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How to choose the best ED pill

Erectile dysfunction (ED) is a condition where men are unable to get and maintain an erection that’s firm enough for sexual intercourse. Erectile dysfunction affects as many as 30 million men in the United States and is usually caused by a combination of psychological and physical issues that affect the brain, hormones, muscles, blood vessels, and nerves. 

Stress, anxiety, depression, and low self-esteem are some of the most common psychological causes of ED. Experiencing erectile dysfunction can be difficult to deal with both physically and emotionally, but there are several medications on the market that can help treat the condition. Let’s take a look at how to choose the best ED pill.   

What is the most effective pill for ED?

There isn’t one single prescription drug that’s best for treating ED. There are multiple drugs that can help improve erectile function. The most popular erectile dysfunction pills are Viagra, Levitra, Cialis, and Stendra. These medications are classified as phosphodiesterase-5 (PDE5) inhibitors. 

Erectile dysfunction medications help improve erectile function by increasing levels of nitric oxide, a chemical that relaxes the smooth muscles in the blood vessels. This in turn increases blood flow to the penis, which allows men to get and maintain an erection that’s firm enough for sex. If used correctly, erectile dysfunction drugs are safe to use and can be very effective at helping men feel more fulfilled in their sex lives.   

Let’s take a more in-depth look at how effective these medications are. 


Viagra is the brand-name of the generic medication sildenafil citrate. It’s one of the most popular drugs in the world and has been given the nickname “the little blue pill” because of its appearance. Viagra is thought of as being a safe and effective medication for most men. According to a study from the Journal of Urology, 95% of men who were using Viagra long term (1-3 years) had an improved ability to engage in sexual activity. Numerous other studies show that even though treatment response to Viagra can vary, Viagra is generally well tolerated and improves erectile dysfunction. One 4-year, open-label study showed that the use of Viagra has a low incidence of adverse events and most patients end up being happy with how the medication treated their ED.    


Levitra is the brand name of the generic medication called vardenafil. According to the International Journal of Impotence Research, Levitra doses of 5 mg, 10 mg, and 20 mg have all been proven to be more effective than placebo. About 69% of men receiving vardenafil reported that treatment improved their erections compared with 26% of men allocated to a placebo group. In one study where 4374 patients were evaluated and 2660 received vardenafil, 50.4% reported adverse effects.   


Cialis is the brand name of the generic medication tadalafil. According to the Food and Drug Administration (FDA), the efficacy and safety of Cialis in the treatment of ED has been evaluated in 22 clinical trials, involving over 4000 patients for up to 24 weeks of treatment. When taken as needed no more than once per day, Cialis 5 mg, 10 mg, and 20 mg were shown to be effective for treating erectile function. In clinical pharmacology trials, back and muscle pain were some of the most commonly reported side effects of Cialis. Side effects generally occurred 12 to 24 hours after dosing and typically resolved within 48 hours. 


Stendra is a brand-name medication; its chemical name is avanafil. There is currently no generic version of Stendra available on the market. Compared to other ED pills, Stendra has a faster onset of action. Because of its fast onset, Stendra may be preferred over other ED drugs for patients who want more flexibility with the timing of sexual activity. Some studies suggest that Stendra may be as equally effective as other PDE5 inhibitors, like Viagra and Levitra, while having fewer adverse effects and drug interactions.    

Viagra (sildenafil citrate) Levitra (vardenafil hcl Cialis (tadalafil) Stendra (avanafil) 
How to take it 25 to 100 mg taken as needed 30 minutes to 4 hours before sexual activity. Maximum of 1 dose per day. 5 to 20 mg taken as needed about 60 minutes before sexual activity. Maximum of 1 dose per day. 5 to 20 mg taken as needed prior to sexual activity. Maximum of 1 dose per day. 50 to 200 mg taken as needed as early as 15 minutes before sexual activity. Maximum of 1 dose per day.
How fast it works Starts working 30-60 minutes after taking.

Lasts between 2-3 hours, or longer depending on the dosage. 

Starts working in about 30 minutes

Lasts up to 5 hours, depending on the dosage. 

Starts working in 30 minutes to two hours.

Can last up to 36 hours.  

Starts working 15-30 minutes after taking.

Lasts up to 6 hours. 

