ED Medications

by Shahrokh Shariat | Last Updated: October 8, 2019

We will provide an introduction to oral medications or pills for erectile dysfunction. This information has been taken from a recent review of the medical literature and attempts to be as comprehensive as possible. This material is independently produced, and the mention of any drug or medical product does not imply its endorsement.

If you are prescribed a medication referred to in this article, reading this post does not substitute for reading the package insert that comes with your prescription or sample. Hopefully, you would have already come across some of the products and have some understanding of erectile dysfunction already.

Here we will focus on oral medications for ED, but we will first review some normal anatomy of the penis, describe how erections occur and briefly introduce erectile dysfunction. We will then give a more detailed description of pills for ED including how they work, how to take them to maximize their effect and what the potential side effects and risks are.

Normal Penis Anatomy

The penis contains two chambers called the corpora cavernosa or sometimes referred to as erectile bodies. They run along the length of the penis and are attached to the pelvic bones. Between the two corpora cavernosa runs the corpus spongiosum containing the urine channel called the urethra.

The corpora cavernosa contains spongy tissue made up of smooth muscles, fibrous tissues, veins, and arteries. Spaces called sinusoids within this tissue can fill up with blood during an erection and expand the corpora dramatically.

All of this tissue is surrounded by a fibrous coating called the Tunica Albuginea.

How Does An Erection Occur?

An erection is initiated by physical or mental stimulation or a factor of both combined. Nerve impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the sinusoids spaces.

The penis expands as it fills with blood. The Tunica Albuginea helps to trap the blood inside the corpora cavernosa, maintaining the erection. The erection is then reversed when blood vessels in the penis contract to stop the inflow of blood and open outflow channels.

What Is Erectile Dysfunction?

Simply put, erectile dysfunction is the inability to get or maintain an erection satisfactory for intercourse. It is also commonly referred to as ED. Erectile difficulties or impotence (ED) can range in severity amongst individuals. For some, it may be just inconsistent erections, for others, erections that are too soft to penetrate for intercourse.

Others may experience early loss of erections while still others may achieve no erection whatsoever. Interruption with any of these essential steps in the erection process can cause ED.

This includes lots of stimulation to start the process, weak nerve transmission of the stimulus to the brain and back to the penis, reduced blood flow into the penis, hardening of the penile tissue or an inability to contain the blood within the penis.

Poor blood flow to the penis, caused by narrowing of the small blood vessels is by far the most common medical cause of ED. Pills to treat ED are designed to improve the flow of blood to the erectile tissue.

Here are some of the specific factors that may lead to ED;

Age, family history, high blood pressure, smoking, obesity, and diabetes can all contribute to the narrowing of the small blood vessels to the penis. Many of these factors are controllable through lifestyle changes.

What Are The Treatment Options?

ED can be treated at any age. Many treatment options exist. The best treatment varies depending on an individual’s situation, and your doctor will use all the information at hand to choose the best treatment for you.

Treatment options include lifestyle changes, adjusting medications, psychotherapy such as counseling and behavior modification. Oral medications or pills, topical medications such as creams and gels, vacuum devices, injection of drugs into the penis and surgery including penile implants or prosthesis.

But, this article will focus on oral medication or pills for ED. We have other sections that review different treatment options in more detail.

Lifestyle Changes

All patients should strive to introduce lifestyle changes which may improve the quality of their erections and all other aspects of their sexual function. These include smoking cessation and embarking upon an exercise program that emphasizes cardiovascular conditioning, improving dietary habits and weight loss. Finally, couples should take the time to focus on their relationship and make changes where necessary.

ED Pills

Beyond lifestyle changes, oral medications have become the mainstay of initial treatment for ED. Three drugs now dominate the market for ED treatment. Sildenafil or Viagra, Vardenafil or Levitra and Tadalafil (Cialis). All three of these fall within a class of drugs called PDE – 5 inhibitors. As they block an enzyme in the penis called Phosphodiesterase-5 to improve blood flow to the erectile tissue.

How Do They Work?

By blocking PDE – 5, these drugs enhance the standard erection response allowing more blood to flow into the penis during sexual stimulation. It is essential to understand that taking one of these pills will not affect one’s sex drive and they do not by themselves produce an erection.

They only enhance the standard response, you will still need mental and physical stimulation to achieve an erection.

How Well Do They Work?

These medications have become widely recognized and prescribed for a good reason, as a general rule they are a very effective treatment for ED. Exactly how useful, depends on both the underlying cause of the problem and how the user defines success.

Overall, for all types of ED – about 60 to 75% of men will achieve erections sufficient for intercourse with the use of PDE-5 inhibitors.


An important point to understand is that these medications do not reverse the underlying cause of the problem. Men with ED must continue to work on lifestyle changes, control chronic medical conditions, etc. to prevent ongoing worsening of their situation.

How To Take Them?

This table highlights some of the key features of how to efficiently take these medications.

Sildenafil Or Viagra

It should be consumed about 30 to 60 minutes before anticipated sexual activity. Its effects may last for up to 24 hours.

This does not mean that an erection will be sustained for this entire time, rather, that it may still be in the system during this period to help enhance the standard erection response. A second dose should not be taken within this 24 hour period. The effectiveness of Viagra is hindered by fatty food and alcohol consumption.

Viagra is typically prescribed at 100 mg doses. However, 50 mg tablets are also available, and your doctor may choose dosages ranging from 25 all the way to 200 mg depending on the situation.

Vardenafil Or Levitra

It should be taken 25 to 60 minutes before sexual activity. Its effects may last for up to 4 to 5 hours. A second dose should not be taken within 24 hours of this previous treatment being administered.

