Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Over the last 25 years, erectile dysfunction (ED) medications such as Viagra® and others have become common and normal pieces of bedroom tool kit. These little pills have helped hundreds of millions of men all over the world get hard and stay that way when it counts most.
While pills like Viagra, Cialis® and Stendra® might look similar, they’re unique medications with their own strengths and weaknesses for dealing with ED.
This means that there’s no one best drug for ED for every guy — instead, each medication comes with its own list of pros and cons, which could make one a better choice for your sex life than the others.
Below, we’ve discussed what these medications are, as well as how they work to help you get hard, maintain your erection and improve your sexual performance.
We’ve also listed the advantages and disadvantages of each erectile dysfunction treatment, from ease of use to duration of action, side effects and more.
Currently, there are four pills on the market that are scientifically proven to improve erections and sexual performance in men with ED. They are:
Sildenafil (the active ingredient in Viagra)
Vardenafil (the active ingredient in Levitra®)
Avanafil (a newer medication sold as Stendra)
All of these medications belong to a class of drugs called phosphodiesterase type 5 inhibitors, or PDE5 inhibitors, which improve the flow of blood to the tissue inside your penis.
This improvement in blood flow makes it easier for your penis to become firm and enlarged in response to sexual stimulation.
The FDA has approved all of these medications, and you’ll need a prescription to buy and use them as ED treatments.
As for over-the-counter ED pills, these aren’t supported by any solid scientific evidence, and a few — including many of the ED pills sold in gas stations — are associated with serious safety risks. That means it’s best to avoid them.
We’ve profiled all four FDA-approved ED treatments below, and provided some information on which pill is usually the best for each purpose.
Sildenafil is the OG prescription medication for erectile dysfunction. It came onto the market in the late ‘90s under the brand name Viagra and, for several years, was the only medication available for men with ED.
Today, sildenafil is available in its generic version, meaning it’s much more affordable than when it first hit the market. It works quickly, provides relief from ED for several hours and is sold in just about every pharmacy, making it a reliable option for improving your sexual function.
Best for: Guys who want a reliable treatment option for ED, with a long track record and a good price per tablet.
Advantages: Sildenafil starts working in less than one hour and provides relief from ED for about four hours per pill, making it great for a single night.
Disadvantages. Sildenafil takes longer to work after a large, high-fat meal and can’t be taken more than once a day, making it less than ideal for twice-a-day (or more) sex.
Sildenafil is ol’ reliable when it comes to treating ED. It’s been around for decades, is affordable, is readily available and, well, just works. In research published by the FDA, between 63 and 82 percent of men with ED showed improvements after taking it.
A more recent study published in the International Journal of Clinical and Experimental Medicine found that 98.4 percent of men with ED who used sildenafil reported improved erections.
A typical dose of sildenafil lasts for approximately four hours, making it a good option if you want an ED pill that’s designed to last for one night of sexual activity.
Since sildenafil doesn’t last for too long, it could be a good choice if you often notice side effects from ED pills and don’t want them to persist for hours after you have sex.
Finally, sildenafil is a good ED treatment from a cost perspective. Provided you stick to generics, each pill only costs a few dollars, meaning you won’t need to spend much to enjoy better sex.
Sildenafil is only active for about four hours, so you’ll need to take it close to the time you plan to have sex.
This means that you might have to plan ahead of time if you’re going out on a date and want to make sure sildenafil is working its magic once you get home.
You can also only use sildenafil once every 24 hours, meaning this ED pill might not be the best option if you and your partner like to have sex more than once a day.
Sildenafil is affected by food and might take longer to begin working if you have a fatty meal just before or after you take it.
It can also cause side effects, including:
Changes in vision
However, it’s important to keep in mind that most side effects of sildenafil can also develop with other ED medications.
Tadalafil is the active ingredient in Cialis, which was approved by the FDA as an ED medication in 2003. These days, it’s available in its generic form and as a brand name for use as-needed or as a daily tablet that improves blood flow and makes getting an erection easier.
Thanks to its very long duration of action — something we’ve discussed in more detail below — tadalafil is sometimes referred to as the “weekend pill” for treating erectile dysfunction.
Like sildenafil, tadalafil has a long track record. It’s been researched extensively, meaning both its effects and its side effects are well known.
Best for: Men who like a long-lasting pill to treat ED, allowing for spontaneous sex or sex more than once a day.
Advantages: Tadalafil lasts longer than any other ED treatment, with one pill providing relief from ED for approximately 36 hours. It can also be taken daily at a low dosage.
Disadvantages: Tadalafil might last longer than needed for many men. Tadalafil’s long duration of action means side effects may persist for longer than with other ED pills.
Tadalafil has a half-life of 17.5 hours, meaning it remains active in your body for far longer than other ED medications. A single dose of tadalafil can improve blood flow to your penis and make it easier to get an erection for up to 36 hours.
This makes tadalafil a great choice if you want to have sex more than once a day, or only want to take one pill over the course of an entire weekend.
Another advantage of tadalafil is that it’s also available as a daily-use medication. This version of tadalafil is ideal if you want to have sex spontaneously during the day, or prefer to take your ED tablet on a daily basis instead of as-needed.
You can also take tadalafil without regard to food, meaning there’s no need to avoid large meals before using this medication.
Tadalafil’s biggest strength is also its biggest weakness. Because it’s a long-lasting drug, it can cause side effects that may continue for up to 36 hours after a typical dose.
So, if you’re prone to side effects from oral medication for ED, you might prefer to use a shorter-acting ED medication, like sildenafil, vardenafil or Stendra.
