Best Pills And Medications For Erectile Dysfunction

Erectile dysfunction (ED), also called impotence, is the ongoing inability to get or keep an erection firm enough for sexual activity. It affects about 40% of men in their 40s and up to 70% of men in their 70s, according to the Massachusetts Male Aging Study.

The most common prescription ED pills are PDE5 inhibitors such as Sildenafil, Tadalafil, Vardenafil, and Avanafil. These drugs block the phosphodiesterase type 5 enzyme, which relaxes blood vessels in the penis during sexual stimulation. This allows more blood to flow into the tissue. Hence, making it easier to have a firm erection. Each medication works differently in terms of onset, duration, dosage, and side effects. Sildenafil (Viagra) is fast-acting and suited for occasional use. Tadalafil (Cialis) lasts longer and supports more spontaneous activity. Vardenafil (Levitra, Staxyn) offers reliable results with a shorter effect window. Avanafil (Stendra) works quickly and often has fewer side effects. Generic versions such as Kamagra, Cenforce, and Fildena for Sildenafil, or Vidalista and Tadarise for Tadalafil, offer lower-cost options.

ED pills are usually taken before sexual activity or as a low daily dose, depending on the drug and the patient’s needs. Some dissolve under the tongue, while others are swallowed with water. Doses can range from 2.5 mg daily Tadalafil to 100 mg Sildenafil or 200 mg Avanafil for as-needed use.

The following table compares leading ED medications based on dosage, onset, duration, prescription requirement, pricing, and side effect profile.

What Are Erectile Dysfunction (ED) Pills and How Do They Work?

Erectile dysfunction (ED) pills are phosphodiesterase type 5 (PDE5) inhibitors that enhance penile blood flow by preserving cyclic guanosine monophosphate (cGMP) levels. These medications treat erectile dysfunction, a condition characterized by the persistent inability to achieve or maintain an erection sufficient for sexual activity. ED pills such as sildenafil, tadalafil, vardenafil, and avanafil act by inhibiting the PDE5 enzyme, which normally breaks down cGMP in the smooth muscle cells of the corpus cavernosum. By preventing cGMP degradation, these drugs promote prolonged smooth muscle relaxation, leading to arterial dilation and increased penile blood flow in response to sexual stimulation. ED pills require sexual arousal to be effective. They do not trigger erections spontaneously. Refer to the list below for the pharmacokinetics of the various ED pills.

• Sildenafil (Viagra): Onset in 30 to 60 minutes, effective for up to 4 to 6 hours.
• Tadalafil (Cialis): Onset in 30–45 minutes, duration up to 36 hours.
• Vardenafil (Levitra): Onset in 30–60 minutes, effective for up to 5 to 8 hours.
• Avanafil (Stendra): Fast onset (15–30 minutes), fewer side effects.

According to Harvard Health Publishing, choice of ED pill depends on individual factors such as timing preference, food interactions, half-life, and tolerability. Some formulations like Tadalafil Daily offer continuous therapeutic levels for men who prefer spontaneity over timed dosing. All ED medications are prescription-only and should be taken under medical supervision, especially in patients with cardiovascular conditions, nitrate therapy, or hepatic or renal impairment.

What Are the Top Prescription ED Medications?

Top prescription ED medications are PDE5 inhibitors like Sildenafil, Tadalafil, Vardenafil, and Avanafil, which increase penile blood flow by blocking the PDE5 enzyme. A 2021 systematic review in Frontiers in Pharmacology confirmed that oral PDE5 inhibitors significantly improve erection firmness and sexual satisfaction compared to placebo. These drugs work only in the presence of sexual arousal and differ in chemical structure, onset, and duration. Some ED pills, such as Super Kamagra, also combine Sildenafil Citrate with Dapoxetine to treat both erectile dysfunction and premature ejaculation.

