6 best ED medications and pills: pros, cons, and costs in 2025

The best ED medication depends on your health needs and circumstances. Viagra (sildenafil) and Stendra (avanafil) act fast but last a few hours. Cialis (tadalafil) offers longer-lasting effects and has a daily use option. As you can see, various medications can help treat ED, with pros and cons for all of them.

Erectile dysfunction (ED) is a condition that affects millions of people across all age groups. Finding the best ED pill depends on how often you need it, how quickly it works, and how long the effects last.

This guide compares the top options available today, whether you're looking for the strongest ED medication or the best drug for your situation.

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There’s no single “best” ED medicine, as it depends on your health, lifestyle, and preferences. Common options include sildenafil (Viagra) for quick results and tadalafil (Cialis) for longer-lasting effects. Other choices like vardenafil and avanafil may cause fewer side effects. A healthcare provider can help you choose the best ED pill for your needs.

Some of the best erection pills work quickly, while others last longer or offer daily convenience. The table below compares key options to help you find the one that best fits your needs.

*How long each medication lasts in your body may depend on your age, kidney or liver function, and if you’re taking certain other medications. In these situations, your healthcare provider may recommend a different dosage to adjust for differences in how your body processes the medication.

Below, we will break down the best ED meds available today.

What is it?

Sildenafil (brand name Viagra) is a medication used to treat ED. It belongs to a class of drugs called phosphodiesterase-5 (PDE5) inhibitors, which work by relaxing blood vessels and increasing blood flow to the penis. This can make it easier to get and maintain an erection when sexually aroused.

Ro offers Viagra via telehealth from $90 per dose, and the generic of Viagra (sildenafil) starts from $4 per 25 mg dose, with free shipping and provider visit included. The cost of Viagra generally depends on where you purchase it from and whether you’re buying the generic or branded version.

What dosages are available?

Viagra is available in tablet form in the following strengths:

• 25 mg

• 50 mg (standard starting dose)

• 100 mg (maximum recommended dose)

The medication should be taken as needed, no more than once per day, and approximately 30 minutes to four hours before sexual activity.

When should you choose this medication?

Sildenafil may be a good option if you want an on-demand ED treatment that can work relatively quickly. It’s useful for people who don’t need a daily medication but want something they can take as needed.

Viagra’s effects can typically last for up to four hours, and sildenafil can be effective for a wide range of ED causes. However, it might not be the best fit for everyone. If you experience side effects such as headaches, flushing, or a stuffy nose, you may want to discuss other options with your healthcare provider. 

Pros and cons of sildenafil

Where to buy

You can get sildenafil (Viagra) through Ro’s website with a prescription from a licensed healthcare provider.

Here’s a guide on how to safely use Viagra.

What is it?

Tadalafil (brand name Cialis) is a prescription medication used to treat ED. Cialis may also be prescribed to treat benign prostatic hyperplasia (BPH). 

What makes tadalafil unique is its longer duration of action (effects can last up to 36 hours). It also offers the alternative option of daily low-dose treatment, providing continuous treatment for ED without needing to time doses around sexual activity​.

Cialis costs can vary. Generic tadalafil starts at $8 per dose from Ro for 2.5–5 mg daily tablets. Branded Cialis (also containing tadalafil) starts at $20 for 5 mg pills to be taken as needed. All prices include visits with a provider. 

What dosages are available?

Tadalafil is available in tablet form in the following strengths:

• 2.5 mg (daily use)

• 5 mg (daily use, also for BPH)

• 10 mg (as-needed use)

• 20 mg (as-needed use, maximum dose)

For as-needed use, tadalafil should be taken at least 30 minutes before sexual activity. While many people should start to see its impact by then, it can take two hours for some (since each dose has a long half-life of 17.5 hours). The best timing for you depends on your dose and how your body responds.

When taken daily, Cialis builds up in your system so you can stay ready for more frequent and spontaneous sex.

For daily use, it is taken at the same time each day, regardless of sexual activity​.

When should you choose this medication?

