Erectile dysfunction is a problem that has always existed but only came to the forefront of health education in the 1990s, give or take. Since then, numerous erectile dysfunction drugs for the treatment of ED have been released and millions of prescriptions have been filled.
The term erectile dysfunction refers to an inability to develop or maintain an erection firm enough for sex, though there are no diagnostic criteria for how consistent the problem must be or for how long it must persist before men should seek treatment. According to the Massachusetts Male Aging Study conducted in 1994, the prevalence of ED is around 52%, but the study also revealed that its prevalence increases with age. As more men experience erectile issues, newer and better ED treatments are being developed with prescription medications among the most common.
Before you head to your doctor’s office to get a prescription, you should consider all of the erectile dysfunction treatment options available to you. Ask yourself whether ED drugs are really the best choice, or if an alternative form of treatment might be safer or more effective. Keep reading to learn about the best questions to ask and, if you do decide to go the route of ED drugs, which options are available.
The Risks of Prescription Erectile Dysfunction Drugs
Erectile dysfunction aside, prescription drugs always come with risks. Just because something is prescribed by a doctor doesn’t necessarily mean that it is inherently safe for everyone—it is impossible to predict exactly how an individual’s body will respond to a particular drug. Even the most common erectile dysfunction drugs that have been prescribed millions of times come with the risk of side effects, and there may be complications with long-term use.
Though side effects are a risk with any medication, it is important to take a look at the side effects specifically linked to ED drugs. In a 2007 study published in the journal Therapeutics and Clinical Risk Management, a study involving 979 men with erectile dysfunction tested the long-term safety of sildenafil or Viagra. Over a four-year period, roughly 3.8% of participants experienced one or more adverse side effects (none of which were serious), which led to either a change in dosage or temporary or permanent discontinuation of the drug.
Statistics vary for different drugs, but some of the most common side effects reported for erectile dysfunction medications include the following:
- Body aches and pains
- Digestive upset
- Changes in vision
- Runny nose
Though side effects of ED drugs are typically minor and temporary, there are some reports of serious side effects, including sudden changes in hearing, loss of vision and priapism or an erection lasting longer than four hours. Your risk of side effects depends on numerous factors, most notably any underlying medical conditions, as well as medications you may be taking for those conditions.
Important Questions to Ask Yourself Before Taking ED Drugs
Because ED drugs come with risks, it is always a good idea to consider all of the erectile dysfunction treatment options before taking them. Sure, it might seem like popping a pill is the easy way to solve your erectile issues, but it may not be simple as that. ED drugs may help you achieve or maintain an erection, but they could mask underlying health problems or cause side effects and complications. So, before you start taking ED drugs, there are some important questions you need to ask yourself:
Is the cause of your erectile dysfunction treatable with medication?
When you experience erectile dysfunction, your primary focus is probably going to be on the problem itself, not the cause. In order to properly treat this condition, however, you have to know what is causing it. Occasional erectile dysfunction is often caused by psychological issues like stress, excessive alcohol consumption, fatigue, certain medications and personal or relationship problems. In cases like this, the problem usually resolves on its own without medical treatment. If your erectile dysfunction becomes chronic, however, you may want to consider treatment.
When it comes to causes of erectile dysfunction, they can be broken into two main categories—medical and psychological. Medical conditions that may contribute to chronic erectile dysfunction include the following:
- Heart disease
- High cholesterol
- High blood pressure
- Metabolic syndrome
- Parkinson’s disease
- Multiple sclerosis
- Peyronie’s disease
- Sleep disorders
- Prostate cancer
If your doctor determines that one or more of these conditions may be to blame for your ED, the first step is to treat that condition. In addition to treating those conditions, your doctor may also recommend erectile dysfunction drugs.
