Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 9/05/2020
Dealing with erectile dysfunction can be a stressful process, affecting everything from your sex life to your emotional wellbeing.
Erectile dysfunction, or ED, can range in severity. If you have severe ED, you might find that it’s difficult to get an erection at all, even when you’re feeling aroused. If your ED is less severe, you might simply notice that you aren’t fully hard, or that you often lose your erection during sex.
When ED strikes, it’s easy — and normal — to feel a little embarrassed and even ashamed.
This can often make the problem worse by causing you to avoid sexual activity, or feel apprehensive before sex. We get it — it’s hard on us. Luckily, what you’re experiencing is common, and treatment options are available.
Today, a range of proven, highly effective medications are available to treat erectile dysfunction. These include well-known pills like Viagra®, as well as an entire range of newer treatments.
Each type of ED pill offers its own range of unique benefits, as well as some downsides that you should be aware of. We’ve listed these ED pills below and provided our thoughts on which pill is likely the best option for you based on your ED symptoms, lifestyle and needs.
Interested in learning more about ED? Learn more about the causes of ED in our detailed guide, or schedule a free online consultation to talk to a healthcare provider about the best ED treatment for you.
Before we look at the options for treating ED, it’s important to explain why erectile dysfunction happens in the first place.
Erectile dysfunction can occur for a variety of reasons. Sometimes it’s physical, meaning your body physically can’t supply the penis with sufficient blood flow to give you a steady, consistent erection.
This can often stem from cardiovascular health issues such as heart disease, atherosclerosis, high cholesterol, and high blood pressure. Diabetes, which damages your nerves, also has the potential to cause physical erectile dysfunction.
It’s also possible for conditions like Parkinson’s disease, multiple sclerosis, Peyronie’s disease, sleep disorders, alcoholism and drug abuse to contribute to physical ED.
Sometimes, erectile dysfunction isn’t caused by a physical factor, but a psychological one. If you feel stressed, depressed, fatigued or simply find it difficult to get aroused, you might not be able to get an erection before or during sex.
Sexual performance anxiety is also a potential cause of psychological ED.
Finally, frequent use of pornography can change the degree to which you become aroused by real-life sexual activity, potentially affecting your ability to get and stay hard.
If you’re experiencing erectile dysfunction, it could potentially be caused by one or several of the factors listed above.
Currently, there are four different erectile dysfunction pills available on the market in the United States. They are sildenafil (the active ingredient in Viagra, AKA generic Viagra), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®).
All of these pills achieve approximately the same effects — making it easier for you to get hard and stay that way during sexual activity. However, there are some subtle differences between each pill that could make one a better option for you than the others.
For example, certain ED pills have a longer half-life than others, meaning they’ll keep working for longer. Others are shorter-acting, making them a better choice for a single night than for an entire weekend.
We’ve profiled all four ED treatments below, along with information on which pill is typically the best for each purpose.
Best for: Men who need an affordable, convenient erectile dysfunction pill that works for three to five hours at a time.
Disadvantages: Only lasts for three to five hours and can only be used once per day.
Sildenafil is the oldest, most popular pill for treating erectile dysfunction. You’ve probably heard of it as Viagra, the pill that’s been heavily marketed on TV, in magazines and in other forms of popular media for more than 20 years.
These days, sildenafil is available as a generic medication, meaning you no longer need to buy brand name Viagra to access it. It’s a prescription medication, meaning you’ll need to schedule a consultation with a healthcare provider and receive a prescription before you can buy and use it.
Like all of the medications listed on this page, sildenafil is a PDE5 inhibitor. It works by inhibiting the enzyme that controls blood flow to the soft tissue of the penis. This makes it easier for blood to flow into your penis, helping you get and keep an erection when you’re aroused.
Contrary to popular belief, sildenafil will not cause you to randomly get erections. After you take sildenafil, you’ll only get an erection if and when you feel aroused.
We’ve explained the specific details of how sildenafil works in more detail in our guide to how Viagra affects your sexual experience. For most men with ED, it’s a highly effective treatment, with more than 95 percent of men reporting satisfaction with its effects in a 2002 study.
Sildenafil is affordable, readily available and effective. It lasts for about three to five hours after you use it, making it the best ED pill if you’re seeking a treatment that’s designed to last for one night of sexual activity.