Tadalafil is a great option if you want long-lasting effects that allow for more flexibility and spontaneity. Unlike shorter-acting ED medications, it lets you stay ready for sex for up to a day and a half, reducing the need to plan ahead.

The daily version is also useful for people who want a consistent treatment option without thinking about timing.

Pros and cons of tadalafil (Cialis)

* Eight or more standard drinks per week for women and 15 or more per week for men. A standard drink equals one 12-ounce regular beer (5% alcohol), one 5-ounce glass of wine (12% alcohol), or one 1.5-ounce shot of liquor/spirits (40% alcohol).

Where to buy

You can get tadalafil (Cialis) through Ro’s website with a prescription from a licensed healthcare provider.

Here’s a guide on how you can use Cialis safely.

What is it?

Ro Sparks is an alternative ED treatment that combines the active ingredients of Viagra (sildenafil) and Cialis (tadalafil) into a single dissolvable tablet. It has provided fast-acting results for many people.

Unlike traditional ED pills, it dissolves under the tongue, allowing it to be absorbed directly into the bloodstream. Each tablet contains 55 mg of sildenafil and 22 mg of tadalafil, offering a two-in-one treatment that can take effect in as little as 15 minutes and last up to 36 hours​.

Ro Sparks costs $12 per dose on a monthly subscription plan, including visits with your provider.

What dosages are available?

Ro Sparks comes in a single pre-measured dissolvable tablet containing 55 mg of sildenafil and 22 mg of tadalafil.

It’s designed to be taken as needed, no more than once per day​.

When should you choose this medication?

Ro Sparks may be a good alternate option if you want both fast-acting and long-lasting results in a single dose. It's especially useful for people who prefer a dissolvable tablet, want to avoid timing their dose around meals, or are looking for a more discreet, travel-friendly option.

If you’ve had success with either sildenafil or tadalafil in the past, combining them might offer even better results. Just be sure to review all medications with your healthcare provider before starting.

Pros and cons of Ro Sparks

Where to buy

You can get Sparks through Ro’s website with a prescription from a licensed healthcare provider.

What is it?

Daily Rise Gummies offer an alternative daily ED treatment in a chewable, fruit-flavored gummy. They contain 7 mg of tadalafil, the same active ingredient as Cialis, but in a more convenient and enjoyable form.

When taken daily, they can help maintain steady levels of tadalafil in your system, so you can be ready for more spontaneous sex without needing to plan ahead​. A 30-tablet supply of Daily Rise Gummies is available for $89 per month.

What dosages are available?

Each gummy contains 7 mg of tadalafil. Daily Rise Gummies are taken once per day, just like daily Cialis​.

When should you choose this medication?

Daily Rise Gummies are a good choice for those who want a daily ED treatment that provides steady, continuous effects without the need to plan around medication timing. With consistent tadalafil levels in your system, you can be ready for spontaneous sex without the need for on-demand dosing. The chewable pill also makes it an easier alternative, which may be appealing to those who dislike swallowing tablets.

Pros and cons of Daily Rise Gummies

Where to buy

You can get Daily Rise Gummies through Ro’s website with a prescription from a licensed healthcare provider.

What is it?

Avanafil is the active ingredient in Stendra. Currently, you can only get this ED pill as the brand-name drug Stendra, as there is no generic available.

What sets avanafil apart is its ultra-fast onset—it can start working in as little as 15 minutes, making it one of the quickest-acting ED medications available. It’s also known for being well-tolerated, with fewer side effects compared to other PDE5 inhibitors​.

The recommended dose for Stendra is 100 mg, which can be increased to 200 mg or decreased to 50 mg according to your healthcare provider’s direction. It should not be taken more than once a day. 

What dosages are available?

Avanafil is available in tablet form in the following strengths:

• 50 mg

• 100 mg (standard starting dose)

• 200 mg (maximum dose)

When should you choose this medication?

Avanafil is a great choice if you want an ED medication that works quickly with minimal planning. It can have the fastest onset among PDE5 inhibitors, making it a good option for spontaneous sex.

