Erectile dysfunction (ED)


What is ED?

Erectile dysfunction (ED) is the inability to get or keep an erection that’s firm enough for sexual intercourse. For many men, erectile dysfunction is difficult and stressful to deal with both physically and emotionally. ED medications have been the saving grace for millions of men worldwide, but it can be overwhelming to find the safest erectile dysfunction pill. The most popular ED medications are Viagra, Cialis, Levitra, and Stendra. Let’s take a look at these popular brand names to answer: What is the safest drug for erectile dysfunction?

It occurs when a man can't get or keep an erection firm enough for sexual intercourse. Erectile dysfunction can be a sign of a physical or psychological condition. It can cause stress, relationship strain, and low self-confidence. The main symptom is a man's inability to get or keep an erection firm enough for sexual intercourse. Patients suffering from erectile dysfunction should first be evaluated for any underlying physical and psychological conditions. If treatment of the underlying conditions doesn't help, medications and assistive devices, such as pumps, can be prescribed.


  • Avanafil
    It can treat erectile dysfunction.
  • Vardenafil
    It can treat erectile dysfunction.
  • Sildenafil
    It can treat erectile dysfunction. It can also treat high blood pressure in the lungs (pulmonary arterial hypertension).
  • Tadalafil
    It can treat erectile dysfunction and enlarged prostate (benign prostatic hyperplasia). It can also treat high blood pressure in the lungs (pulmonary arterial hypertension).


Affects body processes by regulating the activity of the organs.


  • Testosterone
    It can treat conditions caused by low testosterone.

Consult a doctor for medical advice
Sources: Mayo Clinic and others. Learn more

How does ED medication work?

Erectile dysfunction affects as many as 30 million men in the United States, and it’s usually caused by a combination of psychological and physical issues that affect the brain, hormones, muscles, blood vessels, and nerves. Erectile dysfunction medications help improve erectile function by enhancing the effects of nitric oxide, a chemical in the body that relaxes penile muscles. This in turn increases blood flow to the penis, which allows men to get and maintain an erection that’s firm enough for sex. If used correctly by healthy individuals, ED medications are safe to use and can help men feel happier with their sex lives.

Man stressed out about erectile dysfunction

Prescribed medicines you take by mouth

A health care professional may prescribe you an oral medicine, or medicine you take by mouth, such as one of the following, to help you get and maintain an erection:

All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation. You should not take any of these medicines to treat ED if you are taking nitrates to treat a heart condition. Nitrates widen and relax your blood vessels. The combination can lead to a sudden drop in blood pressure, which may cause you to become faint or dizzy, or fall, leading to possible injuries.

Also talk to your health care professional if you are taking alpha-blockers to treat prostate enlargement. The combination of alpha-blockers and ED medicines also could cause a sudden drop in blood pressure.

A health care professional may prescribe testosterone if you have low levels of this hormone in your blood. Although taking testosterone may help your ED, it is often unhelpful if your ED is caused by circulatory or nerve problems. Taking testosterone also may lead to side effects, including a high red blood cell count and problems urinating.

Testosterone treatment also has not been proven to help ED associated with age-related or late-onset hypogonadism. Do not take testosterone therapy that hasn’t been prescribed by your doctor. Testosterone therapy can affect how your other medicines work and can cause serious side effects.


The main differences between the most popular ED medications—Viagra, Cialis, Levitra, and Stendra—are how much each drug costs, how they’re taken, how long they last, and their side effects. For example, Viagra typically only stays in the body for about four to five hours before it wears off completely. Cialis, on the other hand, stays in the body for up to 36 hours and can help men get erections anytime during that time frame.

When comparing how fast the different medications start working, both Viagra and Cialis take about 30 minutes to start working, whereas Levitra and Stendra may start working as soon as 15 minutes after ingestion. It’s important to note that when treating erectile dysfunction with ED pills, sexual stimulation is needed to help the pills do their job. It’s not enough to simply take a pill.

Some of the ED treatment medications can be taken daily instead of on an as-needed basis. Cialis is popular for this reason—it allows men to have sex anytime because it continuously circulates in the bloodstream. On the opposite end of the spectrum, Viagra must be taken one to four hours before sexual activity and is taken at a much higher dose.


The cost of each medication is also something to consider; erectile dysfunction medications aren’t known for being cheap. Brand name Viagra is quite expensive at about $70 per pill, while the generic form is only around $40 per pill. Cialis costs about $12 per pill or $360 for a month’s supply, and Levitra has an average cost of $111 per pill. Even though ED pills are expensive, many companies like AffordableMeds offer coupons for ED medications online.

All this to say that even though ED medications work to help men get and maintain an erection, they differ mostly in how they work and how much they cost. If you’re interested in learning more about the specifics of how ED medications work or want to find the most cost-effective way to include ED pills in your life, it’s best to talk with a medical professional.

Which ED medication has the least side effects?