After you take sildenafil, it takes about 30 to 60 minutes for the medication to start working. You can safely take sildenafil with or without food, although taking it after a large, high-fat meal may slow down your body’s absorption of the medication.
Sildenafil first came onto the market in 1998, giving it the longest track record of any medication used to treat ED. Because of this, a wealth of information is available on its effects, side effects and more.
If you’re looking for a single-night ED treatment, sildenafil’s three to five hour effects make it a good choice. However, its short duration of action also means it isn’t the best ED medication if you want something that will last for the entire day.
You can only use sildenafil once per day. This means that if you use it at midday, you won’t be able to use it again at night.
Sildenafil can also cause certain side effects. Most of these are minor and temporary, although there are potential interactions that you should be aware of if you use medication to treat high blood pressure or other cardiovascular conditions. We’ve listed these side effects here.
Overall, sildenafil is one of the best ED treatments if you only need to treat erectile dysfunction for a few hours at a time. Its short duration of action means that you can take it after dinner for relief from ED when you need it, without any lingering effects the next morning.
Best for: Men who need a long-lasting pill to treat erectile dysfunction. Tadalafil lasts for up to 36 hours at a time, giving it a far longer duration of action than sildenafil, vardenafil or avanafil.
Disadvantages: May last longer than needed for many men. This medication’s long duration of action means that side effects can persist for longer than with other ED pills.
Tadalafil is the active ingredient in Cialis. First approved for medical use in 2003, tadalafil lasts for significantly longer than sildenafil, meaning it’s generally a better choice if you want an ED treatment that can last for the entire day.
Like sildenafil and other ED pills, tadalafil is a prescription medication, meaning you’ll need to schedule a consultation with a healthcare provider.
A single dose of tadalafil can remain active in the body for as long as 36 hours. This means that if you take tadalafil on a Friday night, you’ll still experience its effects on Sunday morning, albeit at a reduced strength.
Because of this long half-life, tadalafil has earned the nickname, “the weekend pill.” It’s by far the longest-lasting ED pill on the market.
Like sildenafil, tadalafil is a PDE5 inhibitor. It works in exactly the same way, by improving blood flow to the penis to help you get and maintain an erection. Because it works in the same way as sildenafil, tadalafil has very similar side effects.
The biggest advantage of tadalafil is its long half-life. Simply put, tadalafil is the best ED pill on the market for people seeking long-lasting relief from ED. If you only want to take one pill for a whole weekend, tadalafil is typically far superior to other ED treatments.
After you take tadalafil, it takes about 15 to 45 minutes to start working. Most people notice the full effects of tadalafil about two hours after they take it. Like sildenafil, you can take tadalafil on its own or with food.
Tadalafil has been available since 2003, giving it a long track record. Its effects, side effects and potential interactions have been studied in depth and are well known.
Tadalafil’s biggest strength — its long duration of action — is also its biggest weakness. If you’re only looking for short-acting relief from ED, tadalafil isn’t the right choice. This medication lasts for a very long time, meaning you’ll notice its effects for almost two days after you take it.
Because tadalafil lasts for such a long time, you may experience side effects for longer than you would with a shorter-acting ED medication. If you’re prone to side effects, pills such as sildenafil or vardenafil (which we’ve listed below) might be better choices.
Finally, tadalafil costs slightly more to purchase than sildenafil. If you’re budget conscious, you might prefer sildenafil due to its stronger value for money.
Overall, tadalafil is by far the best ED pill if you’re seeking long-lasting relief from ED, such as for an entire weekend. While its side effects are similar to those of sildenafil, its longer half-life means that they could last for longer, affecting your overall experience.
Best for: Men who need an erectile dysfunction pill that lasts for slightly longer than sildenafil, but don’t need the all-day effects of tadalafil.
Disadvantages: More expensive than sildenafil. Like sildenafil, vardenafil can only be taken once per day.
Approved by the FDA in 2003, vardenafil is the active ingredient in Levitra. Like sildenafil and tadalafil, vardenafil is a PDE5 inhibitor that treats erectile dysfunction by increasing the rate of blood flow to the penis.