Sildenafil Citrate

Sildenafil citrate is a fast-acting PDE5 inhibitor that enhances penile blood flow by preserving cGMP levels in erectile tissue. Sildenafil treats ED by relaxing the corpus cavernosum smooth muscle, allowing more blood to enter the penis during sexual stimulation. It does not work without arousal. A research article published in The New England Journal of Medicine reports that 46.5% to 87% of men report improved erection quality after 12 weeks of treatment, compared to 11–41% in placebo groups. Sildenafil is ideal for men with a predictable sexual routine. It’s sold under several branded and generic forms.

• Onset: 30–60 minutes (faster on an empty stomach)
• Duration: 4–6 hours
• Common Side Effects: Headache, flushing, nasal congestion, dyspepsia
• Serious Risks: Hypotension (with nitrates), visual disturbances, priapism

Viagra (Pfizer)

Viagra is the original FDA-approved brand of sildenafil citrate developed by Pfizer for the treatment of erectile dysfunction. It was launched in 1998 as the first oral ED treatment. Available in 25 mg, 50 mg, and 100 mg, Viagra should be taken 30–60 minutes before sex and not more than once per day.

• Peak effect: ~60 minutes post-dose
• Maximum duration: Up to 8 hours
• Prescribed for: On-demand use, or in low daily doses under medical supervision

Doctors assess cardiovascular history, nitrate use, allergies, and previous side effects before prescribing Viagra.

What Are the Generic Options for Viagra?

Generic Viagra products contain sildenafil citrate and offer comparable efficacy at a lower cost. These include India-manufactured options like Kamagra, Cenforce, Fildena, and Suhagra, each offering unique forms, strengths, and benefits.

Kamagra (Ajanta Pharma, India)

Kamagra is a flavored generic sildenafil medication offered in tablets and oral jelly formats.

• Forms: 50 mg, 100 mg tablets; Oral Jelly
• Variants: Super Kamagra (Sildenafil + Dapoxetine)
• Onset: ~30 minutes (jelly form may act faster: 15–30 minutes)
• Duration: 4 hours
• Special Feature: Assorted flavors for easier intake

Cenforce (Centurion Labs, India)

Cenforce is a cost-effective sildenafil brand available in multiple dosages for customized treatment.

• Doses: 25 mg, 50 mg, 100 mg, 150 mg, 200 mg
• Recommended Use: 30–60 minutes before sexual activity
• Notable Option: Cenforce 200 mg for men with higher tolerance or severe ED

Fildena (Fortune Healthcare, India)

Fildena is known for its “Purple Triangle” branding and various specialty forms.

• Dosages: 50 mg, 100 mg, 120 mg, 150 mg
• Variants: Fildena Super Active (soft gel); Fildena Chewable 100 mg
• Onset: ~30 minutes
• Duration: 4–6 hours
• Best Taken: On an empty stomach or with light food

Suhagra (Cipla, India)

Suhagra is a sildenafil-based blue tablet manufactured by Cipla as a direct alternative to Viagra.

• Strengths: 25 mg, 50 mg, 100 mg
• Onset: 30–60 minutes
• Duration: Up to 6 hours
• Administration: With or without food

Suhagra offers a trusted and affordable sildenafil option for men seeking regulated treatment under clinical guidance.

Tadalafil

Tadalafil is a long-acting PDE5 inhibitor that treats erectile dysfunction by enhancing blood flow to the penis and sustaining cGMP-mediated smooth muscle relaxation. Tadalafil works by inhibiting the phosphodiesterase type 5 enzyme (PDE5), which allows cyclic guanosine monophosphate (cGMP) to accumulate in the corpus cavernosum. This accumulation results in prolonged vasodilation, improving penile blood inflow during sexual stimulation. A integrated analysis of the primary efficacy and safety studies, published in the Journal of Urology, showed that 81% of patients reported improved erectile function after taking 20 mg of tadalafil as compared with 35% of placebo-treated patients. Unlike sildenafil, tadalafil has a longer half-life, making it ideal for men who prefer spontaneity over timing.

