Written and medically reviewed by Dorcas Morak, Pharm.D
What Is Erectile Dysfunction (ED)?
Erectile dysfunction (ED) is the consistent inability to achieve or maintain an erection firm enough for sexual activity. It affects an estimated 30 million men in the U.S. alone and can result from physical causes (such as diabetes, high blood pressure, or nerve damage), psychological factors (such as stress or anxiety), or a combination of both.
Treating ED often starts with identifying underlying health issues, making lifestyle changes, and considering medical treatment options—most commonly, oral medications.
Which ED Medications Are Most Common?
The most widely prescribed ED treatments are PDE5 inhibitors, a class of medications that enhance blood flow to the penis during sexual arousal. These include:
- Sildenafil (brand name: Viagra)
- Tadalafil (brand name: Cialis)
- Vardenafil (brand names: Levitra, Staxyn)
- Avanafil (brand name: Stendra) Each works similarly by relaxing blood vessels and increasing blood flow to support an erection, but they vary in how quickly they take effect and how long they last.
Do Some ED Medications Work Better Than Others?
Research shows that ED medications like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) all work better than a placebo at helping men get and keep an erection. Some studies suggest tadalafil may be the most effective overall, with vardenafil close behind.
That said, everyone responds differently:
- One man might like tadalafil because it lasts up to 36 hours.
- Another might choose avanafil for how quickly it works and its lower chance of side effects.
Since results vary, it often takes some trial and error—with your doctor’s help—to find the one that works best for you.
How Do These ED Medications Compare?
| Medication | Onset Time | Duration | Notes |
|---|---|---|---|
| Sildenafil (Viagra) | 30–60 min | 4–6 hrs | One of the most affordable generics; ideal for occasional use. |
| Tadalafil (Cialis) | 30–45 min | Up to 36 hrs | Offers daily low-dose option for spontaneity. |
| Vardenafil (Levitra) | 30–60 min | 4–6 hrs | Also available as a dissolvable tablet under the name Staxyn. |
| Avanafil (Stendra) | 15–30 min | 6–12 hrs | Fastest acting; may have fewer side effects. |
Are There Health Considerations to Keep in Mind?
Yes. PDE5 inhibitors should never be taken with nitrate medications (commonly used for chest pain) or with certain alpha-blockers due to the risk of dangerous drops in blood pressure. Also consult your doctor if you have:
- Cardiovascular disease
- Liver or kidney disease
- Retinitis pigmentosa
- A history of stroke or low blood pressure
How Can You Save on ED Medications?
ED medications—especially brand-name versions—can be expensive, and insurance coverage is often limited or non-existent. Here’s how to reduce your costs:
Use generics:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Avanafil (Stendra)
- Vardenafil (Levitra, Staxyn)
Compare pharmacy prices: Costs may differ dramatically depending on location and chain.
Use the RxLess® Assurance Plan: Find sildenafil or tadalafil for as little as $2–$10 per pill at over 70,000 pharmacies. Download the free app, search your prescription, show your free coupon at the pharmacy, and pay the lowest available price—no insurance or sign-up required.
What If Pills Don’t Work for You?
If oral medications don’t help, other options include:
- Alprostadil (injection or urethral suppository)
- Vacuum erection devices (penis pumps)
- Penile implants (surgical)
- Vascular surgeryn(rare; for specific cases)
These treatments are usually recommended only after oral medications have failed or are contraindicated.
