What is the best ED treatment?

Erectile dysfunction, or ED, is a common condition affecting around 40% of men by age 50 and up to 70% of men by age 70. The good news is that ED is treatable, with several safe and effective ED treatments currently available.

With so many options to choose from, the real question becomes, “What is the best ED treatment?” The answer depends on a number of factors, from your personal medical history to cost, convenience, and lifestyle considerations. 

Currently, there are several ED pills approved by the U.S. Food & Drug Administration (FDA) to treat erectile dysfunction. These include sildenafil (brand name Viagra), tadalafil (Cialis), avanafil (Stendra), and vardenafil (Levitra). You can also find compounded medications that contain one or more of the active ingredients in traditional ED drugs, such as Ro Sparks, which combine the active ingredients in Viagra and Cialis (sildenafil and tadalafil). All of these ED treatments are available by prescription only, so you’ll need to connect with a licensed healthcare provider in order to get them.

We’ll dive into the details of each ED pill below, but here’s a quick look at the key details.

ED medications belong to a class of drugs known as phosphodiesterase 5 (PDE5) inhibitors, which help strengthen erections by increasing blood flow to the penis. They don’t give you an automatic erection, though. You need to be aroused for them to work. 

When you’re aroused, a complex interplay between your nerves and your blood vessels allows for blood to flow into the penis where, when everything is working as it should, it gets trapped, resulting in an erection. When blood flow to the penis is impaired (which happens as we age but can be made worse by things like diabetes and other conditions affecting the nerves and blood vessels), we see erectile dysfunction. ED drugs work by increasing blood flow into the penis, giving you harder and longer-lasting erections. 

ED pills are the first-line treatment for erectile dysfunction and work for up to 70% of men the first time they try them. Some people find that they need their dosage or treatment regimen adjusted to get the best results. They’re also generally considered safe and well-tolerated by most people — although they’re not recommended for everyone, including those who take nitrates or certain blood pressure medications or people who have a history of heart problems that might make sexual activity dangerous.

The various ED pills available differ in various ways that may make one a better fit for you over another. They vary in how long they take to work, as well as how long they last. Some need to be taken with food. And they can vary in cost. If you try an ED pill and find that it doesn’t work for you, do not despair. Many people find success with another ED medication or dosage.

With so many options available, the best treatment for ED can depend on your personal health situation (including underlying conditions and other medications you’re taking), as well as your personal preferences. Below we take a look at the best ED treatments available today.

Sildenafil (Viagra)

Sildenafil is the active ingredient in Viagra. You can get this ED pill as a brand-name drug (Viagra) or as a generic (sildenafil). The recommended starting dose of Viagra is 50 milligrams (mg) one hour before sex, although it can be increased to 100 mg or decreased to 25 mg, as needed. It should not be taken more than once per day.

Pros of sildenafil:

• Proven history: Viagra was the first pill approved by the FDA to treat ED and is one of the oldest ED medications.

• Fast-acting: Sildenafil can start working within 30 minutes and keeps working for 4 hours.

• Cost: Since you take Viagra only when you plan on having sex, it may be more cost-effective than a daily ED pill.

• Side effects: Sildenafil’s most common side effects are typically manageable and may include headache, flushing, upset stomach, abnormal vision, nasal congestion, back pain, muscle aches, nausea, dizziness, and rash.

Cons of sildenafil:

• Serious side effects: While rare, sildenafil can cause tinnitus (ringing in the ears) or sudden vision or hearing loss. As with other ED pills, there is a risk of priapism (an erection that lasts more than 4 hours) when taking Viagra. This is a medical emergency and requires immediate medical attention.

• Contraindications: Sildenafil should not be taken by people taking nitrates, alpha-blockers, guanylate cyclase (GC) stimulators, CYP3A4 inhibitors, or certain medications that treat high blood pressure. Viagra can also affect how other medications work, so you should give your healthcare provider a full list of any medications you are currently taking before starting treatment.

• Some planning required: Sildenafil should be taken 1 hour before you plan on having sex. It takes longer to kick in if you take it after eating a high-fat meal.

Tadalafil (Cialis)

Tadalafil is the active ingredient in Cialis. You can get this ED pill as a brand-name drug (Cialis), or as a generic (tadalafil). Cialis may also be prescribed to treat benign prostatic hyperplasia (BPH). When treating ED, tadalafil can be taken as needed, at least 30 minutes before sex, or it can be taken on a daily basis. The recommended dose for as-needed use is 10 mg, which can be increased to 20 mg or decreased to 5 mg. The recommended dose for daily use is 2.5 mg, which can be increased to 5 mg. Cialis should not be taken more than once a day. 