• Onset: 30–60 minutes
• Duration: Up to 36 hours (“weekend pill”)
• Common Side Effects: Headache, dyspepsia, nasal congestion, flushing
• Serious Risks: Priapism, vision loss, hearing loss, hypotension (with nitrates)

Tadalafil can be taken as needed or in low daily doses (2.5 mg or 5 mg), based on medical advice.

Cialis

Cialis is the branded Tadalafil ED tablet developed by Eli Lilly, offering long-lasting erectile function support for up to 36 hours. Cialis provides a flexible treatment option as it can be prescribed for on-demand dosing: 10 mg or 20 mg, and daily use: 2.5 mg or 5 mg. Patients often choose Cialis for its extended action window, which allows more natural sexual experiences. A comparative study showed higher patient preference for Cialis over sildenafil due to this convenience. Cialis must be prescribed by a doctor, especially for those with underlying cardiovascular, hepatic, or renal conditions.

Vidalista (Centurion)

Vidalista is a generic tadalafil-based ED medication made by Centurion Labs, offering multiple strengths for personalized treatment.

• Strengths: 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, 60 mg, 80 mg
• Daily use: 5 mg (mild ED)
• High strength: 40 mg and 60 mg for severe ED
• Onset: ~30–60 minutes
• Duration: Up to 36 hours

Vidalista is considered a cost-effective substitute for Cialis and is often preferred in long-term ED therapy.

Tadarise (Sunrise Remedies)

Tadarise is a generic Tadalafil ED pill available in multiple dosages and formulations, including soft tabs and oral strips. Manufactured by Sunrise Remedies, Tadarise matches Cialis in effectiveness and safety profile.

• Dosages: 2.5 mg, 10 mg, 20 mg, 40 mg, 60 mg
• Formulations: Regular tablets, soft tabs, oral strips
• Use: As needed or daily, depending on clinical assessment

Like other tadalafil options, Tadarise should be taken at least one hour before sexual activity, with or without food.

Vardenafil

Vardenafil is a selective oral PDE5 inhibitor that treats erectile dysfunction by enhancing nitric oxide-mediated vasodilation in penile tissue. Vardenafil inhibits the PDE5 enzyme, allowing cGMP to accumulate in the corpus cavernosum. This action relaxes smooth muscle, increases arterial inflow, and supports firm erections during sexual stimulation. Unlike sildenafil, vardenafil has a higher selectivity for PDE5 over PDE6, reducing the risk of vision-related side effects. A randomised, double-blind study published in International Journal of Clinical Practice, showed that 92% experienced improved erectile function and 94% achieved successful intercourse after daily use of 10–20 mg. Compared to sildenafil and tadalafil, vardenafil is 10 times more biochemically potent, meaning lower doses achieve therapeutic results with fewer side effects.

• Onset: ~60 minutes
• Duration: 4–5 hours
• Common Side Effects: Nausea, abdominal pain, flushing, nasal congestion, dizziness
• Serious Risks: Hypotension, tachycardia, myalgia, vision disturbances (rare)

Vardenafil is available as Levitra (brand) and Vilitra (generic) in oral tablet form.

Levitra (Brand)

Levitra is the brand-name version of Vardenafil, developed by Bayer Pharmaceuticals, prescribed for short-acting ED treatment. Levitra contains Vardenafil hydrochloride and is available in 2.5 mg, 5 mg, 10 mg, and 20 mg strengths.

• Recommended Starting Dose: 10 mg, taken ~60 minutes before sex
• Effect Duration: 4 to 5 hours
• Food Interactions: May be delayed by a high-fat meal

Levitra is ideal for patients who need an on-demand ED solution with fewer visual side effects compared to sildenafil.

Vilitra (Generic Vardenafil)

Vilitra is a cost-effective generic version of Vardenafil, manufactured by Centurion Laboratories in India. It provides the same active ingredient as Levitra but at a lower price point.

• Available Dosages: 10 mg, 20 mg, 40 mg, 60 mg
• Use: Taken ~1 hour before sexual activity
• Duration: Lasts up to 5 hours

Higher-dose options like Vilitra 40 mg and 60 mg are typically reserved for men with moderate to severe ED under professional guidance.

