Erectile Dysfunction
Updated: Dec 1, 2021
What Is the Best Medicine for Erectile Dysfunction (ED)?
Published: Nov 23, 2021

Erectile dysfunction is treatable and there are numerous treatment options, including pills, injectables, surgical procedures, and alternative treatments. Each man and his needs will determine the best ED medicine. 

The first step in evaluating any medical condition is a thorough history and physical exam. Uncovering the underlying cause of ED sets up the potential for curing it instead of treating the symptoms.

Read More: Is There a Cure for Erectile Dysfunction (ED)?

Some causes of ED are fully reversible, such as medication side-effects, lifestyle habits, and some psychological and emotional factors. Some are treatable, such as cardiovascular disease, high blood pressure, and diseases due to excessively high or low levels of hormones such as testosterone. Testosterone levels decrease with age, making testosterone replacement therapy a preferred treatment in some men in whom testosterone deficiency and low libido contribute to ED symptoms.

Read More: How to Naturally Boost Your Testosterone

It is important for all men dealing with erectile dysfunction to understand the full range of potential treatment options available to them so they can be active participants in selecting the best drug to treat their ED.

Erectile Dysfunction Pills

Erectile dysfunction, like all medical conditions, has a variety of causes, risk factors, treatment options, and complications. The American Urological Association stresses that even though phosphodiesterase 5 (PDE5) inhibitors are the first-line treatment for ED, men should be informed of all treatment options as long as they are not medically contraindicated.

Having an erection depends on having adequate blood flow into the penis. High blood pressure, diabetes, and other diseases affecting the cardiovascular system can damage blood vessels, making it difficult to have and sustain an erection.

Nitric oxide is a small molecule that plays an important role in maintaining blood flow into the penis. Following sexual stimulation, nitric oxide is released from nerve endings near small blood vessels entering the penis. It initiates a chemical cascade that dilates blood vessels and increases blood flow into the penis.

Oral ED medications work in this cascade, keeping nitric oxide levels high and blood flowing into the penis. These medications cannot cause an erection without sexual stimulation. The success rate for oral ED medications ranges from 50% to 85% (Hsieh & Kuo, 2012).

All PDE5 inhibitors work the same way, have similar side effects, and all require a prescription. Incorrect usage of PDE5 inhibitors can increase the risk of priapism, a prolonged erection that may cause damage to the penis if it is not treated.

Avanafil (Stendra)

Avanafil is taken approximately 15 to 30 minutes before sexual activity. Its effects last up to six hours. Avanafil cannot be taken more than once per day.

Avanafil can be taken with or without food. However, using alcohol with Avanafil increases the risk of side effects.

The most common side effects associated with Avanafil are headaches, flushing, nasal congestion, and sore throat.

Sildenafil (Viagra)

Sildenafil should be taken as needed 30 to 60 minutes before sexual activity. Its effect peaks in 60 minutes and lasts for up to four hours. Sildenafil is taken on an as-needed basis, but not more than once every 24 hours. 

Sildenafil can be taken with or without food. However, a high-fat meal may slow its absorption, which means it will take longer for it to work. Grapefruit and grapefruit juice interfere with Sildenafil metabolism and can increase side effects.

Headache, facial flushing, upset stomach, and nasal congestion are the most commonly reported side effects.

Sildenafil is a great choice for men who need an ED treatment that will last a few hours.

Tadalafil (Cialis)

Tadalafil has two dosage options, daily or as needed. For as-needed dosing, men can take tadalafil 30 to 60 minutes before sexual activity. The other option is to take one tablet as directed daily. Tadalafil has a much longer duration of action than Sildenafil. It lasts up to 36 hours.

Tadalafil’s long duration of action means that men who experience side effects have them longer than with short-acting medications. Headaches, upset stomach, nasal congestion, and cough are the most commonly reported side effects.

Tadalafil can be taken with or without food. Grapefruit and grapefruit juice may interfere with tadalafil’s metabolism and increase the risk of side effects.

Tadalafil is a great choice for men who do not want to associate taking a pill with sexual activity. Tadalafil can be purchased online after scheduling a telehealth visit with a healthcare provider at Invigor Medical.

Read More: Sildenafil vs. Tadalafil

Vardenafil (Levitra)

Levitra is taken as needed approximately one hour before sexual activity and lasts four to five hours. The maximum dosage is one tablet daily.

The most common side effects associated with Levitra are headache, flushing, runny nose, and indigestion. Drinking alcohol while taking Levitra can increase the risk of side effects.

Erectile Dysfunction Injections

Oral ED medications work for approximately 70% of men who use them. For those who switch to injectable ED medications, 95% get and sustain an erection suitable for sexual activity.

Injectables are considered a second-line treatment for ED for men who have not had success with oral ED medications, have had side effects when taking these medications, or have a medical problem that contraindicates the use of oral ED medications.

While injectable ED medications are considered second-line therapy. The American Urological Association stresses that men should be presented with all options for treating ED.

Unlike oral ED medications, injectables do not require sexual stimulation to work. Erections typically occur spontaneously within 10 to 15 minutes and last between 30 and 60 minutes.