Efficacy  As many as 95% of people in long-term studies of Viagra have an improved ability to get an erection.  In one study where 4374 patients were evaluated and 2660 received vardenafil, 69% reported that it improved their erections.  According to the FDA, Cialis 5 mg, 10 mg, and 20 mg proved to be statistically significant at improving erectile function. Stendra has comparable efficacy to other ED pills and may cause fewer adverse effects.  
Side effects  Flushing, nasal congestion, and headache.   Stuffy/runny nose, dizziness, and flushing.  Headache, upset stomach, and backache.  Flushing, backache, and headache. 
Coupon  Save money on Viagra Save money on Levitra Save money on Cialis Save money on Stendra

Prescription gels and creams

There are currently no topical creams that have been approved by the FDA to treat ED. Topical medications AndroGel and Axiron are approved to increase testosterone for men with lower than normal testosterone levels. The active ingredient in these medications is testosterone, and men who use them may experience improved erectile function as a secondary result of using them. However, these medications won’t work for ED patients who have ED that’s caused by something other than low testosterone.   

Are ED treatments available over-the-counter?

Some ED treatments may be available to purchase over-the-counter (OTC) without a prescription. These OTC products aren’t actually medications but supplements. The following supplements won’t work as well as Viagra or other ED meds, but may be helpful for some men. It’s important to consult a healthcare provider before trying an OTC product or supplement for ED. 

  • Dehydroepiandrosterone (DHEA): DHEA is a steroid prohormone that has been shown to decline as a part of the aging process. Low levels of DHEA are associated with a higher risk of ED, so taking the supplement may improve ED-related symptoms.  
  • Ginseng: Ginseng is a root that may help improve sexual function in men with ED. It is believed to work by relaxing smooth muscles in blood vessels to allow more blood flow to the penis and acting as a natural libido booster
  • L-arginine: L-arginine is an amino acid that forms the building blocks of proteins. It is also converted in the body to nitric oxide. The evidence for using L-arginine alone for ED is not strong. However, some studies have shown that L-arginine may help improve ED when combined with other ingredients.. 
  • Propionyl-L-carnitine: Propionyl-L-carnitine is a naturally occurring chemical in the body. Studies have shown that it can enhance the effects of Viagra. 
  • Yohimbe: Yohimbe is a supplement that may help improve sexual function by increasing the effects of nitric oxide to relax blood vessels and improve penile blood flow. It may also help improve libido.  

It can be difficult to decide when to use an OTC treatment versus a prescription medication. Some men who only have mild and inconsistent ED may find that supplements work well for them. Other men who have severe or chronic ED may need a prescription ED pill. If you’re unsure about what’s right for you, talking to a medical professional may help give you some clarity. 

Alternative ED treatments 

Erectile dysfunction medications aren’t the only way to treat ED. Some men are able to use alternative ED treatments successfully, while others may need to combine ED pills with alternative treatments in order to see results. Here are a few examples of alternative erectile dysfunction treatments:

  • Supplements: Dietary supplements like ginseng, Ginko biloba, L-arginine, and DHEA may help some men with their ED. It’s important to note that supplements aren’t regulated by the FDA in the same way that medications are.  
  • Exercising regularly: Getting enough exercise can help improve blood flow throughout the body and to the penis. 
  • Quitting smoking: Smoking can damage blood vessels and reduce overall blood flow to the penis. Nicotine is the main chemical in cigarettes that constricts the blood vessels and causes reduced blood flow. 
  • Getting adequate sleep: Being chronically sleep-deprived can cause low testosterone levels and poor circulation. One study found that approximately half of men with sleep apnea had low libido. Getting enough sleep is also essential for overall health.    
  • Surgery: Penile implants that are either inflatable or malleable can be inserted into the penis to help men get and maintain an erection.  

“The latest treatment for erectile dysfunction is acoustic pressure wave or shockwave therapy,” says Alexander Lightstone Borsand, MD, a board-certified Lifestyle Medicine physician who runs a men’s health clinic specializing in ED called Camelback Medical Clinic. “This treatment utilizes sound waves to target the inner lining of the blood vessels of the penis to stimulate nitric oxide synthase and promote neovascularization. By increasing the amount of nitric oxide produced, the blood vessels will widen to allow more blood flow, leading to better erections. Promoting the development of new blood vessels through neovascularization will also allow for increased volume of blood to the penis.”  

How to find the best ED pill for you 

Finding the best ED pill may take some trial and error. Everyone responds to medication a little bit differently, so what works for one person may not work for another. Talking to your doctor is the best way to make the right decision as to which ED treatment is right for you. 

Here are some questions you might ask your doctor in order to come to the best decision:

  • Which ED pills have the least side effects?
  • What are the most serious side effects of ED pills? 
  • Which ED pills have the least amount of drug-drug interactions?
  • Which ED pill is safest for long-term vs short-term use? 
  • Will my age affect which ED pill is best for me? 
  • I have other health conditions, what ED treatment is best for me?

If your doctor writes you a prescription for an erectile dysfunction medication, you may be able to save money by using an online coupon through