Avanafil

Avanafil is a second-generation PDE5 inhibitor that treats erectile dysfunction by enhancing penile blood flow with a rapid onset and a short half-life. Avanafil selectively blocks phosphodiesterase type 5 (PDE5), preserving cGMP levels in penile tissue. This action results in rapid smooth muscle relaxation and vasodilation, enabling stronger erections during sexual stimulation. Its high selectivity for PDE5 over PDE6 and PDE1 reduces the risk of visual and cardiovascular side effects compared to older drugs.

According to a NIH clinical trial, men taking 100 mg of Avanafil reported significantly higher success in intercourse within 15 minutes versus sildenafil. This makes Avanafil the fastest-acting oral ED drug on the market.

• Onset: 15–30 minutes
• Peak Plasma Time: ~30–45 minutes
• Duration: 4–6 hours
• Common Side Effects: Headache, flushing, nasal congestion, sore throat, back pain
• Severe Risks: Hypotension (especially with nitrates), priapism, vision or hearing loss

Avanafil is available as Stendra (brand) and Avana (generic) in multiple strengths.

Stendra

Stendra is the branded version of Avanafil, developed by Vivus Inc., known for its rapid onset and fewer systemic side effects. Stendra allows men to take the medication as little as 15 minutes before sex, with or without food.

• Available Strengths: 50 mg, 100 mg, 200 mg
• Typical Starting Dose: 100 mg, adjusted based on response
• Duration: 4–5 hours
• Dosing Limit: No more than one dose per 24 hours

Stendra is especially suited for men seeking spontaneity and faster results.

Avana

Avana is a generic version of Avanafil, offering a low-cost, fast-acting ED treatment with flexible dosing. Manufactured by several Indian pharmaceutical companies, Avana tablets deliver identical efficacy to Stendra at a reduced price.

• Available Strengths: 50 mg, 100 mg, 200 mg, 250 mg
• Use: Taken 30 minutes before sexual activity
• Duration: 4–6 hours
• Food Interaction: Minimal, can be taken with or without meals

Avana is a viable alternative for men prioritizing fast onset, affordability, and reduced side effects.

Alprostadil Injection

Alprostadil is a prostaglandin E1 (PGE1) analog administered via intracavernosal injection or urethral suppository to induce penile erection by relaxing smooth muscle and dilating blood vessels. Alprostadil is classified as a vasodilator. It directly stimulates cyclic adenosine monophosphate (cAMP) production in the corpus cavernosum, causing smooth muscle relaxation and increased arterial inflow to the penis. It bypasses the nitric oxide–PDE5 pathway, making it effective even in patients who do not respond to PDE5 inhibitors. In a 6-month clinical trial with 683 men, 94% reported improved erections after self-injection. The medication is used both therapeutically for ED and diagnostically in penile function tests.

• Onset: 5–20 minutes (injection); 5–10 minutes (suppository)
• Duration: 30–60 minutes
• Formulations: Injection (powder + liquid), Urethral suppository
• Dosing Frequency: Max 3 times/week, 24-hour gap required
• Common Side Effects: Pain at injection site, Bruising or bleeding, Priapism (rare), Testicular or pelvic discomfort, Dizziness, Urethral irritation (with suppository use)

Patients must be trained by a healthcare provider before self-injection or self-insertion. The first dose is always administered in-clinic to assess tolerance and determine appropriate strength. Alprostadil is sold under several brands as listed below.

• Caverject (injection powder)
• Caverject Impulse (prefilled injection system)
• Edex (injection system)
• Muse (urethral suppository)

These options offer a non-oral ED treatment pathway, especially beneficial for men with contraindications to PDE5 inhibitors or those with nerve damage after prostate surgery.

How Do You Choose the Right ED Pill?

