Erectile Dysfunction (ED)

If you get dizzy from taking any of these medications, you should share this observation with a healthcare provider; it could indicate a potentially unsafe drop in blood pressure.

• ED can be a sign of underlying cardiovascular disease.
• Early intervention can prevent long-term complications.
• Team approach involving urologists, psychologists, and cardiologists is beneficial.
• Patient education improves management and outcomes.

One rare but noteworthy side effect of some PDE5 inhibitors is a change in visual color processing.

Which erectile dysfunction treatments are most effective?

Men taking nitrates and alpha-blockers to treat hypertension may need to find other ways to treat their ED. Other health conditions could make PDE5 medications unsafe for men as well. These potential complications are why you need a prescription for ED medication. Your consulting physician will determine what will be safe and effective based on your medical history and any current medications that you use. Thankfully, PDE5 medications for ED are prescribed very widely, and the healthcare community considers them safe for most men, with the likeliest side effects being mild.

Injecting the medication

When side effects happen, they tend to be mild and commonly include some of the following: A sensation of flushing in the face Though they rely on the same primary vardenafil 5 mg mechanism to treat ED, research confirms that these different PDE5 inhibitors tend to produce side effects to varying degrees. For instance, a slightly higher percentage of people who take sildenafil (and Viagra) report flushing and headaches,11 while a slightly higher percentage of tadalafil (and Cialis) users report muscle pain.12 “It is quite common for patients to report muscle pain during the use of PDE5 inhibitors,” Dr. Urdaneta notes. “However, the daily dose of 5mg [tadalafil] is well tolerated.” Any of the PDE5 inhibitors can also cause your blood pressure to drop (though Stendra is less likely to cause this to happen). You might think that’s a good thing, but blood pressure that gets too low is also dangerous. This occurs when a PDE5 inhibitor collaterally inhibits PDE6.

If you’re one of the relatively few men to experience this phenomenon, you should ask your doctor about vardenafil, which does not seem to cause this side effect.

In response to reader requests, we created a comprehensive guide to the side effects of BlueChew, which is a useful resource if you're interested in learning much more about the likelihood of experiencing side effects while taking PDE5 inhibitors.

Penile Injections

Patients who have suffered a major cardiovascular event in the past two weeks cannot receive PDE5 inhibitors. Studies comparing oral medications for ED come to the conclusion that there are few meaningful differences in their respective safety profiles. Some men develop visual color processing issues when they take PDE5 inhibitors that also act to inhibit PDE6 — a common but usually benign collateral effect. Muscle pain can also result from collateral inhibition of other phosphodiesterase enzymes. For these men, avanafil would be preferable to sildenafil, as it more selectively targets PDE5 without affecting PDE6 and other PDE enzymes.

Shockwave treatment for ED

Vardenafil is also a superior choice to sildenafil in this regard, but between common doses for avanafil and vardenafil, avanafil has lower incidences of side effects in scientific research.25 (The major downside is that avanafil is only available as brand-name Stendra, which is much more expensive than generic ED medications.) Tadalafil is less associated with visual disturbances than sildenafil, though muscle pain is somewhat common. Common but typically mild side effects associated with popular ED medications include: Access to these ED medications requires a prescription, which means you’ll have the opportunity to talk with a physician along the way. Take the time to ask your doctor about any of these issues during your consultation. You deserve a high degree of discretion when acquiring medication for ED, especially considering the stigmas around the condition and the shame you may feel about the issue. All of the companies we’ve included here provide significant protections and stringent practices for the safeguarding of medical data.

Penis pumps, surgery and implants

They abide by HIPAA regulations, or else they would lose their right to offer prescription medications. So, when it comes to comparing these companies to one another on the basis of privacy, the only two parameters left are their online tracking practices and medication delivery systems. All of these companies use cookies and web beacons to track your browsing habits on their site. The data shouldn’t link to you directly, but it will connect with your IP address and possibly information about your device. We want to see these companies make it as easy as possible to opt out of their tracking systems. When we break down your top choices for ED medication, we find it useful to refer only to the names of the active ingredients (i.e., sildenafil, tadalafil, etc.) as opposed to their brand names.

• Oral PDE5 inhibitors are taken 30-60 minutes before activity.
• Injections should be used with proper medical guidance.
• Vacuum devices require consistent use for effectiveness.
• Surgical options are generally considered after less invasive treatments.

Unless you’re going through your insurance company, there’s almost never a good reason to buy branded ED medication — generic options are therapeutically identical. We always recommend that people start with generics for ED, so let’s look at which medications are available in generic form: During the course of your research or in conversation with your consulting physician, you might come across the term “authorized generic,” which is distinct from simply “generic.” Here’s how they differ: Generics — with no additional word to modify the meaning — are produced by companies other than the original manufacturer.