Additionally, it may be a better fit for those who are sensitive to side effects, as studies suggest it has a lower risk of headaches, flushing, and stuffy nose compared to similar medications.

Pros and cons of avanafil

* Eight or more standard drinks per week for women and 15 or more per week for men. A standard drink equals one 12-ounce regular beer (5% alcohol), one 5-ounce glass of wine (12% alcohol), or one 1.5-ounce shot of liquor/spirits (40% alcohol).

Where to buy

You can get avanafil (Stendra) with a prescription from a licensed healthcare provider. Average costs start at $315 to $415 per pack of six tablets of the 50 mg branded Stendra dose.

What is it?

Vardenafil (previously sold under the brand name Levitra) is a PDE5 inhibitor used to treat ED. Although Levitra was a popular ED medication, it has been discontinued in the United States. However, generic versions of vardenafil are still available, offering the same effectiveness and benefits as the original brand-name drug​.

What dosages are available?

Vardenafil is available in tablet form in the following strengths:

• 2.5 mg

• 5 mg

• 10 mg (standard starting dose)

• 20 mg (maximum dose)

It should be taken as needed, about 60 minutes before sexual activity. The effects can last for up to about six hours, and the maximum dosing frequency is once per day​.

When should you choose this medication?

Vardenafil may be a good choice if you are looking for an effective ED medication with a slightly longer duration than sildenafil (Viagra) but without the extended effects of tadalafil (Cialis).

Since Levitra has been discontinued, those interested in vardenafil will need to look for a generic version. It may not be the best option if you want a brand-name medication or a treatment with longer-lasting effects​.

Pros and cons of vardenafil

Where to buy

Although Levitra is no longer available, generic vardenafil can be prescribed with a consultation from a licensed healthcare provider. Average costs start at about $35 per 10-tablet pack of 20 mg vardenafil. 

The best erectile dysfunction pills are PDE5 inhibitors, namely sildenafil (Viagra), tadalafil (Cialis), vardenafil, and avanafil (Stendra). Each one has different pros and cons. For example, sildenafil and avanafil last a few hours, while tadalafil can work up to 36 hours. Your best choice depends on your health, timing needs, and your health provider’s recommendation.

Here’s what to consider:

• Need something that works fast? Ro Sparks can start working within 15 minutes, making it one of the quickest options.

• Want longer effects? Tadalafil (Cialis) can last up to 36 hours, allowing for more flexibility.

• Prefer a daily option? Low-dose Cialis or Daily Rise Gummies may help maintain steady levels for continuous support.

• Looking for a combination approach? Ro Sparks can provide both fast onset and longer duration by combining sildenafil and tadalafil.

• On a budget? Generic sildenafil (Viagra) and tadalafil (Cialis) may offer similar benefits as brand-name drugs at a lower cost.

The best erectile dysfunction pills can help improve blood flow to the penis, which can make it easier to get and maintain an erection when sexually aroused. ED pills don’t increase libido or cause an erection on their own. Their effectiveness comes from supporting the body’s natural erection process by improving blood vessel relaxation and circulation.

During sexual stimulation, the body releases nitric oxide, which triggers the production of cyclic guanosine monophosphate (cGMP). This chemical relaxes the smooth muscles in the corpora cavernosa, the sponge-like erectile tissue in the penis. As these muscles relax, blood vessels widen, allowing more blood to flow in and create an erection.

ED medications belong to the drug category called PDE5 inhibitors. They help by blocking the enzyme PDE5, which would otherwise break down cGMP too quickly. By inhibiting PDE5, these medications allow cGMP levels to remain higher for longer, sustaining the muscle relaxation and blood flow needed for a firm erection.

However, ED medications do not cause automatic erections—they require sexual arousal to initiate the nitric oxide release. Without stimulation, the medication has no effect.

Different PDE5 inhibitors vary in how quickly they work, how long their effects last, and their side effect profiles. Some, like avanafil, work in as little as 15 minutes, while others, like tadalafil, take longer to kick in but can last up to 36 hours.