In cases where erectile dysfunction is caused by psychological issues, ED drugs may not be effective. According to the University of Cambridge, as many as 20% of men experience psychological impotence at some point in their lives, often triggered by periods of extreme stress or anxiety, depression, relationship problems, personal problems, performance anxiety and even pornography dependence or addiction. Because these causes for ED are not biological in nature, taking an oral medication may not work. Psychotherapy is likely your best way to overcome psychological causes for ED, and taking that little pill would be like putting a bandaid on a flaccid bullet wound.
Are prescription drugs a safe choice for you?
Before taking any prescription drug, you need to make sure that it is safe for you to do so. Erectile dysfunction drugs belong to a class of medications known as vasodilators or, to be more specific, they are phosphodiesterase type 5 (PDE5) inhibitors, which provide the benefit of vasodilation. PDE5 inhibitors increase the amount of nitric oxide in the body, which works along with other substances to relax and open (dilate) the blood vessels, allowing blood to flow freely into the penis to create an erection firm enough for sex.
Phosphodiesterase type 5 inhibitors are generally well tolerated but may cause side effects including headache, nasal congestion or runny nose, back pain or muscle aches, flushing, indigestion and dizziness. Though these side effects are typically mild, taking PDE5 inhibitors with certain other medications may produce more serious and dangerous side effects. For example, nitrates prescribed for chest pain and blood pressure medications may interact poorly with ED drugs. ED drugs are also not recommended for patients with heart disease or heart failure, severe liver disease or kidney disease that requires dialysis.
Could your erectile problems be solved with an alternative form of treatment?
Even if your doctor determines that your erectile dysfunction is related to medical causes and that prescription drugs are safe for you, you should still consider all of your options—this includes alternative forms of treatment. The most effective alternative treatment for erectile dysfunction consists of diet and lifestyle changes that remedy underlying factors contributing to ED such as obesity, diabetes and high blood pressure. Improving your diet, losing weight, quitting smoking and limiting your alcohol intake are all excellent ways to improve your health and your ED.
In addition to diet and lifestyle changes, certain supplements and other natural remedies have shown potential in treating ED. Panax ginseng, for example, has been shown to improve ED symptoms in men with high cholesterol and metabolic syndrome. DHEA, a hormone produced by the adrenal glands, is also available in supplement form and may provide benefits for men with low testosterone levels, as well as men with diabetes. Another option is L-arginine, an amino acid that helps the body produce nitric oxide. One study showed a significant improvement in sexual function among 31% of men taking 5 grams of the supplement daily.
Considering Erectile Dysfunction Drugs? What Are the Options?
If you’ve asked yourself the questions above and your doctor agrees that erectile dysfunction drugs are the best course of treatment, your next step is to consider the options. While you’re probably familiar with some of the most common ED drugs like Viagra and Cialis, there are more choices out there. Not only should you consider prescription drugs, but there are also several erectile dysfunction drugs over the counter, as well as non-oral medications. Here is an overview of the different types of ED drugs available:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Avanafil (Stendra)
- Alprostadil suppository
- Alprostadil injection
Sildenafil (brand name Viagra) was the first erectile dysfunction drug to hit the market in the United States. The drug was originally developed to treat high blood pressure and angina associated with coronary artery disease. When its benefits for erectile dysfunction were discovered, the drug was rebranded and approved by the FDA in 1998. In August of 2003, the FDA approved vardenafil hydrochloride, sold under the brand name Levitra. Tadalafil or Cialis was approved and released later that same year. In 2012, The FDA approved avanafil, or Stendra.
Viagra, Cialis, Levitra and Stendra are all prescription oral medications for the treatment of erectile dysfunction. These four drugs work by improving blood supply to the penis and, when combined with sexual stimulation, these drugs help produce an erection firm enough for sex. Though the results vary from one man to another, ED drugs produce an erection firm enough for sex in about 70% of the men who take them. They are available in different dosages—usually 2.5 mg or 5 mg—and they typically begin working within 15 to 60 minutes of ingestion.
