ED Medications – Urologist’s Comprehensive Guide & FAQs

Learn the best options, costs, side effects, limitations, and more in our comprehensive guide

ED medications

ED Medications – Key Takeaways

  • ED medications work by increasing blood flow to the penis
  • PDE5 inhibitors are effective for about 60-70% of men, and injections for about 90% of men
  • ED medications may stop working over time, often due to a change in a medical condition or not taking the medication as prescribed
  • To improve their effectiveness, men can adopt a healthy lifestyle and address any underlying medical conditions
  • ED medications may not work for men with psychological ED
  • ED medications differ in cost, timing of use, side effects, and interactions with other drugs.


Erectile dysfunction (ED) is any condition that affects a man’s ability to get or stay erect. ED can be caused by physical conditions, illnesses, and medications but also by mental, emotional, and psychological distress.

Many men with ED feel they are “less of a man” and avoid getting treatment. Yet, about 20% of men in their 50s experience ED. That is why it is important that men get clear and honest information.

In this article, we’ll talk about ED medicines and what you should know before taking them.   

How do erectile dysfunction medications work?

Several medicines treat Erectile Dysfunction (ED). The most common are the Phosphodiesterase- 5 Inhibitors (PDE5 Inhibitors) that include Viagra, Cialis, Levitra and Stendra.

PDE5 inhibitors increase nitric oxide, a compound that opens up the blood vessels in the penis. When more blood flows to the penis, it is easier to get and maintain an erection. However, PDE5 inhibitors only work when the man is aroused and ready for sex.

Men can also inject medicines directly into the penis or into the urethra as a suppository. A common option is Alprostadil. Like PDE5 inhibitors, it increases blood flow to the penis, but it can work faster than ED pills since it goes directly into the penis.

Finally, men with low blood testosterone levels causing ED can take testosterone. These men can also take PDE5 inhibitors at the same time.

What is the success rate of ED medications?

About 60- 70% of men taking PDE-5 Inhibitors are satisfied with sex – compared to only 35% of men who don’t take the pills. Injections work even better, with nearly 90% of men feeling satisfied. Of course, success rates depend on if men take the medicines as directed as well as the underlying cause of their ED.

Do ED Medications stop working after some time?

For many men, ED medications keep working for years and even decades. If ED medicines stop working for you, it’s important to make sure that you are still taking them as your doctor prescribed.

You can check in with your doctor to make sure that there isn’t a change in any medical condition you have, such as worsening heart disease or poorly controlled diabetes. Sometimes injections may stop working if men develop scar tissue that impairs erections.  

What can you do to make ED drugs work better?

Men can stay as healthy as possible since ED is often caused by heart disease, diabetes, and other conditions that a healthy lifestyle can prevent or even treat.

That means eating healthily, exercising, losing weight (if you are overweight), and treating any medical condition you have. For men who smoke, it’s important to quit. Research shows that men committed to a healthy lifestyle can use these daily choices to treat their ED. 

When will ED medications not work?

Men experiencing deep sadness, stress, or anxiety have psychological ED. They can treat those underlying causes to improve ED. Since ED pills require a man to be aroused, if you are anxious about sex, depressed, or overstressed, they may not work at all.

ED pills and medicines, on the other hand, work best for men with “organic ED,” or ED caused by a physical problem. Often, it’s because men don’t have enough blood flow to allow firm erections to last long enough to enjoy sex. Common causes are high blood pressure and diabetes.

Other causes of organic ED, such as hormone problems or medication side effects, are better treated by addressing those underlying issues or stopping the offending medicines.

How much do ED medications cost?

Prices vary greatly. It may range from under a dollar to several hundred depending on the drug, the pharmacy, and your insurance status. GoodRx is an excellent website to compare shops and save hundreds of dollars.

Geneally speaking, Stendra is the newest and most expensive ED pill, while injection medicines are more expensive than pills.

Insurance can help make ED medicines more affordable, but it may not cover all ED medications. If covered, insurance may only allow one type of ED pill or limit the number of pills you can have. Insurance will typically cover the generic brand, which has the same active medicine and is cheaper.

Some doctors can give you coupons for free pills. Also, some men get a higher dose pill than needed and cut the pill to save money by increasing the number of doses they have.  

Comparing ED medications

PDE5 inhibitors are the first choice for ED medications. Viagra is the most well-known, but is there an ED drug better than Viagra? The answer is that all PDE5 inhibitors work equally well to get men erect and enjoying sex. Six to seven of every ten men have successful sex with ED drugs.

PDE5 inhibitors also have similar side effects. They can’t be used if you take Nitrate medicines and can cause an unsafe drop in blood pressure. Men may notice, headaches, facial flushing, nasal congestion, heartburn, and occasionally vision changes.

Other differences may make one of the ED pills a better choice for you. So, let’s compare them. Below, we’ve included a table comparing the main features. We added more details about each drug under the table. We mentioned the brand name and the generic version in parentheses.

