another country, check to see if pharmacy association or regulation agencies offer services like these. Make sure you get the right prescription and dose.

ED Prescriptions for $1-2 Per Pill

When you order medicines and when you receive them in the mail, make sure they're the exact dose and type prescribed by your doctor or other health care professional. The dose is the amount of medicine you take. Don't be fooled into buying "herbal viagra." Never take any medicines that claim to be the "herbal" or nonprescription version of an oral medicine for ED. These aren't an effective option, and some contain harmful substances. Our caring team of Mayo Clinic experts can help you with your health concerns.

ED overview

Visit Mayo Clinic Men's Health to get started. Although the term “ED” is often associated with a complete inability to get an erection sufficient for sex, the reality of erectile dysfunction is that it can vary hugely in severity. Can get a normal erection, but find it difficult to maintain it during sex Can get a normal erection, but find it difficult to maintain it during sex Find it difficult to get an erection every time you want to have sex Find it difficult to get an erection every time you want to have sex Can’t get an erection at all, even when you’re sexually stimulated Can’t get an erection at all, even when you’re sexually stimulated A Hims medical provider will help determine which treatment is most appropriate for you. All of the active ingredients in our treatments are approved by the FDA based on extensive, high-quality clinical trials. These trials have uniformly demonstrated that ED medications are safe and effective for the vast majority of men. Counselors can help you lower anxiety and stress about sex.

Interacting Drug/Class	Effect on ED Medication	Clinical Concern	Recommended Action
Nitrates	Potentiate hypotension	Risk of dangerous blood pressure drop	Avoid concurrent use
Alpha-blockers	Additive blood pressure lowering	Dizziness, fainting	Dose adjustment, monitoring
CYP3A4 inhibitors	Increase ED medication levels	Increased side effects	Dose reduction, careful monitoring
Grapefruit juice	Inhibits CYP3A4 enzyme	Raises drug plasma levels	Avoid consuming with ED meds

Your counselor may ask you to bring your partner to sessions for more support. Your health care professional may review any medicines you are taking to see if a medicine you need for another health condition is causing ED. They may suggest taking a different dose of medicine or switching to another medicine. Do not stop taking any medicines on your own. Talk with your health care professional first.

Medication	Onset (minutes)	Duration (hours)	Food Interaction
Sildenafil	30-60	4-6	Fatty meals may delay absorption
Tadalafil	30-60	Up to 36	Less affected by food
Vardenafil	25-60	4-5	Fatty meals may delay onset
Avanafil	15-30	Up to 6	Less affected by food

Health care professionals may also prescribe other types of medicines for your ED. Phosphodiesterase type 5 (PDE5) inhibitors are oral medicines that improve blood flow to the penis. These the pink pill for women medicines may help you get and keep an erection. If you have ED and low testosterone, health care professionals may prescribe testosterone with PDE5 inhibitors.

Brand Name	Generic Name	Dosage Forms	Mode of Action	Typical Dosage
Viagra	Sildenafil Citrate	Tablets	Vasodilation via PDE5 inhibition	50-100 mg as needed
Cialis	Tadalafil	Tablets	Long-lasting PDE5 inhibitor	10-20 mg as needed
Levitra	Vardenafil	Tablets	PDE5 inhibition	10-20 mg as needed
Stendra	Avanafil	Tablets	Rapid onset PDE5 inhibitor	50-200 mg as needed

You may be given testosterone as an oral medicine, a patch, or a gel.

Benefits of Oral Medications

Learn more in our guide to the safest drug for erectile dysfunction.Our guide on how to know if you have ED goes more into detail about common signs that you’re affected by erectile dysfunction. Most ED medications take 15 min to 1 hour to “kick in” and start producing a noticeable effect on your ability to develop and maintain an erection, so make sure you’re timing your specific dosage accordingly. While you may experience side effects from your medication, most are mild and temporary. Your body may just need some time to get used to the effects of ED medication, so give it a few tries before making any adjustments. Reviewed by Howard E.

FYI on ED

LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing Since the 1990s, erectile dysfunction (ED) drugs have helped millions of men continue to enjoy an active sex life. "While not much has changed in how they work or the types of drugs available, there still are things men should consider when choosing which one to try," says Dr. Michael O'Leary, a urologist and former director of men's health at Harvard-affiliated Brigham and Women's Hospital's Department of Urology. There pink pills for woman are four main FDA-approved ED drugs: sildenafil (Viagra), tadalafil (Cialis), vardenafil, and avanafil (Stendra). All of these come as pills; vardenafil also is made in a dissolvable version you place under your tongue.

