Before you begin taking medication for erectile dysfunction, know that ED can be symptomatic of many underlying problems more serious than erectile dysfunction. Please read “What is low testosterone?” and “If you feel your testosterone petering out, do something.”
Pfizer, the drug company, was trying to develop a blood pressure treatment when they accidentally developed a drug that revolutionized erectile dysfunction treatment. It was patented in 1996 and approved by the FDA two years later.
These drugs, called PDE-5 inhibitors, lead to an increase in nitric oxide in the penis. This causes relaxation of the smooth muscles in the vessels leading to the penis, and improves erections. PDE-5 inhibitors have revolutionalized sex for older men and have had a dramatic impact on the treatment of ED around the world.
Just remember, these ED medications make people with erectile dysfunction able to have erections. They don’t make the ED go away and these drugs certainly don’t make the underlying conditions go away. Erectile dysfunction is often a sign that something is wrong in your body. These drugs allow your johnson to still run marathons, but be sure to see a doctor and find out what is actually wrong.
The brands
Many competitors followed Viagra’s swift market penetration.
- Viagra
- Levitra
- Staxyn
- Cialis
- Stendra
These drugs all work in a similar way: they boost the effect of nitric oxide, a chemical in your blood vessels that relaxes muscles in your penis. How can that possibly help, you ask? With the muscles relaxed, blood can flow more easily into your penis with sexual stimulation and there’s your erection. These drugs amplify the signal to get blood flowing to your penis.
Think of these drugs as a rocket you’re piloting.
| Rocket | Fueling | Blast off | Cruising time |
| Viagra | On an empty stomach | 30 min. to one hour | 4-5 hours |
| Levitra, Staxyn (fast dissolving, put under your tongue) | On an empty stomach | In one hour | 4-5 hours |
| Cialis, high dose | With or without food | 30-45 minutes | 36 hours! |
| Cialis, low dose for daily use | With or without food | On demand | Continuous |
| Stendra | With or without food | 15-30 minutes | 6-12 hours |
Your doctor will help you decide which one to use based on personal preferences.
If the drug should be taken on an empty stomach, you can’t have a romantic dinner, take the pill, and expect to be a stallion in the bedroom. Instead of dinner, plan an afternoon delight, instead. Remember, too, they all require sexual stimulation. You must engage in foreplay before getting an erection.
Differences among drugs
The cost and how many pills your insurance covers are important differences as well. Shop around for the best prices using tools such as goodrx.com. You can also talk to your doctor about getting a higher dose than you need, and then save money by splitting the pills at the time of dosage. Look for manufacturer discounts for a limited supply of an introductory offer.
Generic versions of Viagra, Levitra, Staxyn, and Cialis are all available and are generally lower-priced than the name brands.
Differences in the various ED drugs:
Viagra – (generic is sildenafil) Good potency. Often causes facial flushing and congestion. Was the first drug designed and may still be the best. Maximum dose is 100mg. Can cause visual changes and color changes with vision.
Levitra – (generic is vardenafil) Similar in onset to Viagra. Sometimes this works when Viagra does not.
Cialis – (generic is tadalafil) Lasts much longer than all the other medications. Can be prescribed as an on-demand drug or to be taken daily. Occasionally the daily use causes muscle cramps (legs, lower back). Stop taking and tell your doctor if this happens to you. Onset is slower than Viagra and causes less facial congestion.
Staxyn – Taken under your tongue. Can be used with alcohol, unlike the others.
Stendra – Maximal dose is 200mg. This medication occasionally works when the others are no longer effective.
Effectiveness
About 70% of men achieve an erection sufficient for intercourse. But if you have diabetes or cardiovascular disease, you will not respond as strongly to PDE-5 inhibitors. Nerve damage from prostate surgery may also limit the success of these drugs. However, in one study 75% of the men who had nerve-sparing prostate surgery or the more precise forms of radiation therapy for prostate cancer successfully had erections after taking these drugs, so not all hope is lost.
Some men may not benefit at all from the drugs; if you have sickle cell anemia, leukemia, or multiple myeloma, or you have an abnormally-shaped penis, you’re more likely to have limited success.
And keep in mind, no matter how healthy you are, during periods of high stress the drugs may not work.
Warning
You’re not supposed to take any of these drugs without seeing your doctor first. And they could actually harm you if you:
- Take nitrate drugs (Nitro-Dur, Nitrostat and others, Monoket, or isosorbide dinitrate)
- Have high or low blood pressure
- Have severe liver disease
- Are on kidney dialysis
If you take alpha blockers for urinary symptoms, take the ED drug at least four hours apart from the alpha blocker.
Side effects
These are mild: flushing, headache, indigestion, seeing a blue tinge, light sensitivity, blurred vision, stuffy or runny nose, diarrhea, dizziness, rash, back pain
These are more serious, but rare:
- hearing or vision loss. Seek prompt medical attention.
- Priapism, an erection that lasts over four hours. (While this is listed as a side effect from these drugs, it is extremely rare.)
A caution
Because you can buy ED drugs very easily online, you must research the pharmacy before you purchase.
In the US, find out if the pharmacy is legitimate by contacting the National Association of Boards of Pharmacy. Ask if it’s licensed and in good standing. Don’t trust pharmacies with no phone number. In fact, for ones with phone numbers, call as a test to see if someone answers and can answer questions about the various medications. If their prices are too good to be true, they’re probably not really the drugs you think you’re buying. Don’t trust a pharmacy that doesn’t require a prescription.
When you find a reliable pharmacy and order meds, double check the dose and the drug name when you receive it.
Don’t buy herbal Viagra. It’s not Viagra. At the very least, herbal Viagra will not help. At the worst, it will harm you.
Conclusion
Subtle differences among the ED drugs give you choices regarding how you take them and how you and your partner need them. There’s nothing wrong with trying one and if that doesn’t work as well as you want, trying another. Remember, you’re the pilot.