DrugTiming of UseCan you eat?How do you take it?CostsMost common side effect
Viagra (sildenafil)1 hour before sexNoOrally$15-$20 per pill, $20 for 30 days with insuranceHeadache (most commonly causes vision changes)
Cialis (Tadalafil)Daily or 30 minutes before sexYesOrally$10 per pill, $100 for 30 day with insuranceHeadache
Levitra (Vardenafil)1 hour before sex (30 minutes for fast acting pill)No (low fat meals ok for fast acting pill)Orally$40 per pill, $20 per pill with insuranceHeadache
Stendra (Avanafil)15 minutes before sexYesOrally$50 per pillHeadache
AlprostadilMinutes before sexYesPenis injection$200 per dosePriapism
AlprostadilMinutes before sexYesPenis suppository$80 per dosePenile pain and bleeding

Viagra (sildenafil)

This is the oldest- and cheapest- of the PDE5 inhibitors, with the most research showing efficacy. Viagra works well for men with mild ED to improve their satisfaction with sex. Without insurance, Viagra averages about $15-20 per pill but can be as low as $20 for a 30-day supply with insurance.

Since Viagra is best taken on an empty stomach one hour before sex, it can take the spontaneity out of sex. It is most likely to cause visual changes.

Cialis (Tadalafil)

The longest-acting PDE5 inhibitor, Cialis, lasts for 36 hours. While some men take high-dose Cialis on demand, you can take a low dose daily. That boosts spontaneity since you can be ready for sex without having to stop to take the pill first.

Daily Cialis might improve long-term blood flow to the penis and may be a good option for men who cannot have an erection with on-demand ED pills. You can eat when taking Cialis. Cialis is about $10 per pill but averages less than $100 for 30 pills with insurance.

Levitra (Vardenafil)

Levitra, like Viagra, is short-acting and is taken within an hour of having sex. Levitra also comes in a fast-acting pill. While you shouldn’t eat when taking the regular Levitra pill, you can eat (a low-fat meal) with the fast-acting pill.

Levitra averages about $40 per pill but can cost under $200 for ten pills with insurance. Levitra is less likely to cause vision changes.

Stendra (Avanafil)

It is the fastest acting choice and can work as soon as 15 minutes before sex. It’s ok to eat with Stendra, but it can cost over $50 per pill, even with insurance.


Unlike ED pills, men either inject Alprostadil or use it as a suppository. It’s vital that you are comfortable using Alprostadil and that your doctor explains (and demonstrates) its use. Alprostadil can act within a few minutes since it goes directly into the penis. Injectable Alprostadil can cost about $200 per dose, while the suppository is about $80 per suppository.

Priapism (an erection lasting more than 4 hours without sexual pleasure) can happen with injections. It is an emergency, and you should go to a doctor immediately for treatment. Men using Alprostadil as a suppository may have pain in the penis.


Testosterone is not a silver bullet for ED. It only helps the few men who have low blood levels of testosterone causing ED. Men with low testosterone and ED can combine a PDE5 inhibitor with testosterone replacement.

The price of testosterone varies depending on how it is given and can range from less than $5 a dose for injections to several hundred dollars for patches or creams.

Are there over-the-counter alternatives?

There are no over-the-counter (OTC) ED pills or supplements that are proven to work. Many supplements or vitamins claim to be a panacea for ED. Unlike medicines, supplements are not regulated, and their claims or listed ingredients are not always accurate. Ingredients in “natural supplements” can include unknown quantities of PDE5 inhibitors or, worse, unsafe and toxic chemicals.

Men use supplements like Yohimbe and Ginseng to treat ED, but research is not clear that they have a true benefit. These supplements also have side effects: Ginseng can increase bleeding, while high doses of Yohimbe can be deadly.  Another supplement, L-arginine, in combination with PDE5 inhibitors, may help to improve blood flow to the penis, but again, there is not yet enough research to know for sure.

One ED treatment without side effects may be Kegel exercises. While you may think they only help with bladder leaks, Kegels also target the penis muscles that are active during an erection. In one small study, men who did Kegels regularly over three months improved or even resolved ED up to 6 months after treatment. 

Is it safe to buy ED medications online?

It may be tempting to skip a doctor’s appointment and order ED pills directly from an online pharmacy, but men should think twice about this. Always choose a reputable and licensed pharmacy, as some ED pills sold online may have incorrect doses and inactive or toxic ingredients.  

Online pharmacies may not spend time discussing how to properly take ED medicines, their side effect, or how they can affect your current health condition or interact with the medicines you are taking.


There are many options for treating ED. From lifestyle changes such as quitting smoking to PDE 5 inhibitors and injections, men should feel hopeful about overcoming ED. Take the time to learn about ED treatments and find the best option for you.

About Oreoluwa Ogunyemi, MD

Urologist and Health and Wellness Coach

Dr. Ogunyemi is a medical doctor, trained urologist and a health and wellness coach. She received her medical degree from the David Geffen School of Medicine at UCLA. Her professional background and love of writing, allow her to efficiently synthesize complex and detailed research, making it accessible to a broader audience.

She serves as a medical writer for the Between Us Clinic.