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Which Erectile Dysfunction Drug Is Best for You?

By Chesney Fowler, MD
Medically reviewed
March 31, 2021

Erectile dysfunction, or the inability to get and maintain an erection, affects around 30 million American men. While prevalence increases with a person’s age, ED can occur in anyone, especially those with certain underlying physical or mental health conditions. 

As common as it is, erectile dysfunction can be uncomfortable and embarrassing, and it can also interfere with intimacy in relationships. If you think you may have ED, it’s important to speak with a doctor. In some cases, erectile dysfunction may be linked with other diseases. Your doctor can help determine the underlying cause of your ED, as well as identify the best option for treating it. 

In some cases, remedying erectile dysfunction is as simple as treating the underlying medical problem. Other times, doctors recommend medications to treat ED. Several options exist, each with various side effects. Your provider can help you decide which is best and alter your course of treatment if needed.

Skip Ahead: What Is ED & What Causes It? | What Erectile Dysfunction Pills Are Available? | How Effective Are ED pills? | Side Effects | How to Decide Which ED Medication Is Right for You

What Is ED & What Causes It?

An erection is caused by increased blood flow in the penis, usually during sexual arousal or direct contact with the penis. During arousal, penis muscles relax, allowing for more blood flow in the penile arteries. The penis then becomes rigid.

Erectile dysfunction, also called impotence, occurs when someone cannot get or maintain an erection that’s firm enough to have sexual intercourse. Common ED symptoms include: 

  • Difficulty getting an erection 
  • Difficulty maintaining an erection
  • Loss of sexual desire

What causes erectile dysfunction varies person to person. The brain, hormones, nerves, muscles, and blood vessels all play a role in erection, so problems with any of these may lead to challenges with sexual arousal.

Additionally, since sexual arousal has an emotional component, underlying psychological factors may contribute to ED. 

Some of the most common causes of erectile dysfunction include: 

  • Heart disease
  • Diabetes
  • Obesity
  • Parkinson’s disease
  • Multiple sclerosis
  • Atherosclerosis, or clogged blood vessels
  • High cholesterol
  • High blood pressure
  • Metabolic syndrome, a condition that involves high blood pressure, high insulin, and high cholesterol
  • Alcoholism and other forms of substance abuse
  • Tobacco use
  • Low testosterone levels
  • Scar tissue in the penis
  • Depression or anxiety
  • Chronic stress
  • Relationship difficulties

Erectile dysfunction can be upsetting and interfere with relationships, which is reason enough to seek medical treatment.

But because ED is connected with many underlying medical conditions, it’s important to talk to a medical provider if you think you might have it. They can help determine the cause of the dysfunction and pinpoint the best course of treatment. 

What Erectile Dysfunction Pills Are Available? 

If there’s no underlying condition causing someone’s ED or if treating that condition does not fix the ED, a doctor may recommend a prescription medication. 

One of the most common types of erectile dysfunction pills is Phosphodiesterase type 5 (PDE5) inhibitors. PDE5 is an enzyme in blood vessel walls that helps control blood flow. PDE5 inhibitors work by impeding the function of these enzymes, increasing blood flow and allowing for an erection. In order for PDE5 inhibitors to help, a person has to be sexually aroused.

Below are some of the most common PDE5 erectile dysfunction pills doctors prescribed.

Sildenafil (Viagra)

  • How to take it: Don’t take sildenafil with food. Try to wait at least 60 minutes after eating before you take a pill. Avoid drinking, too, since alcohol can prevent it from working properly.
  • How fast it works: Viagra can work within 30 minutes.
  • How long it lasts: For many people, the effects of Viagra last around four hours. In rare cases, however, painful, hours-long erections may occur. 
  • Typical dosage: Usually, doctors start patients on 50 mg of Viagra. For people experiencing unwanted side effects, your provider might suggest a 25-mg dose; if the Viagra isn’t working the way you want it to, a doctor may prescribe up to 100 mg.
  • Cost: Name-brand Viagra costs $60-$80 per pill, which is about $2,100 for a 30-day supply. Fortunately, most insurance covers Viagra. Sildenafil (generic Viagra) costs around $13 for a 30-day supply of 50-mg pills, plus the costs of a doctor’s visit. K Health offers sildenafil 50-mg for $2.70 per dose, which includes the price of the doctor writing a prescription.

