What are the Risks of Taking Over-the-Counter ED Drugs?

When you have a cold, you probably head to the drugstore to buy cough medicine and throat lozenges. If you have a headache, you might pick up some acetaminophen or ibuprofen. 

Over-the-counter (OTC) medications are available for a wide range of ailments, and the fact that they’re usually readily available and affordable makes them convenient to use.

But when it comes to men’s health conditions like erectile dysfunction, you won’t find medications like Viagra over the counter in any gas station or local pharmacy. These sexual health medications are available by prescription only, and anything claiming to be like them or do what they do can be — and usually is — more trouble than it's worth.

Below, we've explained why Viagra and other ED drugs are only available by prescription and how you can get your hands on them if you're experiencing erectile dysfunction.

We’ve also discussed over-the-counter “Viagra substitutes” and why these are best avoided in favor of real, proven options for ED, including brand-name Viagra and its generic version, sildenafil (also called sildenafil citrate).

Can You Buy Viagra Over the Counter?

Viagra is a prescription drug used to treat erectile dysfunction. So, if the question you’re asking is whether or not you can buy Viagra over the counter, the answer is no — you’ll need to have a prescription from your healthcare provider. 

However, many “online pharmacies” claim to sell OTC Viagra. Many of these products not only use fake or unproven ingredients but are often made in unsafe, unsanitary conditions. 

The good news is that if you have erectile dysfunction (ED), getting a prescription for Viagra or a similar medication isn’t as difficult — or as jarring — as you might think.

In fact, it’s something you can do with ease, either by talking to your primary care provider, scheduling an appointment with a urologist or even connecting with a licensed healthcare provider online. 

Is it as easy as buying some weird pill from the gas station? No. But it’s pretty close and at least you know what you’re getting actually works. 

What are Over The Counter Viagra Substitutes?

Search online for terms like “over-the-counter Viagra” and you’ll find page after page advertising Viagra “substitutes” that are available without a prescription. You may not immediately think aspirin erectile dysfunction medication as a Viagra substitute though.

You can find these "Viagra substitutes" behind the counter at your local gas station (somewhere between the blunt wraps and the iPhone 6 chargers), as well as in places like local convenience stores, sex shops, and even online. 

And you know those banner ads you see on those "certain websites" that you only ever go to for research purposes? Yeah, you can find them there, too.

Most of these products are supplements that haven’t been tested or approved by the FDA. For the most part, there’s no proof that they provide any real benefits for your sexual performance or that they work effectively to treat erectile dysfunction. So while you might see amazing Performer 8 reviews hyping the product, there's no truth to it.

And since they’re sold without a prescription, they may be unsafe if you use other types of medication, especially for hypertension (high blood pressure) or heart disease.

That said, concerns over affordability and the perceived hassle of obtaining a prescription drug drive many men with ED to seek out other options, which sometimes include OTC erectile dysfunction drugs or “Viagra substitutes.”

What's So Bad About OTC ED Pills?

Most over-the-counter Viagra substitutes usually contain herbal ingredients such as horny goat weed, ginseng and L-arginine. 

The most recent scientific evidence on the effectiveness of these herbal ingredients is mixed, at best, with many performing no better in testing than placebos. 

Overall, there’s very little evidence that these herbal supplements have any real benefits for erections, sexual desire or general sexual activity. As such, it’s best not to rely on them as any type of reliable treatment for ED.

In addition to their lack of efficacy data, it’s especially important to avoid over-the-counter alternatives to Viagra due to the large amount of unknown, frequently unlabeled ingredients that are used in these products.

This means you face a real risk of experiencing drug interactions if you use these products with other prescription medications. Like Spanish fly and other alternative products, these products are all flash and no substance.

So, when it comes to the questions, “Is Viagra over the counter?” or “Can you get Cialis without a doctor's prescription?” the answer is a definitive no. If you see over-the-counter Viagra, or any cleverly marketed “Viagra substitutes,” it should be avoided at all costs.

Other Popular Over-the-Counter ED Pills and Risks

If you take a stroll through the aisles at your local drug store, you’ll probably come across a variety of options for over-the-counter erectile dysfunction supplements. Many packages for supplements read:

 “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

That’s because the FDA doesn’t regulate these statements — something that makes them different from the likes of Viagra. 

Some OTC ED pills on the market include:

• Libido Max®

• Male Extra®

• Virectin®

• VigRX Plus®

When shopping for OTC erectile dysfunction remedies, you’ll find that most are marketed as “male enhancement” pills. 

