Erectile dysfunction (ED), also known as impotence, is a condition in which a person has difficulty achieving or maintaining an erection sufficient for sexual activity.
ED becomes more common with age. By the age of 70, 70% of men report experiencing ED, and it can also affect young men, with 40% of men by age 40 reporting symptoms.
While ED is common and affects an estimated 322 million men worldwide, it is not a normal or inevitable part of aging. Many underlying risk factors that contribute to ED are treatable.
Effective medicines to treat ED are available. Addressing ED can significantly improve quality of life. A healthy sex life is an important component of physical and emotional health.
Erectile Dysfunction (ED) Symptoms
- Getting an erection sometimes — but not every time you want sex
- Having difficulty maintaining erections that last long enough for sex
- Being unable to have an erection at all
Erectile Dysfunction Causes
There are many causes of ED, and they can be either psychological or physical. These may include:
Psychological causes
- Anxiety
- Depression
- Chronic stress
- Low self-esteem or negative body image
- Feelings of isolation or loneliness
Medical conditions
- Diabetes
- Heart disease
- High blood pressure
- High cholesterol
- Chronic obstructive pulmonary disease (COPD)
- Kidney disease
Hormonal conditions
- Low testosterone
- Thyroid disorders
Neurologic conditions
- Nerve damage
- Spinal cord injury
- Multiple sclerosis
Reproductive system conditions
- Peyronie’s disease (curvature of the penis)
Lifestyle factors
- Overweight or obesity
- Alcohol use
- Tobacco use
Erectile Dysfunction (ED) Risk Factors
Factors that may increase risk of ED include:
Risk Factors |
Examples |
| Blood Vessel or Nerve Injuries |
|
| Medical Conditions |
|
| Medical treatments |
|
| Medications |
|
| Mental Health Conditions |
|
| Substance Use Disorder |
|
Erectile Dysfunction (ED) Diagnosis
ED can be diagnosed in various ways. Some diagnostics your clinician could perform include:
| Medical history | Your clinician will go over your medication list. They will also ask questions about your sexual activity and mental health status. |
| Physical examination | Your clinician may examine your penis and testicles for injuries or other physical concerns. They will also check for any concerns relating to your blood vessels, nervous system, and hormonal imbalances. |
| Blood test | This is used to check for other underlying health conditions, like heart disease, diabetes, thyroid imbalance, and enlarged prostate. |
| Ultrasound | This is used with a special device that's safely moved over your penis to check for proper blood flow. |
Erectile Dysfunction (ED) Medication Treatments |
|||
| Generic Name (Brand) | Dosage | How do I take it? | When do I take it? |
| sildenafil (Viagra) | The starting dose for most men is 50 mg but can increase to 100 mg as needed. The starting dose for men over 65 years is 25 mg. | It is best to avoid fatty foods to prevent absorption problems. Refrain from consuming grapefruit juice to avoid possible interactions, which can increase the risk of side effects. | Take Viagra 30 to 60 minutes before sex. Viagra can work for up to four hours. |
| tadalafil (Cialis) | Cialis can be taken two ways. The daily way is a 2.5 mg or 5 mg tablet taken once daily; most men start with the lower dose. The on-demand way is taking 5 mg, 10 mg, or 20 mg as needed; the recommended starting dose is 10 mg as needed. | Cialis can be taken with or without food. Refrain from heavy drinking when taking Cialis, to avoid possible headaches, dizziness, heart racing, and lowered blood pressure. | When taken daily, Cialis takes 5 days to reach steady levels in the blood. When taken on demand, Cialis can start working quickly within 30 minutes and will work for up to 36 hours. |
| vardenafil (Levitra) | The recommended starting dose for most men is 10 mg, but it can go up to 20 mg. For men 65 years and older, the recommended starting dose is 5 mg. | Levitra can be taken with or without food; however, fatty foods may affect absorption. Avoid anything containing grapefruit juice, as it may increase vardenafil levels in your body and worsen side effects. | Levitra is taken 1 hour before sex. It will take 4 - 5 hours to clear half of the Levitra dose from your body. |
| vardenafil (Staxyn) | Staxyn is available only as a 10 mg tablet; do not exceed one tablet per day. | Place it directly on the tongue until dissolved. Avoid taking it with any liquid. Fatty foods may affect absorption. | Staxyn is taken 1 hour before sex. It is a rapidly dissolving tablet (taken without water), for people who prefer discretion. |
| avanafil (Stendra) | The recommended starting dose is 100 mg for most men. Other available doses include 50 mg and 200 mg. | Stendra can be taken with or without food; however, fatty foods may affect absorption. Moderate consumption of alcohol is ok. Avoid drinking more than 3 glasses of wine or 3 shots of whiskey. Drinking more than that can lead to headaches, dizziness, heart racing, and lowered blood pressure. | Stendra 100 mg or 200 mg can be taken 15 minutes before sex, and the 50 mg tablet can be taken 30 minutes before sex. It will take 5 hours to clear half of the Stendra dose from your body. |
Other Treatments Beyond PDE5 Inhibitors
The above table of phosphodiesterase type 5 (PDE5) inhibitors is not an exhaustive list of all ED medications. Depending on individual factors, testosterone with or without a PDE5 inhibitor might be another option after a discussion with your clinician.