Alternative medicine

There are options for restricting the sale of your information on each of the top sites we cover here, but BlueChew has the easiest interface. You don’t have to send an email or make a phone call. When you’re logged into your account, you can click “Your Privacy Choices” at the bottom of almost any page and quickly submit an automated request to opt out. For the actual delivery, none of these companies ship their products in boxes that show what’s inside. Some Hims and Roman deliveries will have Hims or Roman in the return address, but those companies’ product lineups are large enough that no one could deduce the box’s contents.

Common Treatment Options for ED

BlueChew gets the edge here because of the way its meds are packaged. Since they’re individually wrapped tablets, their packaging is rather flat; it doesn’t look like it would contain medicine, and there’s no audible rattling of pills in a bottle or tin. Another way to think of medication format is, essentially, “convenience.” When Viagra hit the market in 1998, it quickly became known as the “little blue pill,” a coy way for men to gain some distance from any potential stigma associated with ED at the time. It wasn’t hard in those days to imagine the “little” or the fildena super active 100 “blue” aspects of Viagra evolving as generic sildenafil and competitive medications came out. But recently, it seems the industry is paying closer attention to the “pill” aspect of ED treatment.

In-office Therapies for Men with Erectile Dysfunction – Summary

Sildenafil, tadalafil, Stendra, and vardenafil are typically delivered in pill form, but pills aren’t always the most convenient format. Many people have trouble swallowing pills, and — particularly in the case of pills you take just before intercourse — finding a drink to wash those pills down can be an annoyance. BlueChew and Rugiet developed workarounds to this issue by providing chewable tablets and dissolving lozenges. Hims and Roman later came out with chewables of their own. There is some evidence that chewable and dissolvable delivery methods can accelerate the time to action since the medication can be absorbed through oral membranes and into the bloodstream without having to pass through the digestive tract. They bear only the name of the active ingredient (i.e., sildenafil), and telemedicine companies typically advertise them as such.

When oral medications might not be safe

However, it may only be the difference of a few minutes. These methods are ultimately more about maximizing convenience than anything else. Hims currently has the best prices for chewable daily tadalafil, but it’s only available at 8.5mg, which may be higher than needed for some men. However, if that dose is high enough that it works for you on an as-needed basis, you could save a lot of money by getting the daily prescription, stocking up, using it only as needed, and canceling your subscription until you run low. You can do this penalty-free, provided your doctor prescribes daily chewable tadalafil.

Inflatable penile prosthesis

Hims also has a chewable as-needed tadalafil at 11.2mg, but it’s not the best deal for as-needed chewable tadalafil around. That honor goes to BlueChew’s as-needed chewable tadalafil (which starts at 6mg), and the company’s free trial makes them a more convenient place for men to start. If you’re comfortable titrating up to 8.5mg, you can save money by migrating to Hims, and you can always switch back to BlueChew if Hims’ 8.5mg dose causes side effects. Nitric oxide (NO) mediates vasodilation (widening of blood vessels) in the penis, increasing blood flow. PDE5 inhibitors promote the release of NO, improving blood flow, helping the muscles in the penis to relax, and causing the penis to enlarge and grow rigid, forming an erection.10 Meanwhile, PDE5 (phosphodiesterase-5) is a chemical that the body releases to signal that it’s time for the erection to end.

Men’s health resources

PDE5 inhibitors slow the activity of PDE5, allowing the NO activity to continue, bringing forth a sustained erection. Taking one of these medications should not result in an instant erection — stimulation is still required. But when stimulation occurs, the medicine helps boost NO and its effects. Every ED drug has contraindications (i.e., reasons why a person should not use it). Men with certain liver, kidney, or cardiovascular conditions may not be able to take ED medications safely. Effects on the body are identical to the original; the only differences may be in the appearance of the pills and the inactive ingredients used.

• Oral PDE5 inhibitors like sildenafil and tadalafil.
• Injectable medications such as alprostadil for direct penile injection.
• Vacuum erection devices that increase blood flow mechanically.
• Penile implants for a permanent surgical solution.

Authorized generics are either made by the original manufacturer or by a company they’ve permitted to do the manufacturing.

These pills are completely identical to the original branded option, right down to the inactive ingredients and appearance, but they usually don’t include the original brand name on the label.

• Testosterone therapy if low hormone levels cause ED.
• Psychological counseling for psychological causes.
• Lifestyle changes: exercise, healthy diet, weight loss.
• Managing underlying conditions like diabetes and hypertension.