Many claim to be designed for more than just boosting erectile function — some also claim to increase stamina, improve libido and boost testosterone levels. 

In a nutshell, they’re all billed as over-the-counter ED pills that work fast. But not quite. 

Below, we’ve taken a closer look at these over-the-counter male enhancement products and supplements.

Libido Max

Alleged to be made with natural ingredients such as L-arginine, horny goat weed and yohimbe, Libido Max is alleged to improve blood flow around the body and function as a natural testosterone booster.

There’s debate about how effective it is, with a variety of users giving it mixed reviews due to potential side effects and lack of efficacy. 

All in all, although it’s available over the counter, there’s no guarantee that Libido Max is safe to use or that it’s in any way effective at treating erectile dysfunction.

Male Extra

Manufactured by Marlia Health Innovations in the UK, Male Extra claims to produce larger and harder erections while also enhancing sexual ability. 

This male sexual performance supplement features natural ingredients such as pomegranate, L-arginine and creatine, which are purported to improve circulation.

Although L-arginine and creatine may offer some performance benefits, there’s very little in the way of clinical research to suggest that they have any effects on erections, performance in bed or general sexual desire.

Virectin

Let's start at the beginning. Virectin contains ingredients you’re already familiar with, including L-arginine, as well as ingredients like tongkat ali, vitamin B3 (niacin) and selenium. On Virectin's packaging, there's a disclaimer that reads: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

That should probably tell you everything you need to know about it. But just in case, here’s the reality. 

While Virectin claims to improve testosterone levels, boost libido and enhance pleasure during sexual activity, and while some of the active ingredients in Virectin may offer mild benefits, there isn’t any high-quality evidence to suggest that it improves sexual arousal or treats issues such as erectile dysfunction. And the vitamins — while nice — aren’t a treatment for ED.

Plus, like, re-read that warning.

VigRX Plus

Marketed as the world’s “leading male enhancement product,” VigRX Plus contains red ginseng, saw palmetto, ginkgo biloba and other ingredients alleged to stimulate sexual activity and help with maintaining a firm erection.

Interestingly, there is some research on the effectiveness of VigRX Plus. In one study published in the journal BMC Complementary and Alternative Medicine, researchers found that the herbal product was more effective than a placebo in improving sexual function in men.

However, there’s currently no reliable, high-quality research that compares VigRX to established medications for ED, such as sildenafil or other PDE5 inhibitors. 

OTC ED Pills with FDA Warnings 

We mentioned above that OTC ED pills aren't regulated by the FDA and why that's potentially dangerous, so now let's talk about specific products. 

Over the years, the FDA has issued numerous health warnings about tainted over-the-counter male enhancement pills. In fact, the FDA has issued so many warnings that it maintains a large online database that lists tainted sexual enhancement products.

Products on the list include several of the supplements we mentioned above, as well as brands such as:

• Man Up Now®

• Stiff Nights®

• Rock Hard Weekend®

• Duro Extend Capsules For Men®

• Vigor-25®

• Magic Power Coffee®

• Time Out®

• Mr. Magic Male Enhancer®

• Vitalex®

• Xiadafil VIP Tabs®

• Extenze®

What is it about these products that made the FDA issue a health warning? For many of them, it was a problem with the purity or safety of the ingredients. 

For example, the product “Man Up Now” is made with Sulfoaildenafil, a synthetic chemical that’s similar to the active ingredient in Viagra, sildenafil.

There’s an FDA notice against Extenze, stating that the company’s products have been found to contain undeclared amounts of sildenafil, a well-known erectile dysfunction drug most commonly found in Viagra.

Most of the other ingredients in Extenze have not been proven to be safe or effective. The company has faced multiple lawsuits that challenge the legitimacy of the product’s claims — most notably, that it can increase penis size.

Vimax is another popular supplement for treating erectile dysfunction and other forms of male sexual dysfunction. It’s marketed as a “100% natural product” that contains herbal ingredients for enhancing male virility.

However, like many over-the-counter ED meds, Vimax also contains ingredients that aren’t listed on its label, namely prescription ED medications.

In a 2015 notification, the FDA warned consumers that Vimax contains tadalafil, an ingredient that’s found in the prescription ED medication Cialis®. 

These ingredients can create safety risks. Tadalafil can interact with many common medications for treating high blood pressure and chest pain, and if you’ve previously had a heart attack or other cardiovascular event, you shouldn’t use tadalafil at all.

Because of these risks, it’s best to avoid any supplements containing unlabeled ingredients and instead stick to proven, FDA-approved treatments prescribed only by healthcare professionals.

