Comparing ED Medications: Questions for Your Prescriber

Understanding Erectile Dysfunction Medications

Erectile dysfunction (ED) affects approximately 30 million men in the United States alone. Several FDA-approved medications exist. This guide explains how the common ED medications differ, so you can ask your prescriber informed questions.

Comparing Common ED Medications

KeyPoints

PDE5 inhibitors are the most common first-line treatments for ED
Medications differ in onset time, duration, and food interactions
Side effect profiles vary between medications
Individual response varies. Your prescriber decides which medication fits you

EndKeyPoints

PDE5 Inhibitors: The First-Line Treatment

The most commonly prescribed medications for ED are phosphodiesterase type 5 (PDE5) inhibitors. These medications work by enhancing the effects of nitric oxide, which relaxes muscles in the penis and increases blood flow. The main differences between them lie in their onset of action, duration, and potential side effects:

Medication	Onset Time	Duration	Food Effect	Unique Features
Sildenafil (Viagra)	30-60 min	4-6 hours	High-fat meals delay absorption	First PDE5 inhibitor approved for ED (1998)
Tadalafil (Cialis)	30-45 min	Up to 36 hours	Minimal food effect	Available as daily low-dose
Vardenafil (Levitra)	25-60 min	4-6 hours	Moderate food effect	Film-coated and orally disintegrating forms
Avanafil (Stendra)	15-30 min	6 hours	Minimal food effect	Newest of the four

Sildenafil (Viagra)

Onset: 30-60 minutes
Duration: 4-6 hours
Best taken: On an empty stomach
Notable characteristic: Food, especially high-fat meals, can delay absorption and reduce effectiveness

Tadalafil (Cialis)

Onset: 30-45 minutes
Duration: Up to 36 hours (often called "the weekend pill")
Best taken: Can be taken with or without food
Notable characteristic: Also available as a daily low-dose medication that maintains constant levels in the bloodstream

Vardenafil (Levitra)

Onset: 25-60 minutes
Duration: 4-6 hours
Best taken: With or without food, but high-fat meals may reduce effectiveness
Notable characteristic: May be less affected by food or alcohol than sildenafil

Avanafil (Stendra)

Onset: As quickly as 15 minutes
Duration: 6 hours
Best taken: With or without food
Notable characteristic: The newest PDE5 inhibitor

Side Effects

Medication Interactions

Headache, flushing, and nasal congestion are common with all PDE5 inhibitors but vary in intensity

All PDE5 inhibitors interact with nitrates, causing dangerous blood pressure drops

Visual changes more common with sildenafil

Alpha-blockers require careful dosing and timing with PDE5 inhibitors

Back pain and muscle aches more common with tadalafil

Grapefruit juice can increase drug levels and side effects

Hearing changes rarely reported with all options

Certain antibiotics and antifungals can increase drug levels

When a Prescriber Orders a Compounded Form

When a commercial product doesn't fit, a prescriber may order a compounded preparation. Compounded medications are not FDA-approved.

Combinations

A prescriber may order more than one active ingredient in one preparation. For example:

PDE5 inhibitor + L-arginine
PDE5 inhibitor + pentoxifylline
Multi-agent topical or sublingual combinations, when a prescriber orders them

Alternative Delivery Methods

For men who prefer not to swallow a tablet, a prescriber may order another form:

ComparisonStart:Alternative Delivery Methods

Sublingual Troches
Dissolve under the tongue or between the cheek and gum. Your prescriber decides whether this form fits you.

Topical Gels
Applied to the skin as your prescriber directs. Your prescriber decides whether this form fits you.

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Adjusted Dosages

Commercial medications come in set strengths. A prescriber may order a strength that is not made commercially. We prepare the strength on the prescription.

Beyond medication

Your prescriber may also look at underlying factors, such as:

Heart and blood vessel health
Hormonal balance evaluation, particularly testosterone levels
Stress management and mental health support
Lifestyle modifications including exercise, diet, and sleep quality

Questions for Your Prescriber

Which medication fits you depends on your health, your other medications and your preferences. Your prescriber decides. If they prescribe a compounded form, they can send it to us and we will prepare it as written.