A second disadvantage of tadalafil is its price. Tadalafil is slightly more expensive than sildenafil on a per-tablet basis, although this may be less of a concern if you have sex more than one time per dose.
Vardenafil is the active ingredient in Levitra, and was approved by the FDA in 2003. Vardenafil is similar to sildenafil but lasts longer, with research suggesting that it provides better blood flow and stronger erections for five to seven hours per dose.
Best for: Men who want a slightly longer-lasting ED medication than sildenafil, but don’t want the all-day effects of tadalafil.
Advantages: Vardenafil lasts for longer than sildenafil and usually starts working faster.
Disadvantages: Vardenafil is typically more expensive than sildenafil. Like sildenafil, it can only be taken one time per day.
Vardenafil offers several advantages, most of which are related to time. First, it lasts for slightly longer than sildenafil, meaning you have a little extra flexibility regarding when you take it prior to having sex.
This longer duration of action also means vardenafil could be a good choice if you like to have sex twice a night.
Second, it starts working quickly, with research suggesting it kicks in after less than 10 minutes in some men (still, it’s best to take it at least 30 minutes before sex).
Like sildenafil, vardenafil can only be used one time per day. This means it may not be the best ED pill if you plan to have sex several times in a day with a break between rounds one and two — for example, once in the daytime and once at night.
Vardenafil also has similar side effects to other ED drugs. Common adverse effects of vardenafil include:
Sinusitis (sinus inflammation)
Increased creatine kinase (CK) levels
Vardenafil is usually more expensive than sildenafil on a per-dose basis. This may make it less appealing as an ED pill if you’re budget conscious and only need relief from erectile dysfunction for a few hours at a time.
Best for: Men who want a fast-acting ED pill that can be taken almost right before sex, without having to worry about avoiding certain foods.
Advantages: Stendra acts quickly — often in as little as 15 minutes — and is less likely to cause side effects than older ED pills.
Disadvantages: Stendra isn’t available as a generic medication, meaning it costs more per tablet than other ED drugs. While side effects are less common, they can still occur.
Stendra contains the active ingredient avanafil, and is a newer ED medication that received FDA approval in 2012.
Avanafil is a newer-generation PDE5 inhibitor that’s more selective than older ED pills about how it inhibits enzymes. It’s less likely to cause side effects than older medications and begins working faster. However, it’s only available under the brand name Stendra, with no generic.
As a second-generation PDE5 inhibitor, Stendra offers several advantages over older drugs for treating erectile dysfunction.
The first is that it’s fast. Stendra is designed for use 30 minutes before sex, although research suggests that it’s effective at treating ED when it’s taken 15 minutes before sexual activity.
Because avanafil is more selective for PDE5 than older ED medications, it’s less likely to cause some side effects.
If you’re prone to side effects from sildenafil, tadalafil or vardenafil, switching to avanafil may be a helpful way to access the benefits of ED medication with a milder side effect profile.
The main disadvantage of Stendra is its cost. Because Stendra is a new ED treatment, it’s still under patent protection. This means there’s no generic form of avanafil — its active ingredient — available in the US.
Although certain side effects are less common with avanafil than with older medications for ED, they can — and often do — still occur. Some of the most common side effects of avanafil include headache, flushing, back pain, nasal congestion and nasopharyngitis (cold-like symptoms in the nasal passages).
The more affordable FDA-approved medication that treats Erectile Dysfunction at a quarter of the cost. 🙌
Affordable and helps get the job done. Generic Cialis helps you get and maintain your erections through a simple, daily dosage.
Cialis helps you get and keep stronger erections with a daily or as-needed pill.
Sildenafil, tadalafil, vardenafil and Stendra are all safe and effective medications when they’re used as prescribed.
If you’re considering using any type of ED medication, you’ll need to be aware of the following potential drug interaction:
Nitrates. When used with nitrates, ED medications can cause a sudden drop in blood pressure that may be life-threatening. Nitrates include nitroglycerin and poppers used for recreational purposes.
Antihypertensives. Certain other medications used to treat high blood pressure, such as alpha blockers, may interact with ED medications.
CYP3A4 inhibitors. Medications that inhibit the enzyme CYP3A4, such as some protease inhibitors, antifungals and antibiotics, may cause interactions when used with ED pills.
Although very uncommon, ED medications may also cause priapism — prolonged, painful erections that can damage the tissue of your penis. It’s important to seek medical help as soon as you can if you develop a persistent and/or painful erection.
Before you use any type of ED medication, make sure to talk to your healthcare provider about any medications you currently use, as well as any medical conditions you have.
Since ED symptoms can differ from person to person and everyone’s needs are different, there isn’t a “best” erectile dysfunction pill for every man.
Each sex pill offers a slightly different experience, from a longer duration of action to a reduced risk of side effects.
If you’re considering ED medication and don’t know which pill is best for you, you’ll want to keep the following in mind:
Sildenafil (Viagra) and vardenafil (Levitra) are short-acting, “one-night” ED medications that are both available as generics, making them good medications to try first.
Tadalafil (Cialis) is much longer-lasting and is a good option if you prefer “all day” relief from erectile dysfunction.
Stendra (which contains the ingredient avanafil) is newer, kicks in fast and doesn’t cause as many side effects as older ED pills, but costs more per tablet.
Above all, you’ll want to provide as much information as you can about your symptoms to your healthcare provider, then closely follow their recommendations to get the best results from any ED medication.
Used right, ED pills can do more than just give you firmer erections — they can also boost your self-confidence in bed.
We also provide chewable ED meds, which are personalized using several active ingredients to match your specific symptoms and needs.