Treatment success for erectile dysfunction (ED) depends on the cause: physical, mental, or both. However, medications you take by mouth are usually tried first on their own, or in combination with non-medication treatments (see below). This is because these pills typically work well no matter what the cause of ED and are also easy to use.
Pills that help you get an erection are all phosphodiesterase-5 (PDE-5) inhibitors that work by increasing blood flow and chemicals that allow the penis to become and remain erect. They include sildenafil (brand name Viagra®) and tadalafil (Cialis®).
You cannot take these medicines if you have heart disease and are also taking nitroglycerin or other medicines that contain nitrates.
Sildenafil - Viagra®
As needed use ONLY:
- Take prescribed dose as needed at least 1 hour before sexual intercourse
- Do not take more than one dose per day (within a 24 hour period)
- Effects can last approximately 4 hours
- Do not use ‘poppers’ (amyl nitrates) at the same time as sildenafil
Tadalafil - Cialis®
As needed use:
- Take prescribed dose at least 30 min prior to sexual activity
- Effects can last up to 36 hours
- Do not take more than one dose per three days (within a 72 hour period)
For daily use:
- Take the prescribed dose around the same time every day, regardless of sexual activity.
- If you have missed your dose and it’s more than 6 hours after you usually take it, skip the missed dose and take the next scheduled dose. If it’s less than 6 hours, take as per usual.
- Do not take more than one dose per day
Side Effects / Safety Considerations
- Do not take with nitrates, including nitroglycerin or poppers, because the combination can cause blood pressure to drop to unsafe levels.
- You may experience the following side effects of the medications that usually resolve on their own or are short-lived: flushing, indigestion, dizziness, vision abnormalities (blue-tinged), and headache.
- A prolonged erection (longer than 3 hours) happens very rarely, but you should seek emergency care if it does.
- If you have taken a pill to help you get an erection within the past 24 hours (or within 72 hours for as-needed dosing of tadalafil) and you have chest pain, do not take nitroglycerin. Seek emergency care and make sure all of the healthcare providers you see know that you took one of these medicines.
- Seek care if you have any erection problems that occur at the same time as pain or difficulty with urination, a fever, or pain in the lower belly.
- These drugs are not approved for use in people who were assigned female at birth.
- To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down. Be careful going up and down stairs.
- Take only whole tablets. These medications are not manufactured to be ‘split’, meaning the medication might not be evenly distributed throughout the pill.
There are non-medical treatments available for erectile dysfunction. These include lifestyle changes and therapies such as:
- Quitting smoking and limiting alcohol
- Sensual exercises
- Treating underlying health issues such as diabetes or low testosterone
- Improving diet, exercise, and sleep and reducing stress