If you don’t like the idea of taking an oral medication for your erectile dysfunction, there are other options. Alprostadil (Muse), for example, is available in the form of a suppository which is inserted directly into the urethra. This treatment typically begins to work within 5 to 10 minutes and lasts for 30 to 60 minutes. This makes it a much more direct, and often quicker, daily treatment for ED than oral medications. Though Alprostadil is generally well tolerated, minor side effects such as penile pain or burning with urination have been reported.
In addition to a suppository, Alprostadil is also available in the form of an injectable and sold under the brand name Caverject Impulse. This medication comes in the shape of a disposable, single-use pre-filled injector that can be self-administered with proper training from a healthcare provider. Caverject Impulse typically begins working 5 to 20 minutes after injection and your erection can be expected to last for up to an hour. You should wait at least 24 hours between doses and use no more than three injections per week. The most common side effects of this medication include penile pain, bruising at the injection site, rash, swelling, changes in sensation and an erection lasting more than 4 hours.
Single-drug injection therapy for erectile dysfunction typically uses alprostadil, but there are also bi-mix and tri-mix injections available as well. These are combination therapies which use either two or three drug mixtures, typically alprostadil combined with either papaverine or phentolamine. Both papaverine and phentolamine belong to a class of medications known as vasodilators that work by relaxing the smooth muscle tissue in the penis, allowing the arteries to open which increases blood flow to the area. Success rates for injectable ED drugs like these are roughly 85%.
If you suffer from occasional erectile dysfunction, taking a prescription medication may help you achieve and maintain an erection firm enough for sex. When erectile issues become chronic, however, it is worth examining those problems in greater depth to determine and treat the underlying cause. Regardless your current health situation, it is always a good idea to consider all your options before choosing drugs, prescription or otherwise.
Important Safety Information
IMPORTANT SAFETY INFORMATION
Do not take Sildenafil (sildenafil citrate) if you:
- take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
are allergic to sildenafil, as contained in Sildenafil and REVATIO, or any of the ingredients in Sildenafil
Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate medical help
Sildenafil can cause serious side effects. Rarely reported side effects include:
- an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get medical help right away. If it is not treated right away, priapism can permanently damage your penis
- sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking Sildenafil and call your healthcare provider right away if you have any sudden vision loss
sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking Sildenafil and contact a doctor right away
Before you take Sildenafil, tell your healthcare provider if you:
- have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
- have had heart surgery within the last 6 months
- have pulmonary hypertension
- have had a stroke
- have low blood pressure, or high blood pressure that is not controlled
- have a deformed penis shape
- have had an erection that lasted for more than 4 hours
- have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
- have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- have ever had severe vision loss, including an eye problem called NAION
- have bleeding problems
- have or have had stomach ulcers
- have liver problems
have kidney problems or are having kidney dialysis have any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Sildenafil may affect the way other medicines work, and other medicines may affect the way Sildenafil works, causing side effects. Especially tell your healthcare provider if you take any of the following:
- medicines called nitrates
- medicines called guanylate cyclase stimulators such as Adempas (riociguat)
- medicines called alpha-blockers such as Hytrin (terazosin HCl), Flomax (tamsulosin HCl), Cardura (doxazosin mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl), Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of Sildenafil with alpha-blockers can lead to a drop in blood pressure or to fainting
- medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase), or atazanavir sulfate (Reyataz)
- some types of oral antifungal medicines, such as ketoconazole (Nizoral) and itraconazole (Sporanox)
- some types of antibiotics, such as clarithromycin (Biaxin), telithromycin (Ketek), or erythromycin
- other medicines that treat high blood pressure
- other medicines or treatments for ED
Sildenafil contains sildenafil, which is the same medicine found in another drug called REVATIO. REVATIO is used to treat a rare disease called pulmonary arterial hypertension (PAH). Sildenafil should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca tadalafil)
Sildenafil does not protect against sexually transmitted diseases, including HIV.
The most common side effects of Sildenafil: headache; flushing; upset stomach; abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision; stuffy or runny nose; back pain; muscle pain; nausea; dizziness; rash.
Sildenafil (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).
Sildenafil is not for women or children.