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Erectile dysfunction:
Viagra and other oral
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Erectile dysfunction: Viagra

and other oral medications
By Mayo Clinic Staff

Medicines that you take by mouth are called oral

medicines. They're often the first line of treatment for
trouble getting or keeping an erection, called erectile
dysfunction (ED). Oral medicines for ED usually work
well and cause few side effects.

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The four main medicines taken by mouth for erectile

dysfunction are:

Avanafil (Stendra).
Sildenafil (Viagra).
Tadalafil (Cialis).
Vardenafil.

These medicines are called PDE5 inhibitors. They

enhance the effects of a chemical the body makes that
relaxes muscles in the penis, called nitric oxide. This
boosts blood flow and helps you get an erection from
sexual activity.

How oral medicines differ

Each oral medicine for ED has a slightly different
chemical makeup. These small differences affect the
way each medication works, such as how quickly it
takes effect and wears off, and the possible side
effects. Your doctor or other health care professional
can recommend one for you based on these factors,
other health conditions you have and any other
medicines you take.

Sildenafil (Viagra). This medicine works best when

you take it on an empty stomach an hour before
sex. The body takes longer to absorb it after a high-
fat meal or alcohol. Its effects often last for 4 to 5
hours. It might work longer if you have mild to
moderate erectile dysfunction.
Vardenafil. This medicine also works best when
you take it an hour before sex on an empty
stomach. As with sildenafil, a high-fat meal or
alcohol keep the body from absorbing it as quickly.

Vardenafil usually works for 4 to 5 hours. Its effects

might last longer if you have mild to moderate ED. A
newer form of the medicine that dissolves on the
tongue might work faster than the pill that you
swallow.

Tadalafil (Cialis). This medication is taken with or

without food an hour before sex. It works for up to
36 hours. You can take it in a small dose daily or in
a larger dose as needed.
Avanafil (Stendra). You can take this medicine with
or without food 30 minutes before sex, depending
on the dose. It lasts 4 to 5 hours, or longer if you
have mild to moderate ED.

These medicines all work well for ED. When choosing

one, tell your doctor or other health care professional
what your preferences are, such as cost, ease of use,
how long the drug's effects last and side effects.
Generic versions of sildenafil, vardenafil and tadalafil
are available.

When oral medications might not be

safe
Check with your health care team before you take any
medicine for erectile dysfunction. Oral ED medicines
might not work or might be dangerous if you also take
any of the following:

Nitrate medicines. Often, these are prescribed for

chest pain called angina. Some examples of nitrates
are nitroglycerin (Nitro-Dur, Nitrostat, others),
isosorbide mononitrate (Monoket) and isosorbide
dinitrate (Bidil).
Alpha-blockers. These are commonly prescribed
for an enlarged prostate or male pattern baldness.
They include dutasteride (Avodart, Jalyn) and
finasteride (Propecia, Proscar).
Medicines that block an enzyme called CYP3A4.
These include itraconazole (Sporanox, Tolsura),
ketoconazole (Extina, Ketozole, others) and
ritonavir (Norvir).

Oral medicine for ED also might not be safe or work

well if you have:

Very low blood pressure, called hypotension, or

uncontrolled high blood pressure, called
hypertension.
Severe liver disease.
Kidney disease that needs to be treated with
dialysis.
Recent heart or blood vessel problems. These
include a heart attack, stroke or a serious heart
rhythm disorder in the past six months.
An inherited eye disease that affects the retina.
Kidney disease that needs to be treated with
dialysis.

Side effects
Side effects of oral ED medicines are often mild.
Common ones include:

Flushing of the skin.

Headache.
Upset stomach.
Visual changes, such as blue tinge to vision,
sensitivity to light or blurred sight.
Stuffy or runny nose.
Back pain.
Dizzy feeling.

Rarely, more-serious side effects can happen,

including:

Hearing loss or vision loss. Some people have

suddenly lost some of their hearing or vision after
taking one of these medicines. But it isn't clear
whether these side effects were caused by the
medicine or by health conditions that the people
already had. Get medical care right away if you take
oral ED medicine and have sudden loss of hearing
or vision.
An erection that doesn't go away on its own.
Called priapism, this rare condition can be painful.
You need to get treatment for it as soon as possible
to help prevent damage to your penis. If you have
an erection that lasts more than four hours, call your
care team right away.

Buying oral erectile dysfunction

medications online
Treatments for erectile dysfunction are big business,
and online scams abound. If you do buy medicines
over the internet:

Check to see if an online pharmacy is legitimate.

Never order medicines from an online pharmacy
that doesn't list its phone number and physical
address, has prices that seem too good to be true,
or tells you that no prescription is needed. Also stay
away from ones that don't have a licensed
pharmacist on staff to answer your questions. Some
illegal businesses sell fake versions of real
medicines, which can be dangerous or might not
work. In the United States, the National Association
of Boards of Pharmacy can tell you whether an
online pharmacy is licensed and in good standing. If
you live in another country, check to see if
pharmacy association or regulation agencies offer
services like these.
Make sure you get the right prescription and
dose. When you order medicines and when you
receive them in the mail, make sure they're the
exact dose and type prescribed by your doctor or
other health care professional. The dose is the
amount of medicine you take.
Don't be fooled into buying "herbal viagra."
Never take any medicines that claim to be the
"herbal" or nonprescription version of an oral
medicine for ED. These aren't an effective option,
and some contain harmful substances.

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June 24, 2023

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