The choice of medication depends on your healthcare provider’s recommendations and your individual needs, tolerance, and lifestyle considerations or pre-existing conditions, like diabetes or heart disease​.

The most effective ED treatment depends on several factors, such as how often a person wants to engage in sexual activity, and their response to different medications.

For many, PDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis), avanafil (Stendra), and vardenafil (Levitra, now discontinued) are the first-line treatment due to their effectiveness, ease of use, and relative safety. Clinical studies suggest these medications help most people achieve and maintain an erection firm enough for intercourse.

However, not everyone responds to ED pills. In these cases, other treatment options may be more effective.

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If oral medications aren’t effective or aren’t an option due to health conditions, several other treatments can help improve erectile function.

External vacuum devices (penis pumps)

Vacuum erection devices use suction to draw blood into the penis, creating an erection. A constriction ring is then placed at the base of the penis to maintain the erection for up to 30 minutes. These penis pump devices are non-invasive and can be used as often as needed, though they require some practice to use effectively.

Intraurethral suppositories

The medicated urethral system for erection involves inserting a small alprostadil pellet into the urethra, where it dissolves and increases blood flow to the penis.

Penile injections

Intracavernosal injections involve injecting medication directly into the penis to relax smooth muscles and improve blood flow. The most commonly used medication is prostaglandin E1, but compounded mixtures like TriMix and QuadMix are also available. These injections are highly effective, but they require careful dosing and proper injection technique.

Low-intensity shockwave therapy (LISWT)

LISWT uses sound waves to stimulate blood vessel growth and improve circulation in the penis. This non-invasive treatment is being studied as an option for people with mild to moderate ED who do not respond well to PDE5 inhibitors. While some research suggests LISWT may improve natural erectile function, long-term effectiveness remains uncertain.

Topical ED creams

Vitaros (alprostadil cream) is a topical medication applied directly to the penis to increase blood flow. It works similarly to penile injections but does not require needles. This treatment is available in some countries and may be an option for people who prefer a non-invasive approach.

Penile implants

Penile implants are a surgical treatment for ED, usually for people who haven’t had success with other options like pills or injections. During the procedure, a physician places devices inside the penis to help create firm, reliable erections.

These implants can be either inflatable (activated with a hidden pump) or malleable (manually positioned as needed).

The surgery is carefully planned to match each person’s body and needs, and it’s done with precision to reduce the risk of problems and help ensure a smooth recovery.

While all surgeries carry some risk, penile implants have been shown to be safe and effective. They offer a long-term solution for people with severe ED and can greatly improve quality of life and sexual confidence.

For those looking for alternatives to ED pills, a healthcare provider can help determine the best treatment based on individual needs and medical history.

While PDE5 inhibitors are generally safe and well-tolerated, they do come with potential side effects, which can range from mild to severe. These side effects occur because PDE5 inhibitors relax blood vessels and affect smooth muscle function, not just in the penis but throughout the body.

Most common side effects are mild and usually resolve within a few hours. These include:

• Headaches

• Facial flushing (warmth or redness in your face)

• Upset stomach or indigestion

• Stuffy or runny nose

• Back pain

• Muscle aches

• Dizziness

• Changes in vision, such as seeing a blue tinge or increased light sensitivity

• Rash

These effects tend to be more noticeable with higher doses. If they bother you or don't go away, your healthcare provider may be able to adjust your dose while keeping the medication effective.

Since these effects can vary from person to person, it’s important to try different options and figure out the one that works best for you by continuing to discuss with your healthcare provider.

Less common but serious side effects

While rare, some people experience more serious reactions that require immediate medical attention. Serious symptoms might include:

• Sudden vision changes: A rare but serious condition called non-arteritic anterior ischemic optic neuropathy (NAION) can cause vision loss in one or both eyes.

• Hearing loss: A sudden drop in hearing or tinnitus (ringing in the ears).

• Priapism: A prolonged, painful erection lasting more than four hours that requires emergency treatment to prevent permanent damage.