As with other ED medications, vardenafil is only available with a prescription, meaning you’ll need to schedule a consultation with a healthcare provider before you can purchase it.
The effects of vardenafil are similar to those of sildenafil. It takes action in about one hour and provides relief from erectile dysfunction for about four hours. This gives it a slightly longer duration of action than sildenafil.
The biggest advantage of vardenafil is because it’s a newer generation of PDE5 medication, research indicates that people who use it are less prone to experiencing side effects.
It also has a terminal half-life of between four and five hours, which means it may last slightly longer than sildenafil.
Vardenafil takes approximately one hour to start working and can be taken with or without food.
You can only use vardenafil once per day, meaning it’s not the best ED medication if you want relief from erectile dysfunction for the entire day.
The side effects of vardenafil are almost the same as those of sildenafil.
Finally, vardenafil is more expensive than sildenafil. If you’re budget conscious and only need relief from ED for a few hours at a time, sildenafil is likely to be a better ED treatment for your needs.
Best for: Men who want a newer, more selective and fast-acting ED pill that’s less likely to cause side effects such as headaches, facial flushing and nasal congestion.
Disadvantages: More expensive than generic sildenafil. While avanafil is less likely to cause certain side effects, a small percentage of users still experience them.
Avanafil, the active ingredient in Stendra, is the newest ED medication on the market. It was approved in 2012 by the FDA. Avanafil is a second-generation PDE5 inhibitor, with a more selective mechanism of action than older erectile dysfunction drugs.
For the most part, avanafil treats erectile dysfunction using the same mechanism as the other erectile dysfunction medications. However, because it’s more selective in the internal tissue it targets, it has slightly lower rates of certain side effects than sildenafil, tadalafil and vardenafil.
Avanafil lasts for up to six hours, giving it a slightly longer duration of action than sildenafil.
While its FDA labels says avanfil should be taken a 30 minutes before sex, some studies suggest it can be taken as early as 15 minutes before sexual activity. it You can use avanafil with or without food.
As a second-generation PDE5 inhibitor, avanafil offers several advantages over older pills used to treat ED.
First, it’s faster acting than older medications. While sildenafil usually needs 30 to 60 minutes to kick in, a normal dose of avanafil starts working in 15 to 30 minutes. This makes it a good ED pill for men who want a medication that’s effective if used shortly before sexual activity.
Because avanafil is more selective than older ED pills, it’s less likely to cause side effects. Men who use avanafil are less likely to report headaches, facial flushing, nasal congestion and back pain than men who use sildenafil or tadalafil.
As a newer ED medication, avanafil costs more than generic ED pills. If you have a tight budget and need a medication that you can use frequently, generic sildenafil is a much more affordable choice than avanafil.
Although side effects are less common with avanafil than with older medications like sildenafil, they can and often do still occur. As with other PDE5 inhibitors, avanafil can interact with some medications used to treat hypertension and other cardiovascular health issues.
As we mentioned earlier, there’s no best erectile dysfunction pill for everyone. Each pill provides a slightly different experience, from a longer duration of action to a reduced likelihood of certain side effects. In general:
If you’re looking for an affordable ED pill that provides relief from ED for between three and five hours at a time, generic sildenafil is an excellent choice.
If you’re looking for a long-lasting ED medication that will improve your performance for an entire weekend, tadalafil (generic Cialis) is a better option.
If you’re looking for an ED pill that may have fewer side effects, vardenafil (Levitra) is worth considering.
If you’re prone to side effects from ED medication, or if you want a fast-acting treatment for erectile dysfunction, avanafil (Stendra) is a great option.
Can’t decide which ED pill is the best option for you? Schedule a free online consultation with a healthcare professional.
During your consultation, you’ll be able to discuss your symptoms, personal needs and health and medical history. Your healthcare provider will evaluate your information and, if appropriate, prescribe a treatment right for you.
Worried about ED? Erectile dysfunction is surprisingly common, affecting men of all ages and backgrounds. Our guide to the causes of erectile dysfunction goes into detail on how and why ED occurs, as well as how you can take action to improve your sexual performance.
Already prescribed ED medication? Our guide to using ED medication effectively explains how you can get the best results from your ED pills through a combination of smart, effective usage and healthy habits.
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