Pros of tadalafil:

• More spontaneity: Tadalafil offers more flexibility than other ED pills, since it can be taken daily or on an as-needed basis, with or without meals.

• Longest-lasting: When taken on the fly, tadalafil starts to kick in after 30 minutes and lasts up to 36 hours, the longest of traditional ED medications. If you take Cialis daily, you don’t have to worry about timing.

• Most effective: Studies have found tadalafil to be the most effective oral ED medication. Also, men report a higher preference for tadalafil, saying it gives them more spontaneity and self-confidence around sex.

• Side effects: Tadalafil’s most common side effects were reported by 15% or fewer men in clinical trials, with those taking Cialis daily experiencing fewer side effects. Common side effects include headache, dyspepsia, nasal congestion, flushing, and back, muscle, or limb pain.

Cons of tadalafil:

• Serious side effects: While rare, tadalafil can cause tinnitus or sudden vision or hearing loss. As with other ED pills, there is a risk of priapism (experiencing an erection that lasts more than 4 hours) when taking Cialis.

• Contraindications: Tadalafil should not be taken by those with heart problems or anyone taking nitrates, alpha-blockers, guanylate cyclase (GC) stimulators, CYP3A4 inhibitors, or medications that treat high blood pressure. Cialis can also affect how other medications work, so you should give your healthcare provider a full list of any medications you are currently taking.

• Limit your drinking: Consuming large amounts of alcohol while taking Cialis can lead to low blood pressure.

• Cost: While low-cost generics are available, the cost of tadalafil can add up if taken daily.

Compounded ED medication

Compounded ED medications contain the active ingredients of other ED meds but have been produced by a compounding pharmacist to meet a patient’s needs. For example, Ro Sparks combine the active ingredients in Viagra (55 mg of sildenafil) and Cialis (22 mg of tadalafil) for a 2-in-1 ED treatment. Unlike traditional ED medications, Ro Sparks come as a sublingual lozenge that melts under your tongue within minutes. Ro Sparks should not be taken more than once a day.

Pros of Ro Sparks:

• Fast-acting: Unlike traditional ED medications, Ro Sparks dissolves under your tongue where it’s absorbed directly into your bloodstream. This allows the medication to bypass your GI tract entirely and start acting in as little as 15 minutes.

• Long-lasting: Because Sparks contain sildenafil and tadalafil, the medication lasts up to 36 hours, offering increased spontaneity for a whole weekend. 

• Discreet convenience: As a sublingual lozenge, Ro Sparks is more discreet and convenient than traditional ED medications that come in pill form and need to be taken water. 

• Side effects: Ro Sparks has the same active ingredients as Viagra and Cialis, and it shares similar side effects, including headaches, nasal stuffiness, flushing, and dizziness.

Cons of Ro Sparks:

• Serious side effects: While very rare, Ro Sparks carry a risk of the same serious side effects as sildenafil (Viagra) and tadalafil (Cialis), its two active ingredients, including sudden hearing/vision loss and the risk of priapism.

• Contraindications: Ro Sparks should not be taken by anyone taking nitrates, alpha-blockers, guanylate cyclase (GC) stimulators, CYP3A4 inhibitors, or certain medications that treat high blood pressure. Ro Sparks can also affect how other medications work, so you should give your healthcare provider a full list of any medications you are currently taking.

Avanafil (Stendra)

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. Stendra is taken as needed, at least 15 minutes before sex. The recommended dose for Stendra is 100 mg, which can be increased to 200 mg or decreased to 50 mg. It should not be taken more than once a day. 

Pros of avanafil:

• Faster-acting: Stendra kicks in after 15 minutes on the 200 mg dose, and after 30 minutes on the 50 mg dose. It keeps working for up to 6 hours.

• Side effects: Stendra is typically safe and well-tolerated, with a shorter list of common side effects than other ED pills. Headache is the most common side effect. Others include flushing, nasal congestion, runny nose, and back pain.

Cons of avanafil:

• Serious side effects: While rare, avanafil can cause tinnitus or sudden vision or hearing loss. As with other ED pills, there is a risk of priapism (experiencing an erection that lasts more than 4 hours) when taking Stendra.