• Severe hypotension (low blood pressure): This occurs more commonly in those taking nitrates or alpha-blockers, which can cause dangerous drops in blood pressure.

ED pills can lower blood pressure, so if you already have low blood pressure or take medication for high blood pressure, you should discuss this with your healthcare provider before taking ED medication.

Sexual activity can strain your heart and may not be safe if you have a history of heart conditions or heart disease. If you have high blood pressure, it’s generally safe to take certain ED medications, but your healthcare provider may suggest checking your blood pressure or adjusting your dosage if necessary.

PDE5 inhibitors interact with various medications and health conditions, so it’s important to discuss potential interactions with a healthcare provider. The most serious interactions involve drugs that affect blood pressure, heart function, or metabolism.

Dangerous drug interactions

• Nitrates (e.g., nitroglycerin, isosorbide mononitrate/dinitrate): When combined with ED medications, nitrates can cause a severe, life-threatening drop in blood pressure. They should never be used together.

• Alpha-blockers (e.g., doxazosin, tamsulosin): These drugs are used to treat high blood pressure or prostate conditions. When combined with ED medications, they can cause dizziness and fainting.

• Guanylate cyclase stimulators (e.g. riociguat): These dilate blood vessels (as a type of vasodilator) and, when combined with PDE5 inhibitors, can lead to extreme drops in blood pressure.

• CYP3A4 inhibitors (e.g. ketoconazole, some HIV medications, erythromycin): These drugs slow down the metabolism of ED medications, making their effects stronger and longer-lasting, which can increase side effects.

• Blood pressure medications (e.g. beta-blockers, diuretics): PDE5 inhibitors can enhance the blood pressure-lowering effects of these drugs, leading to dizziness and fainting.

Pills for ED can be expensive, but there are ways to cut costs. Here’s how to save on Viagra, Cialis, and other ED medications:

• Choose generic versions: Generic sildenafil (Viagra) and tadalafil (Cialis) are significantly cheaper than their brand-name counterparts. For example, Ro’s generic Viagra starts at $4 per dose, while branded Viagra costs $90 per dose. Generic Cialis is available for as low as $8 per dose, compared to $20 for branded Cialis.

• Opt for subscription plans: Services like Ro offer discounts on ED treatments when you opt for a subscription plan. For example, Daily Rise Gummies cost $89 per month, but a three-month plan brings the price down to $69 per month.

• Consider alternative formulations: Dissolvable tablets like Ro Sparks combine sildenafil and tadalafil, offering the cost-effective benefits of both drugs in one pill. Pricing starts at $48 per month for a four-dose plan.

• Bulk purchases: Some services offer savings when purchasing multiple months’ worth of medication at once. For example, Ro’s quarterly plans provide additional discounts on Daily Rise Gummies and Ro Sparks.

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There’s no single “best” ED pill for everyone. It depends on how quickly you want it to work, how long you want the effects to last, and what’s easiest to stick with. Here’s a quick recap of the top options and when they might be right for you:

• Cialis (tadalafil): Best for flexibility and longer-lasting effects: Lasts up to 36 hours and can be taken daily or as needed, making it a good fit if you want less timing pressure around sex.

• Viagra (sildenafil): Best for occasional use and affordability. A well-known, fast-acting option that lasts about four hours. Generic versions are widely available and cost-effective.

• Stendra (avanafil): Best for quick onset. Starts working in as little as 15 minutes and may cause fewer side effects, making it ideal for more spontaneous sex.

• Vardenafil (formerly Levitra): Best for a middle-ground option. Slightly longer duration than Viagra, available as a low-cost generic, and effective for many people.

• Ro Sparks: Best for combining speed and long-lasting effects. An alternative dissolvable pill that combines sildenafil and tadalafil for fast action and effects that can last up to 36 hours.

• Daily Rise Gummies: Best for daily support without pills. A chewable, low-dose tadalafil alternative for people who want ongoing readiness without planning around timing.

Your best option depends on your health, preferences, and how often you want support. An online telehealth provider like Ro can help you choose the safest and most effective fit.