There are also alprostadil injections into the base of the penis, marketed under the brand names Caverject, Caverject Impulse, and Edex. The first injection is done at the clinician’s office to ensure proper and safe use at home.
The recommended alprostadil starting dose is 2.5 mcg for most men, but it is 1.25 mcg among men with a spinal cord injury. You will need to work with your clinician to incrementally increase your dose to the desired effect, which is an erection that lasts long enough for up to one hour of sex. Commonly, doses range between 10-20 mcg. These injections can only be used three times per week, with a minimum of 24 hours between uses.
Other Indications
In addition to treating ED, tadalafil (Cialis) may be taken daily to manage symptoms of an enlarged prostate. Beyond ED, sildenafil and tadalafil are also used for the treatment of pulmonary arterial hypertension (high pressure in the lungs). For this indication, sildenafil is marketed under the brand name Revatio and tadalafil under Adcirca.
Compare Erectile Dysfunction Medication Prices
| Drug Name Strength |
U.S. Pharmacy Retail Price | U.S. Discount Card Price | Lowest Canadian Pharmacy Price | Lowest International Pharmacy Price | Greatest Percentage Savings |
|
Viagra
100 mg |
$3 104,34 | $2 432,76 | $0,0000 | $81,45 | 100% |
|
Generic Viagra (sildenafil)
100 mg |
$486,00 | $41,40 | $0,0000 | $8,43 | 100% |
|
Cialis
20 mg |
$2 145,18 | $1 611,45 | $0,0000 | $285,00 | 100% |
|
Generic Cialis (tadalafil)
20 mg |
$491,46 | $11,41 | $148,27 | $9,27 | 98% |
|
Generic Levitra (vardenafil)
20 mg |
$563,76 | $76,81 | $0,0000 | $11,97 | 100% |
This price data is updated daily. U.S. pharmacy retail price reflects a national average of out-of-pocket cost. All other pricing reflects that of the lowest price per pill multiplied by 30 for a quantity of 30 pills.
Common Versions of ED Medications
Here is a list comparing erectile dysfunction brand names marketed globally. If you choose to order online, you may want to familiarize yourself with the international counterparts.
| US Brand Name (Generic Name) | Indian Brand Names | Turkish Brand Names | New Zealand Brand Names |
| Viagra (sildenafil) | Silagra, Suhagra, Penegra, Caverta | Degra, Sildegra, Vigrande, Sinegra | Silvasta, Vedafil, |
| Cialis (tadalafil) | EDsave, Mildfil, Tadacip, Modula, Forzest, Tadact, Tedup | Afilta, Departon, Hardcis, Lex, Lifta Pahtafil, Pubiltor | Cilatil |
| Levitra (vardenafil) | Valif | Lovitrec | Levitra |
Warning: Cheap Erectile Dysfunction (ED) Medication Marketed Online
ED medications commonly advertised online, such as Vidalista (tadalafil), may appear to be affordable options, but may very well be produced, stored, or distributed under poor quality practices, raising serious concerns regarding their safety and effectiveness.
The internet is rife with rogue web operations that sell substandard or even counterfeit ED medications for cheap. Consumers can check whether a website is on our list of rogue online pharmacies to avoid. Another option is to enter a pharmacy’s URL into the PharmacyChecker Verification Portal to determine whether the website in question is properly accredited and meets the safety and quality standards of the PharmacyChecker International Pharmacy Verification Program.
PharmacyChecker independently verifies online pharmacies to help consumers safely search for prescription medications online and avoid counterfeit or unsafe products. A list of PharmacyChecker-accredited online pharmacies is available to help consumers identify legitimate and trustworthy options.
Pharmacist Advice On Taking ED Medication
1. Take ED medication on an empty stomach when possible. If you take it with food, choose a light, low-fat meal. High-fat food can disrupt the absorption of the medication in your body, making it less effective.
2. The “best” ED medication varies by individual. Several factors, such as cost, insurance coverage, your preferences, and desired results, all play a role. Discuss options with your clinician and share what has or hasn’t worked for you. There are several brand and generic versions available.
3. Seek immediate medical attention for prolonged erections. If you experience a strong erection lasting longer than four hours, get emergency medical care right away.
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