• Contraindications: Avanafil should not be taken by anyone taking nitrates, alpha-blockers, guanylate cyclase (GC) stimulators, CYP3A4 inhibitors, or medications that treat high blood pressure. Stendra can also affect how other medications work, so you should give your healthcare provider a full list of any medications you are currently taking.

• Watch what you eat and drink: Consuming large amounts of alcohol while taking Stendra can lead to excessively low blood pressure. Also, Stendra can take longer to kick in if you take it after eating a high-fat meal. 

• Cost: Stendra is only available as a brand-name drug, so it can be more costly than other treatment options.

Vardenafil (Levitra)

Vardenafil is the active ingredient in the brand name drug Levitra, although it’s more common to get this drug as a generic. The recommended dose of vardenafil is 10 mg one hour before sex, although it can be increased to 20 mg or decreased to 5 mg as needed. It should not be taken more than once per day. 

Pros of vardenafil:

• Effectiveness: Studies have found vardenafil to be one of the more effective ED medications, second only to tadalafil (Cialis). Effects last for up to 5 hours.

• Side effects: Vardenafil’s most common side effects include headache, flushing, nasal congestion, upset stomach, sinusitis, flu syndrome, dizziness, increased creatine kinase, nausea, and back pain.

• Cost: Vardenafil is quite affordable as it is primarily available as a generic and only taken on an as-needed basis.

Cons of vardenafil:

• Serious side effects: While rare, vardenafil can cause tinnitus or sudden vision or hearing loss. As with other ED pills, there is a risk of priapism (experiencing an erection that lasts more than 4 hours) when taking vardenafil.

• Contraindications: Vardenafil should not be taken by those with heart problems or anyone taking nitrates, alpha-blockers, guanylate cyclase (GC) stimulators, CYP3A4 inhibitors, or medications that treat high blood pressure. Vardenafil can also affect how other medications work, so you should give your healthcare provider a full list of any medications you are currently taking.

• Some planning required: Vardenafil should be taken 1 hour before you plan on having sex, and it takes longer to kick in if you take it after eating a high-fat meal.

Which ED medication is most effective will depend on your lifestyle, medical history, and preferences. And, while ED pills work for many men on the first try, some may have to experiment with more than one until they find the best option for them. Overall, people report enjoying the effectiveness of sildenafil (Viagra) but appreciate the spontaneity they get from long-lasting tadalafil (Cialis). Having to plan meals around their sildenafil treatment (since food affects the medication’s absorption) has been a point of frustration for many patients. 

Ro’s clinicians designed Ro Sparks to alleviate these pain points by creating a combined treatment that offers the benefits of both sildenafil and tadalafil in one easy-to-take lozenge that dissolves under your tongue. Because of how it works, you can take it after a date night meal without worrying about how the food will affect it, and the medication lasts for up to 36 hours, meaning you can go another round if you like. 

The great thing about ED medications is that they are generally safe and well-tolerated, and you have lots of options to choose from. That means you can make a decision based on your lifestyle and personal preferences. 

If you prefer taking a daily treatment for ultimate spontaneity, daily tadalafil (Cialis) may be your best bet. If your main concern is being discreet, Ro Sparks sublingual lozenges are easy to slip under your tongue and dissolve within minutes. If you like to drink, you might want to avoid ones that interact with alcohol, like Cialis or Stendra. If you want to get hard as quickly as possible, a fast-acting option like Stendra, Ro Sparks, or daily Cialis may be for you.

As you can see, there’s a lot to consider! Take time to review your options, and ask your healthcare provider about what they think might be best for you.

In order to buy ED pills, you need a prescription from a licensed healthcare provider. You can do this by making an appointment with your primary care provider and taking the prescription to your local pharmacy, or you can purchase ED pills online through a telehealth company like Ro. When buying ED pills online, you’ll typically need to fill out an online health questionnaire first, which then gets reviewed by a licensed healthcare provider who prescribes the ED medication to you if appropriate. 

With Ro, the questionnaire takes about 20 minutes to fill out, and you’ll hear back from a provider within 24 hours. Then, if prescribed, you can expect to receive your ED medication — be it sildenafil, tadalafil, Viagra, Cialis, or Ro Sparks — in a discreet package by mail within 4–7 days. Learn more about getting your ED medication through Ro.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

February 28, 2024

Written by

Amelia Willson

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.