Injectables should not be used 18 hours before or after taking oral ED medications such as Vardenafil, Avanafil, and Sildenafil, or within 72 hours of taking Tadalafil.

Papaverine

Papaverine is a vasodilator. It widens blood vessels entering the penis and increases blood flow. Papaverine is not used alone for penile injections.

Phentolamine

Phentolamine relaxes the smooth muscle lining blood vessels and increases the output of blood from the heart. Phentolamine is not used alone for penile injections.

Prostaglandin E1

Prostaglandin E1 relaxes the smooth muscle lining blood vessels, which increases blood flow into the penis.

Alprostadil (Caverject, EDEX) is an injectable form of prostaglandin E1. It relaxes smooth muscle and dilates the blood vessels in the penis. The lowest effective dose should be used as about 4% of men develop a prolonged erection called priapism.

Alprostadil is also available as a dissolvable pellet that can be inserted into the urethra. An erection usually starts within 10 minutes and lasts 30 minutes to an hour.

The most common side effects reported are urethral bleeding, scar tissue formation, pain with urination, and aching in the penis, testicles, and perineum. Systemic symptoms include upper respiratory tract infection, muscle aches, headaches, and pain.

Combinations

The most common form of penile injection is a combination of alprostadil, phentolamine, and papaverine (Trimix). However, only alprostadil is currently approved by the Food and Drug Administration (FDA) for treating ED.  

Combining these three medications improves its effectiveness and decreases the risk of side effects.

Men who injected Trimix to treat ED reported the following side effects:

  • Pain with injection 2.02%
  • Injection site bruise or swelling 14.83%
  • Penile fibrosis 4.53%
  • Prolonged or painful erection 2.80%
  • Priapism 3.15%

Read More: Trimix Injections for ED: The Risks and Benefits

The American Urological Association panel reported that 53.7% to 100% of men achieved a satisfactory erection with Trimix, and 46.3% to 98.8% of men were happy with their choice to use intracavernosal injections as a treatment option.

The most serious side effect of any intracavernosal injection to treat ED is priapism. To decrease the risk of priapism, men should use these medications as instructed.

Trimix, like other medications to treat ED, requires consulting a healthcare provider and getting a prescription. Learn more about getting a prescription for Trimix.

Alternative Treatment Options

Besides oral and injectable medications to treat ED, there are lifestyle, surgical and nonsurgical options. These options may be especially appealing to men who have medical conditions that increase the risk of using medications to treat ED.

Lifestyle changes

Lifestyle changes improve overall health and can help decrease ED risk and even improve symptoms.

Many of these steps improve ED and overall health:

  • Avoid or limit alcohol use

Read More: Does Alcohol Cause Erectile Dysfunction?

  • Engage in physical activity
  • Maintain a healthy weight

Read More: Diet and Exercise to Help with Erectile Dysfunction

  • Stop smoking

Read More: Can Nicotine Cause Impotence

  • Reduce stress

Read More: 7 Tips to Reduce Anxiety and Manage Stress

Therapy

Psychogenic causes of ED are more common in men under the age of 40. Therapy can help men work through performance anxiety and relationship issues that may be contributing factors to ED. In addition, problems with premature ejaculation, genital pain, or pain with sex may also benefit from therapy. The causes of ED may be multifactorial and include both physical and psychological components.

Vacuum devices

Vacuum devices are a nonsurgical alternative that work by placing a tube over the penis and sealing it at the base of the penis with a lubricant. The vacuum pump pulls blood into the penis as air is sucked out of the pump.

Once an erection is achieved, a constricting ring is slid off the base of the tube, where it remains on the penis to restrict blood from draining out of the penis. Because the ring restricts blood flow, it can only be left in place for a maximum of 30 minutes. Bruising and restricted ejaculation are potential side effects of using vacuum devices.

Vacuum devices are used successfully by three out of four men who use them. However, there is a learning curve to using them successfully.

Surgery

When men have not found a suitable option to treat ED, they may opt for surgery. Semi-malleable prosthetics can be surgically implanted in the corpora cavernosa of the penis. A pump is surgically implanted in the scrotum and a reservoir in the abdomen. Risks of surgery include scarring of the penis, mechanical failure, penile shortening, and infection.

In younger men who have had a history of trauma or blood vessel damage to the pelvic region, blood vessel surgery may be an option.

Final Thoughts

Involve your partner as you consider treatment options for ED. Talking to your partner can help to ease anxiety and avoid misunderstandings. Your partner, for example, may interpret ED as a lack of interest in sex or a failure on their part. Open and honest communication with your partner and doctor can help reduce stress and help you find the best medicine or treatment option to treat ED.

Read More: The Connection Between Intimacy and Mental Health

Erectile dysfunction affects almost one in every ten men at some point in their lives. Talk to your doctor about all the treatment options available to treat ED. The healthcare providers at Invigor Medical can discuss your treatment options and answer your questions.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice

  • Hsieh, J. & Kuo, Y. Erectile dysfunction: Causes, risk factors, and management. In Grant, P.S. (2012). Erectile Dysfunction: Causes, Risk Factors, and Management. Nova Science Publishers, Inc.

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