Choose an ED pill based on timing, frequency of sex, health status, medication use, side effects, and budget. With multiple FDA-approved pills like sildenafil, tadalafil, vardenafil, and avanafil, the ED pill market offers several effective options, but not all work equally for everyone. These medications are PDE5 inhibitors, which increase blood flow to the penis by preserving cGMP levels in smooth muscle tissue. The result is better erection quality during sexual stimulation. Even though drugs like Viagra (sildenafil) and Cialis (tadalafil) may seem similar, they differ in onset, duration, food interaction, and tolerance. According to Dr. Michael O’Leary, former director of men’s health at Brigham and Women’s Hospital, choosing the right ED medication requires matching the pill’s profile with your sexual routine, medical history, and lifestyle.

The best erectile dysfunction pills are the ones that match your symptom severity, frequency of sexual activity, and health profile. Always consult a healthcare provider before starting treatment to avoid potential drug interactions or unsafe usage.

Sildenafil vs. Tadalafil: Which One Is Better for Erectile Dysfunction?

Both sildenafil and tadalafil are PDE5 inhibitors, but they differ in key ways. Sildenafil vs tadalafil comparisons often highlight sildenafil’s faster onset (30 to 60 minutes) but shorter effect (4 to 6 hours), while tadalafil works more slowly but lasts up to 36 hours. Sildenafil is suitable for one-time use before sexual activity, whereas tadalafil is preferred by men who want spontaneity or daily dosing. Tadalafil may also be better tolerated in those with stomach sensitivity.

Sildenafil vs. Vardenafil: Which One Is More Effective?

Effectiveness of ED medications varies slightly among users. In sildenafil vs vardenafil comparisons, both drugs are shown to enhance erections by increasing blood flow to the penis, but vardenafil may be more effective in men with diabetes. Vardenafil also has a slightly longer duration and is less affected by food intake. Sildenafil, however, remains more widely prescribed and is available in a greater variety of generic forms.

Which Erectile Dysfunction Drug Works Best with Alcohol?

Among ED medications, sildenafil and alcohol interactions are considered relatively mild when alcohol is used in moderation. However, heavy drinking can reduce the effectiveness of any ED pill and increase side effects like dizziness and low blood pressure. Tadalafil and vardenafil have similar warnings, though sildenafil tends to be better tolerated with small amounts of alcohol. It’s safest to limit alcohol when taking any ED medication.

Can Women Take Sildenafil Citrate?

No, sildenafil is not officially approved by the FDA for women, and its effectiveness for female sexual dysfunction is uncertain. Some studies on sildenafil for women suggest it may improve genital blood flow and arousal, but results are inconsistent. Female sexual issues often involve hormonal, psychological, and emotional factors that sildenafil alone may not address. In certain cases, doctors may prescribe it off-label for conditions like antidepressant-induced sexual dysfunction. Side effects in women can include headache, flushing, and vision changes. Any use should be under medical supervision to ensure safety and to explore other proven treatments where appropriate.

What Are the Alternative Treatments for Erectile Dysfunction?

When oral medications don’t work or aren’t suitable, other erectile dysfunction treatment options include vacuum erection devices, penile implants, and testosterone replacement therapy. Vacuum devices use suction to draw blood into the penis and are non-invasive. Penile implants involve surgically placed rods or pumps and are usually a last resort. Testosterone therapy is recommended only when blood tests confirm low hormone levels contributing to ED.

What Are the Natural Ways to Treat Erectile Dysfunction?

Dietary improvements and lifestyle changes can help improve blood flow and sexual performance. Foods rich in antioxidants, nitrates, and omega-3 fatty acids, such as spinach, beets, walnuts, and salmon, are proven food for erectile dysfunction support. Regular exercise, quitting smoking, reducing alcohol intake, and managing stress also help restore natural erectile function. These approaches may work best for men with mild to moderate symptoms.

Which Natural Pills Are Effective for Erectile Dysfunction?

Several herbal and over-the-counter erectile dysfunction supplements claim to improve sexual performance. Popular ingredients include L-arginine (a nitric oxide booster), ginseng (for stamina), and horny goat weed (for libido). While some men report improvement, clinical evidence is limited. Always consult a doctor before trying supplements, especially if you take other medications, to avoid unwanted interactions or side effects.