Oral Sildenafil in the Treatment of Erectile Dysfunction
They’re what doctors sometimes call “me-too” drugs–drugs that are largely interchangeable. However, some men may benefit from one and not another for reasons that aren’t fully understood. Cialis has a longer time until onset–45 minutes, compared to 30 minutes for Viagra and Levitra, and even less than 30 minutes with Stendra.
Lifestyle Changes
Longo, New London, Conn.; T. Malloy, Philadelphia; A. McCullough, New York; J. McMurray, Huntsville, Ala.; D.F. ; J Susset, Providence, R.I.; J.
Medicines that can cause ED
Tuttle, Lexington, Ky.; G. Wells, Birmingham, Ala.; C. White, Mobile, Ala.; J. Young, Laguna Hills, Calif.; and N. Zinner, Torrance, Calif. Cialis lasts much longer–up to 36 hours compared to 4 hours with the other agents.
- Emerging treatments include shockwave therapy to improve blood flow.
- Low-intensity shockwave has shown promise in clinical trials.
- It may promote new blood vessel growth.
- The procedure is non-invasive and painless.
- Long-term safety and effectiveness are still being studied.
- Consult a specialist to explore experimental options.
High-fat meals can delay absorption and the onset of action of all but Cialis.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Viagra Soft Tabs | 100mg | 180 + 10 Pills | 314.95€ 299.95€ | |
| Levitra Professional | 20mg | 60 + 2 Pills | 223.11€ 212.49€ | |
| Levitra Soft Tabs | 20mg | 180 + 10 Pills | 398.14€ 379.18€ | |
| Viagra Generic | 25mg | 360 + 10 Pills | 213.68€ 203.50€ | |
| Viagra Generic | 50mg | 60 + 4 Pills | 83.93€ 79.93€ | |
| Viagra Soft Tabs | 100mg | 20 Pills | 62.99€ 59.99€ | |
| Viagra Soft Tabs | 100mg | 60 + 6 Pills | 152.94€ 145.66€ | |
| Levitra Generic | 20mg | 90 + 8 Pills | 180.78€ 172.17€ | |
| Cialis Professional | 20mg | 180 + 4 Pills | 423.11€ 402.96€ | |
| Levitra Generic | 60mg | 30 + 2 Pills | 109.43€ 104.22€ | |
| Cialis Generic | 40mg | 10 Pills | 37.79€ 35.99€ | |
| Cialis Professional | 40mg | 270 + 6 Pills | 898.37€ 855.59€ | |
| Super Kamagra | 160 mg | 60 + 4 Pills | 342.71€ 326.39€ | |
| Levitra Original | 20mg | 92 + 4 Pills | 406.22€ 386.88€ | |
| Levitra Soft Tabs | 20mg | 270 + 10 Pills | 521.78€ 496.93€ | |
| Kamagra Oral Jelly | 100 mg | 110 + 9 Sachets | 334.87€ 318.92€ |
Side effect profiles are similar and most commonly include flushing, headache, runny nose, dizziness, and upset stomach.
- Advances in regenerative medicine aim to restore erectile tissue.
- Stem cell therapy is being researched for ED.
- Platelet-rich plasma (PRP) injections are experimental.
- These treatments target tissue repair and blood vessel growth.
- Are still in early clinical trial phases.
- Consult specialists to explore emerging options.
Less common side effects include priapism (a prolonged erection), visual effects (notably “blue vision”), and transient hearing loss. Cialis can be taken daily, so it’s best for men with consistent ED. All these drugs (including Cialis in a higher dose) can be used on an as-needed basis. These drugs can dangerously lower blood pressure and lead to a potential heart attack if you’re taking nitroglycerin.
Which erectile dysfunction treatments have the fewest risks?
However, no erection will occur without an environmental or psychological trigger to stimulate sexual arousal. It’s important to distinguish between ED and other types of sexual dysfunction, such as decreased libido or abnormal ejaculation. ED refers specifically to the inability to acquire or maintain an erection, either occasionally or consistently. Age – The incidence rises from less than 10 percent in men aged 20 to 30 to more than 35 percent in men over 70. Lifestyle – Smoking, inactivity, and obesity can lead to ED. That also means you should be careful when combining them with other blood pressure-lowering substances like alcohol, some antihypertensives, and alpha-blockers, which are often used to treat prostatic hypertrophy and hypertension.
Information & Authors
Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 1996;78:257-261 Rosen, RC, Riley, A, Wagner, G, Osterloh, IH, Kirkpatrick, J, Mishra, A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Riley, AJ, Athanasiadis, L. Impotence and its non-surgical management.
3. Urethral suppository
Br J Clin Pract 1997;51:99-103 Any commercial reuse of NEJM Group content requires permission. From the Department of Urology, Boston University Medical Center, Boston (I.G. ); the Department of Urology, University of California, San Francisco (T.F.L. ); the Department of Urology, University of Southern California, Los Angeles, and the Male Clinic, Santa Monica, Calif. (H.P.-N.); the Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, N.J. Several of these drugs are metabolized by the liver or kidneys, so anyone with liver or kidney problems should avoid them. Always be sure to talk to your doctor about any drugs you’re taking or any other medical conditions you have. Dangerous drug interactions and potential health stay hard pills issues mean you shouldn’t take any of these drugs without a prescription and discussing them with your primary healthcare provider. Recreational use is common–most often to shorten the refractory period between erections–and the side effects are the same as when the drugs are used by men with ED. The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.
| Drug | Effectiveness (%) | Onset Time | Duration of Action | Patient Satisfaction Rate |
|---|---|---|---|---|
| Viagra | 70-80 | 30-60 min | 4-6 hours | 75% |
| Cialis | 75-85 | 30 min | Up to 36 hours | 80% |
| Levitra | 65-75 | 25-60 min | 4-5 hours | 70% |
| Stendra | 70-80 | 15-30 min | Up to 6 hours | 78% |
Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice.