Levitra is not affected by food or alcohol. However, excessive drinking will jeopardize any man’s ability to have an erection regardless.

Levitra is usually prescribed at a 20 mg dose although, five and 10 mg tablets are also available.

Tadalafil Or Cialis

It should be taken 30 to 60 minutes before anticipated sex. Its effects may last for up to 36 hours. A second dose should not be taken within 36 hours of the previous dose. Cialis also isn’t affected by food or moderate amounts of alcohol.

Cialis is typically prescribed at 20 mg, and 10 mg tablets are also available. Your doctor will choose the dose that is best for you if you are not achieving the effect you desire you should talk to your doctor about adjusting the dose. You should not do so yourself without first discussing it.

What Are The Side Effects?

This is where it gets interesting. The most common side effects of PDE-5 inhibitors are headaches, flushing, heartburn or indigestion nasal congestion and allergic reactions such as skin rash are common.

These medications can cause visual impairments, and you should not operate a motor vehicle if you experience these effects until they subside. Levitra is the least likely to cause these changes, and Cialis can commonly cause flu-like symptoms, back pain or muscle aches.

I actually tried Viagra and Cialis myself and regretted it tremendously. I didn’t know at the time that such adverse effects could happen when taking these medications.

What About My Heart?

There is a misconception and fear among some men that PDE-5 inhibitors cause heart attacks and this is certainly not a common side effect.

We will aim to clarify the relationship between these medications and heart problems.

Firstly, PDE-5 inhibitors do not cause heart attacks. The more important question to answer first regarding heart safety and using ED drugs is whether or not your heart is fit enough to allow you to engage in sexual activity regardless of how you achieve an erection.

If you have any questions about your exercise tolerance or your suitability to take ED medications, talk to your doctor.

There is also a myth that men with high blood pressure should not take ED pills, and this is also not entirely the case. It is true however that certain blood pressure medications may need to be considered when prescribing PDE-5 inhibitors. Especially a class of drugs called alpha blockers. Again, talk to your doctor if you do take medication for high blood pressure.


The most important thing to understand about PDE-5 inhibitors and heart safety is that when combined with drugs called nitrates they can cause a sudden drop in blood pressure which can lead to dizziness, fainting or even heart attacks or strokes.

Nitrates are contained in drugs used to treat cardiac chest pain called angina. These include nitroglycerine tablets, nitro spray or nitro patches. They are also an ingredient of the recreational drug Amyl nitrate also known as “poppers.”

If you have any questions about nitrates and if you are unsure if you are using one, talk to your doctor.

Having said that, it follows that if you have ischemic heart disease meaning a history of heart attacks or chest pain called angina and all carry nitroglycerin or other nitrates with you, you must not take PDE-5 inhibitors.

Similarly, if you develop chest pain and have recently taken PDE-5 inhibitors later do not take nitrates and notify emergency medical services that you have taken such a pill.

Prostate Pills

As mentioned earlier, PDE-5 inhibitors combined with the class of drugs called alpha blockers can also lead to a drop in blood pressure. These medications are also used to treat prostate symptoms in men. Ask your doctor about this if you are taking medicines for your prostate.

Other precautions

It is also recommended that you talk to your doctor if you take any of the following drugs;

Furthermore, before taking a PDE-5 inhibitor speak with your doctor if you have any of the following conditions;

Will I Go Blind?

Another myth that has caused some men to fear the use of PDE-5 inhibitors is that they might go blind if they take them. It is true that these medications can be associated with some mild and temporary visual impairments such as blue tinting to the vision. However, they do not cause blindness.

There have been a few case reports published with very few high-risk patients consuming PDE-5 inhibitors experiencing rare occasions of a particular type of blindness called nonarteritic anterior ischemic optic neuropathy.

These men, however, have medical conditions that put them at high risk of this disease and their blindness was not likely related to the use of PDE-5 inhibitors. If you are not satisfied with the results you achieve using a PDE-5 inhibitor. Firstly do not despair, keep trying and focus on just relaxing and enjoying the experience.

If you’re still unsatisfied, you should seek alternative treatments.

Natural Versus Synthetic ED Medications

As you have read that there are many adverse side effects associated with using Viagra, Levitra, and Cialis. These pills are artificial and completely unnatural, and that’s why they can have such devastating consequences and severe drug interactions with other medications you may be using.

Herbal supplements such as VigRX Plus, Male Extra, ExtenZe and ProSolution Plus Pills do not have such negative consequences. They are completely natural and only contain 100% herbal ingredients. They even work on the same drug pathways as the PDE-5 inhibitors we have been speaking about.

It’s as though the pharmaceutical companies had studied the effects of natural herbs and mimicked them synthetically to create their prescription pills to line their pockets with money.

Natural cures are the better option, and you do not need a prescription due to the nature of how safe they are. There is also much scientific proof to prove the efficacy of the herbs and natural ingredients contained in supplements such as VigRX Plus, Male Extra, ExtenZe and ProSolution Plus Pills.

Use A Penis Pump…

Penis pumps or vacuum devices have also been FDA approved to be used as a treatment option for patients suffering from erectile dysfunction. Even doctors have begun to prescribe them, and in some countries, they are covered by health insurance.

The two recommended penis pumps are both water-based as opposed to using air as a medium (water is much safer than air as a medium not to mention more efficient).

We recommend either using the BathMate Hydro Max or the Penomet pump to regain your sexual function and treat your ED naturally without the use of harmful and dangerous prescription PDE-5 inhibitors.