Tadalafil (Cialis)

  • How to take it: Unlike sildenafil, food doesn’t interfere with tadalafil’s effectiveness. Depending on your doctor’s recommendation, you can take it as needed or every day. 
  • How fast it works: Cialis can start working in 15 minutes or so, but maximum effect usually occurs two hours after taking it.
  • How long it lasts: Reports have shown Cialis can last anywhere between 36 and 72 hours.
  • Typical dosage: When taken every day, doctors usually prescribe 2.5 mg of Cialis. On the other hand, if taken as needed, doctors typically start with 10 mg (taken once a day at most). Depending on how you react, your doctor may increase the dosage to 20 mg or decrease it to 5 mg if you have side effects.
  • Cost: Depending on your dosage, a 30-day supply of brand-name Cialis can cost up to $400, and it’s not typically covered by insurance. As of 2020, Tadalafil (generic Cialis) cost around $17 for a 30-day supply of 10-mg pills, plus the cost of a doctor’s visit. K Health offers tadalafil 10 mg for $1.80 per dose, which includes the price of the doctor writing a prescription.

Vardenafil (Levitra)

  • How to take it: Similar to sildenafil, vardenafil is another PDE5 that may work less effectively with food. Try to wait an hour or two after eating until you take it. 
  • How fast it works: Like Cialis, Levitra can start working in about 15 minutes, but it can take up to an hour to reach its full effect.
  • How long it lasts: Usually the effects of Levitra last around four hours. 
  • Typical dosage: Doctors often start patients on 10 mg of Levitra. Depending on how it’s working for you, your provider may increase the dose to a maximum of 20 mg or decrease it to 5 mg. 
  • Ccost: Levitra isn’t covered by most insurance plans, so it’s more expensive than other choices, costing up to around $1,600 for 30 tablets. As of 2020, Vardenafil (generic Levitra) cost around $240 for a 30-day supply of 10-mg pills.

How Effective Are ED Pills?

Viagra, Cialis, and Levitra are all effective options for treating ED. Which one works best for you depends on your lifestyle and your unique medical situation. 

Currently, no clinical studies compare all three medications with each other. However, a 2009 review of studies on the individual medications concluded that each of these medications results in successful sexual intercourse in about 70% of users compared to just 35% with a placebo.

Common Side Effects of Viagra, Cialis & Levitra

As with every medication, PDE5 inhibitors come with potential side effects. Some of the most common effects of each medication are below. 

Common side effects of Viagra

  • Hot flashes
  • Headaches 
  • Stuffy or runny nose
  • Dizziness
  • Vision problems
  • Nausea
  • Back or muscle pain
  • Painful, long-lasting erections

Viagra is also known to interact with other medications, including some heart disease and blood pressure drugs. 

Common side effects of Cialis

  • Hot flashes
  • Headaches
  • Indigestion
  • Stuffy or runny nose
  • Muscle pain
  • Back pain

Cialis can also interact with other prescription medications, including certain blood pressure drugs.

Common side effects of Levitra

  • Facial flushing
  • Stuffy or runny nose
  • Headache
  • Stomach problems
  • Vision problems
  • Back pain

Levitra may interact with other prescriptions, including medications for heart disease.

How to Decide Which ED Medication Is Right for You

If you think you may have erectile dysfunction, talk with a doctor. To help you pinpoint the best treatment option for you, they will consider any pre-existing medical conditions you have, as well as the side effects of ED medications and potential interactions with other medications you’re taking. Price may also play a role in your decision. 

Keep in mind each ED medication comes with its own unique pros and cons.

For example, one study shows Cialis may increase a male’s sexual confidence more than Viagra does. But what works for one person doesn’t always work for another. 

If one medication doesn’t fully resolve your symptoms, you may need to try another one. If you’re not happy with a medication or you experience unwanted side effects, discuss it with your provider or a K physician.

How K Health Can Help

Did you know you can get affordable erectile dysfunction treatment with the K Health app? Download K to check your symptoms, chat with a doctor, and get erectile dysfunction medication prescribed and delivered to your door. 

Frequently Asked Questions

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Chesney Fowler, MD

Dr. Fowler is an emergency medicine physician and received her MD from George Washington University. She completed her residency in emergency medicine at Christiana Care Health System. In addition to her work at K Health, Dr. Fowler is a practicing emergency medicine physician in Washington, DC.