The bottom line
Emerging Trends and Research Focus in Erectile Dysfunction Treatment: A 1993–2023 Bibliometric Analysis, Andrologia, 2026, 1, (2026). With the approval of avanafil (Stendra), a fourth drug has joined the pack in the battle against erectile dysfunction (ED) alongside sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). So it’s a good time to take a look at how effective and safe these drugs are and whether they’re right for you. They all work by inhibiting an enzyme called phosphodiesterase type-5 (PDE5). Blocking this enzyme causes the blood vessels in the penis responsible for achieving and maintaining an erection to dilate. 1Life Healthcare, Inc. and the One Medical entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.
Is one drug better than another?
Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Sex-ual behavior in the human male. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. Treatment of men with erectile dysfunction with transurethral alprostadil. Clinical Guidelines Panel on Erectile Dysfunction: summary report on the treatment of organic erectile dysfunction.
Table 4. Additional Testing in the Workup of Erectile Dysfunction
Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med 1992;326:90-94 Andersson, K-E, Wagner, G. Physiology of penile erection. The role of nitric oxide in the physiology of erection. Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Erectile dysfunction (ED) is the most common sexual problem in men. The incidence increases with age and affects up to one third of men throughout their lives. It causes a substantial negative impact on intimate relationships, quality of life, and self-esteem. History and physical examination are sufficient to make a diagnosis of ED in most cases, because there is no preferred, first-line diagnostic test.
What are the latest treatments for erectile dysfunction?
); the Department of Urology, University of Virginia, Charlottesville (W.D.S. Select the format you want to export the citation of this publication. Multi-view semi-supervised adversarial attention network for drug repurposing, Computer Methods and Programs in Biomedicine, 282, (109406), (2026). Multi‐Target Mechanisms of Moroccan Aphrodisiac Plants: An Integrative Computational and Phytochemical Investigation, Food Science & Nutrition, 14, 5, (2026). Artificial intelligence in drug research cost of vardenafil and development: a review of methods and applications in drug repurposing, Briefings in Bioinformatics, 27, 3, (2026).
Hormone replacement therapy
Endocrine-metabolic crosstalk in erectile dysfunction: mechanistic insights and therapeutic implications, International Journal of Impotence Research, (2026). Therapeutic applications of phosphodiesterase inhibitors in male reproductive health: narrative review, Sexual Medicine Reviews, 14, 2, (2026). Oral suspension versus tablet sildenafil for erectile dysfunction: a prospective multicenter comparative study on patient satisfaction, International Journal of Impotence Research, (2026). Low‐intensity shockwave therapy for erectile dysfunction: An abridged Cochrane review, BJU International, 137, 6, (949-957), (2026). Current state of the problem, Andrology and Genital Surgery, 25, 4, (33-40), (2026). Initial diagnostic workup should usually be limited to a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level. First-line therapy for ED consists of lifestyle changes, modifying drug therapy that may cause ED, and pharmacotherapy with phosphodiesterase type 5 inhibitors.
What Treatments Might Not Work for Erectile Dysfunction?
Underlying diseases – Diabetes, cardiovascular disease, and sleep apnea increase your risk. Drugs – Some drugs, particularly antidepressants, can cause ED. Finally, it is important to recognize that many men without any of these risk factors can have ED. Psychosocial stress may play a role, and while low testosterone won’t necessarily cause ED, some men with low testosterone levels do find that testosterone replacement therapy can improve erectile function. Studies have shown that 60 to 70 percent of men with ED see positive results. Obesity, sedentary lifestyle, and smoking greatly increase the risk of ED. Phosphodiesterase type 5 inhibitors are the most effective oral drugs for treatment of ED, including ED associated with diabetes mellitus, spinal cord injury, and antidepressants. Intraurethral and intracavernosal alprostadil, vacuum pump devices, and surgically implanted penile prostheses are alternative therapeutic options when phosphodiesterase type 5 inhibitors fail. Testosterone supplementation in men with hypogonadism improves ED and libido, but requires interval monitoring of hemoglobin, serum transaminase, and prostate-specific antigen levels because of an increased risk of prostate adenocarcinoma.
| Drug Type | Mechanism of Action | Target Enzyme/Pathway | Typical Use Cases |
|---|---|---|---|
| PDE5 Inhibitors | Inhibit phosphodiesterase type 5 enzyme | PDE5 enzyme | Relaxation of penile arteries |
| Testosterone Replacement | Increase testosterone levels | Hormonal pathway | Hormonal deficiency cases |
| Vasodilators | Directly relax smooth muscle | Nitric oxide pathway | Severe cases of ED |
| Melanocortin Agonists | Stimulate melanocortin receptors | Central nervous system | Experimental, limited availability |
Cognitive behavior therapy and therapy aimed at improving relationships may help to improve ED. Screening for cardiovascular risk factors should be considered in men with ED, because symptoms of ED present on average three years earlier than symptoms of coronary artery disease. Men with ED are at increased risk of coronary, cerebrovascular, and peripheral vascular diseases. Erectile dysfunction (ED) is defined by the National Institutes of Health as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.1 ED is the most common sexual problem in men; it often causes serious distress, prompting men to seek medical attention they may not otherwise seek. It often has a profound effect on intimate relationships, quality of life, and overall self-esteem.