Of All the Oral Erectile Dysfunction Drugs, Which One’s the Best?
If you’ve ever been in a situation where you couldn’t get an erection when you expected to, you know the emotional whirlwind that follows.
Feeling of frustration, embarrassment, shame, and anxiety settle in, especially if the problem continues to go unresolved.
It’s a situation you’ll always remember and one that half of all U.S. men between 40 and 70 years old have experienced too. For many, erectile dysfunction or ED is an all-too-real concern.
Fortunately, there are several ways to manage and treat ED. (Spoiler alert: One option doesn’t even require you to leave your own home to visit a doctor! We’ll get to that part soon.)
What is erectile dysfunction (ED)?
Way back when, ED used to be called "impotence". Nowadays, the more commonly used term is "erectile dysfunction".
ED happens when a man isn’t able to get or keep an erection long enough to complete a desired sexual act, such as intercourse. This can include several different situations:
- You can get an erection but can’t keep it.
- You can become somewhat erect, but not enough to begin or complete sexual intercourse.
- You can’t get an erection at all.
- You can get an erection sometimes, but sometimes you can’t.
The definition of ED doesn’t include low sex drive (don’t think about sex or have no desire to have sex) or premature ejaculation. These are separate issues.
While ED isn’t necessarily a severe medical disease itself, it can certainly have profound psychological and emotional effects.
Some men who have ED experience an unhappy sex life, loss of intimacy with partners, anxiety, and depression. In some cases, ED can also prevent a couple from conceiving a child.
Unfortunately, many of the emotional outcomes of ED further contribute to the psychological causes of ED, resulting in a discouraging cycle.
What causes ED?
ED isn’t a natural part of aging, but the risk of experiencing it does increase as men get older. That’s because many of the underlying causes of ED become more common with increasing age.
Conditions that can contribute to ED include:
- Nerve damage, which can be caused by diabetes or nerve injuries
- Heart and blood vessel damage
- High blood pressure
- Obesity
- Stress, anxiety, and depression
- Alcohol and tobacco use
- Fatigue
- Prostate surgery
- Some prescription medications https://medlineplus.gov/ency/article/004024.htm
Because there are so many potential culprits, one important aspect of diagnosing and treating ED is figuring out the underlying cause.
What are my options for ED treatment?
For many men, oral medications are a standard treatment for ED. There are four oral options on the market:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra, Staxyn)
- avanafil (Stendra)*
The medications all work the same way (however, there are a few differences, which are explained in a chart further down).
When a man is sexually stimulated, a gas called nitric oxide (NO) is released and helps relax the muscles in the penis. As the muscles relax, the penis is able to fill with blood and become erect.
Oral ED drugs help increase the effects of NO to assist men who have trouble getting or keeping an erection.
What ED Drugs Can Do
- Help you get and keep an erection in response to sexual stimulation
- Assist in your physical ability to complete desired sexual activities
What ED Drugs Cannot Do
- Increase libido or sexual desire
- Help every man who has ED
It’s important to understand that oral ED drugs are not aphrodisiacs. They don’t increase your desire to have sex.
Also, not all men with ED will benefit from these medications. Men with certain medical histories – like diabetes or past prostate surgery – may not respond to oral ED drugs.
That’s one reason it’s so important to talk to a doctor before starting any treatment for ED, but there’s another critical reason, too...
What are the risks of taking oral ED drugs?
Ever-present pop culture references to “the magic blue pill” can make it easy to view oral ED drugs as harmless, brightly-colored, sex-life-savers in pill form.
However, as with all drugs, there is a risk for side effects.
Headaches are the most common side effect men have when taking these medications. Other common side effects men taking oral ED drugs experience include:
- Flushing
- Nasal congestion
- Visual changes, particularly a blue tint
- Backache
- Stomach upset
More serious side effects include hearing and vision loss.
Priapism – a condition where the erection will not go away – can also occur. If an erection lasts longer than 4 hours, it’s important to get medical attention ASAP.
There are so many options. Which ED drug is the best for me?
Although the medications work the same, there are some differences.
Generic sildenafil
How long before sex do I take it?: 1 hour
How long does it work?: 4-8 hours
How do I take it?: Best results when taken on empty stomach
Dosing options: 20 mg tablet-As needed, but no more than once daily
Potential side effects: Same as listed above
Price: $2 per 20 mg pill using Lemonaid Health mail order partner
Branded sildenafil (Viagra)
How long before sex do I take it?: 1 hour
How long does it work?: 4-8 hours
How do I take it?: Best results when taken on empty stomach
Dosing options: 25, 50, or 100 mg tablets
Potential side effects: Same as listed above
Price: $65 per pill
Tadalafil (Cialis)
How long before sex do I take it?: 1-2 hours
How long does it work?: 36 hours
How do I take it?: Empty stomach or with food
Dosing options: 2.5, 5, 10, or 20 mg tablets, Smaller daily doses or one larger dose as needed
Potential side effects: No flushing or vision changes, but may cause back pain or muscle aches
Price: $65 per pill
Vardenafil (Levitra)
How long before sex do I take it?: 1 hour
How long does it work?: 8 hours
How do I take it?: Empty stomach or with food
Dosing options: 2.5, 5, 10, or 20 mg tablets, As needed, but no more than once daily
Potential side effects: Same as listed above
Price: $50 per pill
Who should not take oral ED drugs?
You might have heard that sildenafil was originally created to lower blood pressure. This is true. In fact, under the brand name Revatio, sildenafil is still used to treat a condition called pulmonary hypertension.
The same increase in NO that helps penile muscles relax also opens up blood vessels, which can lead to a drastic drop in blood pressure.
That’s why it’s especially important for these groups of men to avoid taking oral ED drugs:
- Men who are taking nitrates or nitroglycerin
- Men who have hypotension (very low blood pressure)
- Men who have heart disease or heart failure
If you take any blood pressure medications, you should be sure to mention this to your doctor before beginning ED treatment.
How can Lemonaid help me treat ED?
If you’re a man who’s 30 years old or older and younger than 67, Lemonaid’s ED service may be able to help you.
Through a convenient mobile app, our US based and US licensed nurse practitioners and doctors are available to provide embarrassment-free diagnosis and treatment of ED when appropriate.
Here’s what you can expect during your convenient mobile visit:
- Download and open the Lemonaid mobile app. Select the ED service.
- Select one of the 3 oral ED drugs available through Lemonaid: generic sildenafil 20 mg or branded sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra).
- Answer the health questions.
- Decide whether you want to get routine lab tests done. This is highly recommended since it will help pinpoint the specific cause of your ED. You can get the tests done at any Quest Diagnostics center near you, and our doctors will follow up with you to review and explain your results. Don’t worry – opting for the lab tests won’t delay your prescription!
- Select the local pharmacy where you want us to send your prescription or choose the convenient mail order option.
- Enter your payment information.
- Do a video visit with a nurse practitioner or doctor.
*Avanafil (Stendra) is not available through Lemonaid’s ED service.