What Is the Best Erectile Dysfunction Medication?

There are many medications and medical treatments aimed at helping a man with erectile dysfunction (ED) achieve and maintain an erection for sexual intercourse. These include Phosphodiesterase-5 inhibitors like Viagra (sildenafil), testosterone replacement therapy, penile self-injection, vacuum-assisted erection devices, penile prostheses, revascularization surgery, lifestyle modifications, and others.

Erectile dysfunction (ED, or impotence) is a condition in which men experience an inability to get or maintain an erection.

The goal of treatment for erectile dysfunction is to enable a man to achieve and maintain an erection for sexual intercourse. 

Medications used to treat erectile dysfunction may include:

• Phosphodiesterase-5 inhibitors 
  • Sildenafil (Viagra)
  • Vardenafil (Levitra, Staxyn ODT)
  • Tadalafil (Cialis)
  • Avanafil (Stendra) 
  • All four PDE5 inhibitors provide similar results
  • Because the drugs are similar, the American College of Physicians recommends the choice of PDE5 inhibitor be based on the patient's preferences, including cost, ease of use, desired duration of action, and adverse effects 
    • Safety record
      • While all the PDE5 inhibitors used to treat ED are considered to have an acceptable safety profile by the Food and Drug Administration (FDA), sildenafil (Viagra) has the longest safety record of all the PDE5 inhibitors 
    • Time it takes the drug to take effect
      • Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are taken 60 minutes before sexual activity, though they may start working before 60 minutes
      • Avanafil (Stendra) and the orally disintegrating tablet (ODT) vardenafil (Staxyn ODT) are more rapid acting and can be taken 30 minutes before sexual activity
    • Duration of action
      • Sildenafil (Viagra), vardenafil (Levitra, Staxyn ODT), and avanafil (Stendra) last up to four to five hours (men with mild to moderate ED may have some effect that persists for 8 to 12 hours)
      • Tadalafil (Cialis) is effective for up to 36 hours after it is taken
    • How the drug is taken
      • Sildenafil (Viagra) and vardenafil (Levitra) are taken on an empty stomach because high-fat meals and alcohol delay absorption
      • Food does not interfere with the absorption Tadalafil (Cialis), Avanafil (Stendra), or ODT vardenafil (Staxyn ODT)
• Testosterone replacement therapy 
  • Used when man's testes do not make enough of the hormone testosterone
  • May be used in combination with a PDE5 inhibitor
  • Does not work to improve sexual function in men who produce normal amounts of testosterone
• Medications for depression and/or anxiety

Lifestyle modifications to treat erectile dysfunction may include:

• Weight loss in men who are obese
• Exercise regularly
• Eat a healthy, balanced diet 
• Don’t smoke
• Limit or avoid alcohol
• Pelvic floor exercises
• Talk to your doctor about using different medications to treat hypertension and pain. Do not stop taking any prescribed medication without first talking to your doctor. 

Medical treatments used to treat erectile dysfunction may include:

• Penile self-injection in which a man injects a medication (alprostadil or papaverine) into the two chambers of the penis that are filled with spongy tissue and blood (corpora cavernosa) to cause an erection by allowing the blood vessels within the penis to expand so the penis swells and stiffens to create a fully rigid erection 
• Intraurethral alprostadil (MUSE) uses the same medication (alprostadil) as penile self-injection but instead, a man inserts a device with an alprostadil pellet (suppository) into the urethra to create an erection
• Vacuum-assisted erection devices involve placing the penis in a plastic cylinder and creating a vacuum around the penis to increase blood flow into the penis. A rigid ring is placed at the base of the penis to hold the blood inside the penis, keeping it erect. 
• Penile prostheses are surgically implanted devices that inflate to allow the penis to become erect
• Revascularization is a surgical procedure used for young men who have experienced pelvic trauma

Because depression and anxiety can cause erectile dysfunction, psychotherapy and psychoactive medications may be recommended. Counseling with a sex therapist may be helpful for men with performance anxiety.