How to find the best medication for erectile dysfunction

ED medications work by inhibiting a specific enzyme that controls the blood flow in your blood vessels. These drugs prevent these enzymes from degrading, which helps improve blood flow to your penis.

These medications may present slightly different side effects and drug interactions that will affect their suitability for you and your lifestyle.

Choosing an ED medication can be daunting for some people, but a doctor can advise on the most suitable treatment for you.

What’s the best ED medication for me?

According to the Centers for Disease Control and Prevention (CDC), ED impacts around 30 million adults in the United States.

Not everyone with ED needs medication to help relieve their symptoms. It is important to understand the cause of your symptoms before taking medication.

If you do need medication, it will likely be one of several different types, each with different requirements and side effects. These include:

Sildenafil (Viagra)

Sildenafil is a prescription-only drug available as the brand-name drug Viagra, but also as a generic version. It belongs to the group of medications phosphodiesterase type 5 (PDE5) inhibitors, which can help to treat both ED and pulmonary hypertension, a type of high blood pressure.

It helps treat ED by increasing blood flow to your penis during arousal. To ensure its effectiveness, you will need to take sildenafil while aroused before sex. This may not always be convenient, so you will want to consider if this works with your lifestyle.

While sildenafil is an effective ED treatment, its effectiveness can decrease as your age increases. For example, according to research from 2016, sildenafil is effective in 80% of individuals ages 65 years and younger. However, this figure decreases to 59% in people over the age of 75 years.

This same research notes how the most common side effects of sildenafil, regardless of age, include headaches and flushing.

Other common side effects include:

• vision changes
• back pain
• nausea
• dizziness
• rashes
• nasal congestion
• indigestion
• muscle aches

If you are already taking medications to lower your blood pressure, a doctor is unlikely to recommend sildenafil. This is because it can cause seriously low blood pressure when you take it alongside other medications that impact your blood pressure.

Having an existing heart condition may also mean sildenafil is unsuitable for you.

Tadalafil (Cialis)

Cialis is another medication that works to increase blood flow. However, unlike sildenafil, you can take tadalafil daily in a low dosage, typically 2.5 milligrams (mg). This means you do not have to take it before sex, and it will still work to improve your sexual function.

However, you can also take Cialis on demand, but this requires a higher dose, such as 10 mg. Cialis lasts longer than sildenafil, up to 36 hours, compared to just 4 hours for sildenafil.

One 2019 review suggests that taking Cialis daily instead of on-demand may be slightly more effective with fewer side effects.

The most common side effects include:

• headaches
• muscle aches
• back pain
• nasal congestion
• flushing

Vardenafil

Vardenafil is another PDE5 medication that helps boost your ability to get an erection. It works quickly, taking effect in under an hour. It was previously sold under the brand name Levitra, but this is no longer available.

One 2018 study assessed the effectiveness of vardenafil in 61 people with sleep apnea who take a continuous dose of 10 mg of vardenafil alongside using a continuous positive airway pressure (CPAP) machine for sleep apnea. This study notes how effective vardenafil is in boosting the ability of these people to maintain an erection.

However, vardenafil can be harmful if you have sensitivities in your kidneys or liver. For this reason, if you have any kidney impairment, you will have limits to your dosage. This is typically 10 mg per day.

The common side effects of vardenafil include:

• headaches
• dizziness
• flu symptoms
• sinusitis
• flushing
• nausea
• back pain
• organ and tissue damage, or creatine kinase (CPK)

If you experience sudden hearing loss while taking this drug, stop taking it immediately and seek medical assistance. Also, if you experience symptoms of QT prolongation, a type of heart condition, or have a family history of it, you must avoid vardenafil.

Testosterone treatment

Testosterone replacement therapy (TRT), also known as androgen replacement therapy, typically treats low testosterone levels. However, it can help manage symptoms of ED.

As you increase in age, your testosterone levels naturally decline. One symptom of low testosterone is ED and low sex drive.

Other symptoms of low testosterone include:

• unexplained weight gain
• trouble sleeping
• low sperm count
• loss of muscle

If a doctor determines you may have low testosterone, they may recommend TRT to help manage your symptoms of ED, including low libido. It can be an effective alternative to PDE5 treatment if these medications have not been effective for you.

However, TRT treatment for ED is only suitable if your symptoms are mild.

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Natural remedies

A range of natural remedies is available for ED symptoms. If you wish to try an alternative method to medication for managing your ED symptoms, speak with a doctor. This is because these methods may be unsuitable due to your medical history, or they might interact with other medications.

Some natural alternative remedies for ED include:

• Ginkgo biloba: Ginkgo biloba is a plant that helps improve blood flow around your body by boosting nitric oxide (NO) levels. This helps to relax your blood vessels. However, there is no conclusive evidence that it is an effective remedy for any health condition.

• L-arginine: This is an amino acid found in fish, meat, and dairy. L-arginine is important in creating proteins and helping produce NO. One review from 2019 notes how taking as little as 1,500 mg can help relieve mild ED symptoms.

• Horny goat weed: Horny goat weed is a herb that also helps boost blood flow and is a common ingredient in ED supplements. It contains icariin, which is a PDE5 inhibitor that works in the same way as many of the medications described above.

How to decide

If you notice symptoms of ED, it is important to speak with a doctor. They can first help you identify the cause of your symptoms, which will help you receive the most effective treatment possible. But several factors can help you decide which is best for you:

• Cost: Vardenafil is a generic medication, meaning it’s likely to be cheaper than the branded drugs Viagra or Cialis. However, Viagra and Cialis are also available in a generic form that may be cheaper.
• Causes: The cause of your condition will affect which drug you choose. For example, TRT may help if your ED is due to testosterone deficiency.
• Type of treatment: Viagra is a common short-term treatment, whereas Cialis is a long-term treatment.
• Side effects and interactions: Vardenafil is unsuitable if you have kidney or liver issues or have certain heart conditions. Doctors might not recommend Viagra if you’re taking blood pressure medications.

Summary

There are many types of ED medications. If you need medical treatment to help manage your symptoms, your doctor can advise you on the best medication. If you do not wish to take medication, there are a variety of natural remedies that you may wish to try.

A doctor can address the cause of your ED and then recommend specific treatment as needed. They will also help to adjust your medication or dosage as your treatment progresses, if necessary.

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