Some of these over-the-counter pills contain more than one active ingredient, meaning they may have a higher risk of causing side effects and/or drug interactions. 

Others contain unsafe, poorly measured doses of active ingredients. For example, the FDA demanded that the manufacturers of “Mr. Magic Male Enhancer” take the product off the market because the two main ingredients, which were illegal sildenafil analogues (hydroxyhomosildenafil and sulfoaildenafil), were not declared on the list of ingredients.

All of the PDE5 inhibitors currently available to treat erectile dysfunction can cause interactions when used with medications for hypertension and some heart conditions, such as a risk of a sudden drop in blood pressure. 

Even though these issues can occur even with FDA-approved, legally prescribed medications in some cases, you typically learn about risks when you speak to a healthcare provider before receiving a prescription.

Your healthcare provider can prevent dangerous drug interactions and keep you from harm from those underlying health conditions. And unlike the “swallow it all” packets the guy with the ponytail hands you, prescriptions come at a dosage that’s appropriate for you. 

With OTC erection pills, the potentially harmful ingredients are not only improperly listed on the product labeling, but they’re often used in unsafe doses.

Many of these products have been found to contain other chemicals, some of which have yet to undergo testing. 

As such,  if you’re considering an “all-natural” over-the-counter alternative to Viagra, our recommendation would be to like, not do it, man.

What About Natural Remedies for ED?

So what about nature? Can some rainforest herbs or a rare flower remake your dong in the image of Excalibur? 

Men turn to several nutritional and herbal supplements and natural remedies for ED for better erections and sexual function, but we have to caution you that the research on the benefits of natural ED treatments is mixed at best.  Some particular compounds have been shown to improve flow in blood vessels, improve muscle function in your penis and more, including:

• Dehydroepiandrosterone (DHEA)

• L-arginine

• Pycnogenol

• Yohimbe

• Propionyl-L-carnitine

Want to see what research has to say about them? Read on. 

Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone, or DHEA, is a hormone produced by the adrenal cortex. It’s an important precursor for several sex hormones, including testosterone.

DHEA appears to decline with age, with low DHEA levels linked with an elevated risk of erectile dysfunction. Although research findings are inconclusive right now, some studies suggest that DHEA may have an effect on receptors that manage blood flow to the penis.

However, there isn’t yet a clear link between DHEA supplementation and improved erections of sexual performance.

L-arginine

Next up on the "Might Work To Help You Get Hard But Probably Not" list is L-arginine, an amino acid that's purported to help boost production of nitric oxide — which plays a role in relaxing corpora cavernosa muscles in your penis, and plays a major role in producing erections. 

The precise role of L-arginine in nitric oxide production and erections is complex, but research suggests it may be useful as a treatment for mild ED.

A meta-analysis published in the Journal of Sexual Medicine looked at 10 different randomized controlled trials and found that arginine supplements may provide benefits for men with mild to moderate ED.

Our full guide to L-arginine and erectile dysfunction goes into more detail about how L-arginine works within your body, as well as its potential effects on your erectile health. 

Pycnogenol

Pycnogenol, a nutritional supplement derived from French maritime pine bark extract, may offer similar benefits for erectile dysfunction. In fact, pycnogenol and L-arginine are sometimes used together in natural supplements for ED. 

One study from 2003 looked into the effects of L-arginine and pycnogenol as a combined treatment for erectile dysfunction and found that a supplement promoted improvements in sexual function after three months of use.

By the end of the three-month study, 92.5 percent of the men that participated had experienced a normal erection.

These are good signs for sure, but we’re far from establishing any actually definitive case for pycnogenol.

Yohimbe

Yohimbe is a type of tree native to central and western Africa. Its bark contains yohimbe, an alleged traditional aphrodisiac. But don't call it the Viagra tree just yet.

Although scientific research on yohimbe and erectile dysfunction is mixed overall, some studies have found that it may offer benefits for men with sexual performance issues.

For example, a recent review published in the Turkish Journal of Urology, which used data from eight studies, found that yohimbine — the active ingredient in yohimbe — was associated with an improvement in erectile function when used in combination with other treatments.

However, the researchers also noted that yohimbe wasn’t fully effective as a treatment for male sexual function issues when it was used on its own.

Propionyl-L-carnitine

Propionyl-L-carnitine, or PLC, is a natural supplement widely promoted for its potential to increase energy levels.

Although research on propionyl-L-carnitine on its own isn’t conclusive, several studies suggest that it may offer benefits for erectile function when used with other ED medications. 

