What is the Safest Drug for Erectile Dysfunction?

April 06, 2021

4 mins

Oral medications are seen as one of the most effective options for treating erectile dysfunction (ED). The most common medications are sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®).

Prescription medications inhibit the natural enzyme PDE5 (phosphodiesterase-5) to enhance the effects of nitric oxide. Nitric oxide is a natural chemical the body produces that relaxes the muscles in the penis. This relaxation increases blood flow and improves the ability to reach and maintain an erection.

Whether or not a drug is the best option for you will depend on any preexisting conditions you may have, your medical history, and certain lifestyle factors.

The most common drug for men in the U.S. to be prescribed is Viagra® (sildenafil). This medication has been on the market for over 20 years. However, every medication affects men differently. Read on to learn more about the potential side effects and which ED medication is the safest for you.

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What is Erectile Dysfunction? 

Erectile dysfunction is having trouble getting or maintaining an erection. While it's normal for men to occasionally have problems getting erect, erectile dysfunction happens more consistently.

Men who experience erectile dysfunction may have an underlying health condition or have elevated stress levels. About 20% of men with ED discover they have an undiagnosed health condition such as heart disease, high blood pressure, diabetes, or other common health conditions.

Potential Causes of Erectile Dysfunction

The risk of erectile dysfunction increases as men age. Men over the age of 40 are more likely to experience ED. Erectile dysfunction can also be the result of the following:

• Being extremely overweight

• Smoking tobacco

• Drinking too much alcohol

• Taking certain types of medications

• Having high levels of stress

• Developing hormonal imbalances

While erectile dysfunction can be frustrating, it can also be resolved through a variety of approaches, including lifestyle modifications and prescription medications.

A healthcare provider can conduct tests to help determine the cause of your erectile dysfunction. Most medications that treat erectile dysfunction are safe, easily available, and effective in the majority of instances.

How Do Erectile Dysfunction Medications Work? 

Sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra) are a few of the most popular drugs used to treat ED. These medications work to slow the end of an erection but do not help to create them. Stimulation and arousal will still be required. 

For an erection to happen, a compound called nitric oxide sends a message to tissue in the penis. It's involved in letting the penis know when to contract and tense up. The erection ends when another messenger called phosphodiesterase 5, or PDE5, is released. A PDE5 inhibitor helps erections last longer.

What are the Differences Between Erectile Dysfunction Medications? 

All of the most popular FDA-approved erectile dysfunction medications have demonstrated varying levels of safety and effectiveness. While they all work by the same mechanism of action, there are some differences between them.

For example, sildenafil (Viagra®) works quickly while tadalafil (Cialis®) may take longer to work and is used in smaller doses. Both of these medications have cost-efficient generic versions. Some people may prefer to alternate between medications, depending on their lifestyle or suggestions from a healthcare provider.

Sildenafil (Viagra®)

• How do you take it? It's typically taken as a single pill one to four hours before sexual intimacy. For best results, wait about one or two hours after eating before taking it. If this can’t be avoided, then stick to a lighter meal. Fatty meals and alcohol can prevent sildenafil from working effectively. Sildenafil should not be taken with a heavy meal.

• How quickly does it work? The effects can start in as little as 15 minutes, but most men will have to wait about an hour before the maximum effect kicks in. Sildenafil will normally continue working for somewhere between three and five hours.

• What's the dose? Sildenafil is available in 20, 25, 50, and 100 mg (milligram) doses. For most guys, the typical sildenafil starting dosage is 50 milligrams. If you're experiencing side effects, you may choose to reduce the dose to 25 milligrams. If this starting dose isn't working, your healthcare provider may increase the dose up to 100 milligrams.

Tadalafil (Cialis®) 

• How do you take it? The two higher doses are taken in the hours before sexual intimacy, though it's known for its ability to work for an entire 36 hours. Tadalafil is unaffected by food, and it can be taken before or after eating with no consequences. It can be taken when needed, or regularly depending on desired results. 

• How quickly does it work? The effects of tadalafil can be felt as soon as 15 minutes, but generally, you will have to wait about two hours for it to reach maximum effectiveness. Tadalafil will stay in your body for a few days, so erections can be achieved at any point in this time period for most men.

• What’s the dose? Tadalafil comes in a variety of doses for both daily and on-demand use, at 2.5, 5, 10, and 20 mg doses. The typical starting dose for tadalafil is 10 milligrams for on-demand use. It can be lowered to 5 milligrams or upped to 20 milligrams depending on your response. For daily use, the dosage typically begins at 2.5 or 5 milligrams.

Vardenafil (Levitra®) 

• How do you take it? Similar to sildenafil, vardenafil should not be taken with food. For best results, wait about an hour after eating before taking vardenafil. A light and low-fat meal probably won't impact its effectiveness significantly.

• How quickly does it work? This drug may start working as soon as 15 minutes after taking it and will reach its maximum effectiveness around 45 minutes. After this, it will continue working for about four to five hours. 

• What’s the dose? Vardenafil comes in 5, 10, and 20 mg doses for use on-demand in the hours before engaging in physical intimacy. The typical starting dose for vardenafil is 10 milligrams. Depending on the results, a healthcare provider can suggest your dosage can be reduced to 5 milligrams or increased to a maximum of 20 milligrams.

What Are the Side Effects and Effectiveness? 

There have been few studies that directly compare sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®). All three medications resulted in successful penetrative sex for 65% to 80% of men, compared to 30% of men who received a placebo. 

The most common side effects of these ED medications include:

• Headache or migraine

• Nasal congestion or runny nose

• Indigestion or nausea

• Vision changes, such as light sensitivity, or blurred vision

• Muscles aches

• Back pain

Side effects may vary depending on which medication you choose. For example, sildenafil has a higher risk of vision changes than tadalafil. According to a study, 3% of people who take sildenafil may experience vision issues that last a few hours. Tadalafil has a slightly higher risk of muscle-related pain than sildenafil or vardenafil. 

For the most part, users are not particularly bothered by the side effects of these medications, and most of them do not last for long. The only serious side effect of taking PDE5 inhibitors is that they may lower your blood pressure. This will most likely not affect the average user unless they're taking blood pressure medications or dealing with underlying health conditions.

A sudden drop in blood pressure can cause dizziness, falling, blacking out, or even a heart attack. If you take any kind of nitrate medication like nitroglycerin then you should not be using any kind of erectile dysfunction medication. Be sure to speak with a healthcare provider before starting a medication.

How Much Do Erectile Dysfunction Medications Cost? 

The cost for erectile dysfunction drug therapy will vary considerably based on a few factors such as pharmacy price, prescription co-pays, and your health plan coverage. Even if private insurance covers ED medications, you may be limited to a few doses per month. 

Here are a few things you can do to help with costs:

• Shop around because pharmacy prices can vary dramatically. There are plenty of online tools that can help you to compare ED prices easily. Rex MD offers affordable options for treating erectile dysfunction.

• Ask your doctor about pill splitting. This involves purchasing pills in a higher dosage than you might need before dividing them into smaller doses.

How Rex MD Can Help

Telemedicine offers an additional option if you are not able to go into a doctor's office for a visit. Rex MD sells generic ED medications directly at affordable prices. A Rex MD membership includes a free physician consultation for evaluation and a prescription, if appropriate.

The most effective and common drugs for erectile dysfunction are sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®). They are all effective and only have a few key differences that may work better for some men than others.

Rex MD can help you find the perfect erectile dysfunction medication tailored to your needs. Just answer a few questions to help you and your doctor determine the best option for you.

Get started today on finding the right treatment that works for you.