Sildenafil (Viagra) is only available by prescription, but there are many OTC options, often labeled as supplements, for ED.
The Food and Drug Administration (FDA) doesn’t regulate supplements in the same way as prescription medications, and they can come with significant risks.
For your safety, it’s vital to read all packing ingredients and manufacturer dosage instructions and consult a healthcare professional before taking any supplements.
What are the OTC alternatives?
A search on the internet provides a wide variety of alternative medications for ED. Though there are many different brands, most contain a combination of the same ingredients. While these ingredients may be natural, it doesn’t mean they are safe, and many medical professionals warn against using them.
Yohimbe herbal supplements
Yohimbe (Pausinystalia yohimbe) comes from the bark of an evergreen African tree. It is thought to increase blood flow to the penis and is available as an ingredient in many supplements.
A 2021 review of studies showed that while yohimbe did not help with ED when someone takes it alone, it did show significant results when combined with other supplements.
However, it is important to note potential side effects, like:
- anxiety
- dizziness
- headaches
- elevated heart rate
- elevated blood pressure
- tremors or shaking
More serious side effects may include a heart attack or seizures.
L-arginine
L-arginine is an amino acid that can help treat ED by relaxing the blood vessels in the penis.
In a small 2020 study of 120 older adult males, l-arginine accentuated the effects of tadalafil (Cialis) — another prescription-only ED medication similar to sildenafil (Viagra).
However, due to the lack of clinical trials, scientists are hesitant to prescribe l-arginine alone as an ED medication.
Common l-arginine side effects are mild and include abdominal cramping and nausea.
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Dehydroepiandrosterone (DHEA)
DHEA is a naturally occurring steroid prohormone that decreases with age.
A 2018 review of studies suggests that supplemental DHEA may improve ED symptoms as it is involved with smooth muscle relaxation. However, 2019 research concluded there was not enough supporting research to show its effectiveness.
Since DHEA changes your hormones, it can cause unwanted changes to the body and may interact with some medications.
Ginseng
People have used ginseng throughout history to improve overall health, with anecdotal evidence pointing toward it being an effective aphrodisiac that boosts sex drive and increases desire.
Ginseng comes in several varieties, but Panax ginseng or Korean red ginseng are more common herbal remedies for ED.
A 2021 review of studies found ginseng’s effect on ED to be of little significance when compared to a placebo.
Some potential side effects may include:
- sleeplessness or insomnia
- blood clot interference
- changes in blood sugar levels in people with diabetes
- medication interactions
Eurycoma longifolia
This supplement comes from a southeastern Asian plant, commonly called “Tongkat ali” or “longjak.” Numerous E. longifolia products are available, including capsules, tablets, and powders.
Older 2016 research concluded that E. longifolia is an encouraging herbal remedy for some health conditions. However, there is not enough evidence around its full safety and efficacy, and more scientific studies are needed to confirm the effects of E. longifolia on ED.
However, the few human trials that have taken place show no sign of adverse side effects in healthy adults.
Are OTC Viagra alternatives safe to use?
The FDA does not regulate ED supplements in the same way as they do for prescribed medications. There are no rules for manufacturers to meet regulatory requirements.
The FDA warns that these medications may be dangerous as they can be counterfeit, contaminated, ineffective, or contain illegal substances.
It also confirms that some drugs with specific labeling contained twice the recommended dosage of sildenafil, the active ingredient in Viagra. This dosage may be dangerous for many people, including older adults and those with impaired kidney or liver function.
This dosage may also interact with other medications containing nitrates, resulting in a dangerous drop in blood pressure levels.
What are the FDA-approved medications for ED?
The FDA has approved several medications for ED. These work by relaxing smooth muscles and increasing blood flow in the penis to help you get and maintain an erection. These oral medications include:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra)
- avanafil (Stendra)
Another option may include prescription testosterone injections. These may benefit you if you have low amounts of the hormones in your blood and if your ED is not due to circulatory or nerve problems.
Additionally, an injection or suppository of alprostadil can produce automatic reactions that could last 30–60 minutes.
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Get free cardAlternative options
MED3000, marketed under the name Eroxon, is a new, nonmedicated gel that is a clinically proven topical treatment for adults with ED. The FDA approved the gel in June 2023. It uses an evaporating and cooling method that triggers nerve sensors, relaxes smooth muscle, and stimulates blood flow.
Vacuum pump devices are a noninvasive, second-line option. These may be suitable options if pharmacological therapies have not worked for you and they have few side effects. However, these devices do not suit people with sickle cell anemia or those taking anticoagulants.
Surgical implantation may be an option when first- and second-line options do not work. This is a surgical implantation of an inflatable device within the penis, and a consultation with a urologist is essential to discuss risks, benefits, and expectations.
Speaking with a doctor or healthcare professional about ED
ED is the most common sexual issue in males, affecting up to one-third of men at some point.
It is important to discuss all options with a doctor or healthcare professional as soon as you can to rule out an underlying medical condition. They will also be able to identify whether your ED could be related to certain medications or psychological or emotional conditions.
Summary
Erectile dysfunction (ED) can have a significant effect on your quality of life. Supplements are available as an alternative to sildenafil (Viagra), including yohimbe, ginseng, and DHT.
However, make sure you fully understand the risks, especially if you have pre-existing medical conditions or are taking specific medications.
Help is always available, so speak with a doctor or healthcare professional to make a plan that works for you.
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