Papaverine HCL / Phentolamine Mesylate (BiMix)

Chewable ED drugs are available that contain the same active ingredients of sildenafil, tadalafil, and vardenafil. However, they are made to order in compounding pharmacies and may include other ingredients. Dr. O'Leary advises against using these custom-made products since they are not regulated or approved by the FDA. The four ED drugs - known medically as PDE5 inhibitors - work similarly to increase blood flow into the penis, which helps men reach and maintain an erection. Injectable medicines and suppositories can enhance erections. An injectable medicine causes a quick, automatic erection by increasing blood flow to the penis. Some people with ED prefer a suppository, a solid piece of medicine that you insert into the urethra.

Speak to your provider about ED

They do this by inhibiting phosphodiesterase type 5 (PDE5), an enzyme in blood vessel walls that controls blood flow. When a man is aroused, his body releases molecules that relax the smooth muscles in the blood vessels, allowing more blood to flow in. ED drugs prevent PDE5 from breaking down these substances, thus keeping the blood flowing. ED drugs are effective in about 70% of men, according to Dr. O'Leary, but the results can vary.

4. Penile injections

"A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs," he says. Also, while ED drugs can help men achieve and maintain an erection, they don't help with other sexual issues, such as low libido, premature ejaculation, or the inability to reach orgasm. The main differences between ED drugs are how quickly they act and how long the effect lasts. Avanafil takes about 15 to 30 minutes to work and lasts six to 12 hours. Sildenafil and vardenafil take effect in 30 minutes to an hour and last four to five hours.

Who should not take Cialis:

Tadalafil kicks in after 30 to 45 minutes and can last 24 to 36 hours. "Many doctors first prescribe sildenafil because it has been around the longest and has blue 100 pill a high success rate," says Dr. O'Leary. Men who want a longer-lasting effect might opt for tadalafil. Tadalafil is also available as a low-dose daily drug, so you have a constant amount of the drug in your bloodstream, which helps with spontaneous sex. Your health care professional will teach you how to give yourself an injection or insert a suppository. Some people say certain alternative medicines help their ED symptoms.

Side effects

"Make sure to take these medications at least four hours apart from an ED drug," says Dr. O'Leary. It's also best not to take sildenafil or vardenafil soon after eating, as food can block their absorption. (Tadalafil and avanafil don't interact with food in this manner.) Matthew Solan, Former Executive Editor, Harvard Men's Health Watch Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing As a service to our readers, Harvard Health Publishing provides access to our library of archived content. For safety reasons, talk with your health care professional before using dietary supplements, such as vitamin or mineral supplements, or any complementary or alternative medicines or medical practices. Vacuum erectile devices (VEDs) pull blood into the penis for an erection.

Insurance Preauthorization: Often required for brand-name medications.
Step Therapy: May require trying generics before brand names are covered.
Medicare: Part D plans typically cover generic ED medications.
Medicaid: Coverage varies significantly from state to state.
Out-of-Pocket Cost: For uninsured or if medication is not covered.
Coupons and Savings Cards: Often available from manufacturers for brand drugs.
Pharmacy Choice: Costs can vary between different pharmacy retailers.

a plastic tube to put around your penis an elastic ring that helps you to keep an erection You may need to practice with or adjust your VED. Sometimes, VEDs can make your penis feel cold or numb. Your penis could look purple or bruised. Bruises are usually painless and will disappear in a few days. VEDs may weaken ejaculation but this doesn’t affect the pleasure of climax or orgasm. Most people with ED do not need surgery.

PDE5 inhibitors have different durations and onset times.
Combining ED meds with other vasodilators may cause hypotension.
ED drugs may improve self-esteem and relationships.
Use caution with recreational drugs when on ED medications.
Proper storage is necessary to maintain medication potency.
Men with kidney impairment may need dose adjustments.
ED medications are sometimes used off-label for pulmonary hypertension.
Some drugs may cause temporary vision disturbances.
Open communication with healthcare providers ensures safe use.
Lifestyle modifications can sometimes eliminate the need for medication.

If you have tried all other options and your ED does not improve, you and your health care professional may consider surgery to implant a device—called a prosthesis—to make the penis erect, either using a pump in the scrotum or a rod that you can control on your own repair arteries to increase blood flow to the penis, a procedure that works best for younger men Your health care professional will describe the benefits and possible side effects of surgery.