For example, one study published in the journal Current Medical Research and Opinion found that men with erectile dysfunction — and diabetes — showed larger improvements with propionyl-L-carnitine and sildenafil (the active ingredient in Viagra) than with sildenafil alone.

However, as noted, diabetes was a pre-existing condition for the participants in this study. There’s no way to know if these results would be replicated in a larger study with healthy participants. 

Other Supplements 

Other supplements that may help to increase blood flow and improve sexual function include:

• Ginseng

• Ginkgo biloba

• Rhodiola rosea

• Horny goat weed

Although these remedies may have some promise, it’s important to keep in mind that they, as well as other natural supplements, aren’t evidence-based medications, nor are they approved by the FDA to treat any type of disease. 

This means that they haven’t been thoroughly tested for efficacy and safety in the precise way that FDA-approved drugs have. The FDA says Viagra works. The FDA says dietary supplements may or may not. What are you going to do with this information? 

What Should You Use to Treat ED Instead of OTC Viagra?

While over-the-counter alternatives to Viagra might seem appealing, you’ll get better results — and keep yourself safer — by working with your healthcare provider to find the right medication for your erectile dysfunction.

They’ll be able to help you identify the underlying cause of your ED and determine the best type of treatment, some of which include:

• Prescription medication

• Therapy and mental healthcare

• Changes to your diet

• Reduced stress

• Increased exercise

• Less drinking and no smoking

Let’s take a look at a few of these in detail.

Prescription ED Medications

If you have erectile dysfunction caused by a physical health issue, using ED medication to improve your erections might be the best option.

These medications work by increasing blood flow to your penis, which can make it easier to get and maintain an erection when you feel sexually aroused. 

Currently, there are several safe and effective FDA-approved medications for treating ED. With a prescription from your healthcare provider, you can purchase ED drugs such as:

• sildenafil (the active ingredient in Viagra)

• tadalafil (Cialis)

• vardenafil (Levitra®)

• avanafil (Stendra®) 

Some of these medications are designed for daily use to improve your erectile function over the long term, while others can be used as needed. 

We offer several ED medications via our online platform, following a consultation with a licensed healthcare provider. This allows you to quickly and easily access FDA-approved medications for ED from home without any awkward visits to your primary care provider’s office.

Lifestyle Changes

We’re not waving crystals around here or talking about your aura or anything. Making simple changes to your habits and lifestyle can improve your erections and sexual performance.

You can reduce the severity of ED (or potentially stop it altogether) by exercising regularly, eating a balanced diet, maintaining a healthy weight, quitting smoking and avoiding excessive alcohol consumption. 

Our guide to naturally protecting your erection can walk you through strategies to get started on your own. 

Therapy

Here’s another not-so-fun fact about ED: It’s not all about the physical stuff. In fact, around 40 percent — nearly half — of all ED cases are psychological in origin, according to some research.

If you’re experiencing some psychological hangups that are causing you some grief in the bedroom — things like PTSD, past trauma, performance anxiety, etc. — therapeutic practices might be just what the doctor ordered. Literally.

We also want to say this: Hey, friend. It’s okay. How you feel is normal and very common, and most importantly, it’s treatable. 

Psychotherapy — like cognitive-behavioral therapy or sex therapy —  is an excellent way for you to work one on one with a mental health provider to isolate your sexual sticking points and grease those bearings.

Getting Pills Like Viagra Over the Counter: What You Really Need to Know

We all want on-demand erection and ejaculation. Needing help is normal for many men, but getting that help unsafely is… Well, it’s unsafe. 

The little blue pill Viagra is a prescription medication for ED, so to get it, you’ll need to talk to a licensed healthcare provider and receive a valid prescription before you can legally purchase and use it.

• ED Solutions are big business. Erectile dysfunction is such a widespread issue for men of all ages, so it’s no wonder that there are so many prescription and over-the-counter medications out there to treat it. 

• A lot of what you see on shelves isn’t going to work. Many over-the-counter alternatives to Viagra that are marketed online and sold in gas stations, sex stores and elsewhere aren’t effective. 

• Those OTC medications could also be dangerous. Many contain unlabeled ingredients that could be dangerous if used with other medications. As such, if you’re considering trying those gas station boner pills you saw for sale for just a few dollars, you should think again. 

Instead of using ineffective and potentially unsafe over-the-counter alternatives, consider an affordable generic medication, such as sildenafil or tadalafil. We offer these medications via our online ED consultation as part of our range of erectile dysfunction treatment options.