Even though ED medications are effective and help millions of men worldwide, they still have the potential to cause side effects. Some of the ED medications will cause different side effects than others. The following table lists the most common side effects of each of the most popular ED medications:

Side effects of ED pills
Viagra (sildenafil citrate)Cialis (tadalafil)Levitra (vardenafil)Stendra (avanafil)
  • Nausea
  • Headache
  • Flushing
  • Stuffy nose
  • Runny nose
  • Blurred vision
  • Muscle pain
  • Indigestion
  • Back pain
  • Dizziness
  • Rash
  • Headache
  • Indigestion
  • Flushing
  • Back pain
  • Dizziness
  • Nasal congestion
  • Muscle aches
  • Headache
  • Flushing
  • Stuffy nose
  • Runny nose
  • Dizziness
  • Vision changes
  • Headache
  • Dizziness
  • Flushing
  • Upset stomach
  • Back pain
  • Constipation

Levitra has the least potential for causing side effects because a lower dose is needed to cause an erection, according to the Boston University School of Sexual Medicine. This doesn’t necessarily mean that it won’t cause side effects though. Each person’s body will react to medication in a different way. It’s possible for one person to have no side effects at all, and for another person to experience multiple side effects. It’s also possible for one person to get side effects from one type of ED medication but not from another.

Permanent ED

One of the biggest concerns about ED drugs is whether or not they can cause permanent erectile dysfunction. It’s very rare that this happens, although it is possible for some men to develop a dependency on ED medications that will make getting an erection without them more difficult. In some cases, ED medications can cause prolonged erections that last longer than four hours, which can be painful and cause long-term damage if left untreated. If you’re taking an ED pill like Viagra and have an erection that lasts longer than four hours (a condition known as priapism), it’s best to seek medical help as soon as possible due to the risk of permanent penile damage.

Vision changes

One of the more serious potential side effects of ED pills like Viagra and Levitra are vision changes. According to Viagra’s official website, taking the medication can sometimes cause sudden vision loss in one or both eyes. This may be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). People who are taking ED medications and notice vision changes should seek medical advice as soon as possible to avoid potential eye damage or loss of vision.

Heart attack and stroke

The rarest and most serious side effects of ED medications like Viagra are heart attacks and strokes. People with underlying heart problems like heart disease are the most at risk for having a heart attack or stroke from taking these medications, which is why they aren’t recommended for these groups of people.

What is the safest ED medication?

The safest ED pill is the one prescribed by your doctor. Doctors take many factors into consideration before prescribing medications and may recommend one ED pill over another for you based on your age, weight, or medical history.

Some ED pills are more popular than others, but this doesn’t necessarily mean that one works better or is safer than the others. For example, Viagra isn’t considered safer than Cialis or vice versa, but each pill may cause different types of side effects.

Viagra is probably the most popular ED pill, and Cialis and Levitra are close seconds. When considering ED pills, it’s always a good idea to be aware of any warnings or restrictions that a medication might have. All erectile dysfunction pills, for example, shouldn’t be taken with nitrates, such as prescription nitroglycerin or street drugs known as poppers (amyl nitrate, amyl nitrite or butyl nitrate), because this combination can cause serious drops in blood pressure.

How to take ED pills safely

An important part of taking ED pills is knowing how to take them safely. When taken properly, ED medication can be very effective, and doctors and researchers know how much medication is needed to be effective. The following table lists the standard doses of the most popular ED medications, as well as how to take them safely and how long they take to work.

Standard dosages of ED pills
Viagra (sildenafil) Cialis (tadalafil) Levitra (vardenafil) Stendra (avanafil)
Dose 50 mg 10 mg 10 mg 100 mg
How long does it take to work? 30 minutes-several hours 30 minutes-several hours 30 minutes-several hours 15-30 minutes
Instructions for taking Taken on an empty stomach 1-4 hours before sexual activity Taken at least 30 minutes before sexual activity Taken 1 hour before sexual activity Taken as early as 15 minutes before sexual activity

If an ED pill isn’t working for you, it’s important to realize that taking more than one dose or taking it more often than needed won’t increase the effectiveness of the drug. This can actually lead to side effects or cause allergic reactions that could be life-threatening.

Who should not take ED medication?

Erectile dysfunction medications aren’t right for everyone, says Lev Elterman, MD, head of urology at Weiss Memorial Hospital in Chicago and owner of Elterman Center for Women’s and Men’s Health. According to Dr. Elterman, the following groups of people should not take ED medications:

  • People who take nitroglycerin or any form of medication that contains nitroglycerin such as Imdur or Nitropaste.
  • People who cannot do physical activity without shortness of breath such as walking up two flights of stairs or a similar level of physical activity.
  • Patients with cardiovascular history whose cardiovascular performance status is unknown and should be evaluated (it should be evaluated with a stress test).
  • Those who are allergic or intolerant of oral ED medications.

In addition, people with low blood pressure, high blood pressure, coronary artery disease, arrhythmias, or those who have had heart attacks or strokes should talk to their doctor about whether or not erectile dysfunction pills are right for them.

Drug interactions

When considering taking erectile dysfunction pills like Viagra, it’s also important to note that they shouldn’t be taken at the same time as certain medications because of the potential for drug interactions. Here’s a list of medications that shouldn’t be taken with Viagra:

  • Alpha-blockers
  • Pulmonary arterial hypertension drugs
  • Recreational drugs (poppers) that contain nitrites
  • Ritonavir
  • Amlodipine
  • Amyl nitrate
  • Saquinavir
  • Doxazosin
  • Riociguat
  • Ketoconazole
  • Itraconazole
  • Isosorbide
  • Erythromycin
  • Levitra (vardenafil)
  • Cialis (tadalafil)
  • Nitroglycerin (common prescription drug for people with angina, heart failure, or high blood pressure)

If you’re not sure whether or not you should be taking erectile dysfunction drugs, it’s always best to stay on the safe side and talk with a healthcare professional. Your doctor can recommend the right medication for you based on your individual symptoms and medical history.

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