Over-the-counter Viagra alternatives: Are they safe?

Erectile dysfunction (ED) affects millions of Americans, but lots of people do not tell their healthcare provider about it. So, it’s no wonder so many folks seek out pills like Viagra over the counter (OTC). 

Here’s the thing, though: You can’t get erectile dysfunction drugs, such as Viagra, over the counter in the US. Other supplements with a similar goal are available, and getting prescription medications without having to visit a healthcare provider in person has never been easier. 

Read on to learn more about pills like Viagra over the counter. 

The short (and probably disappointing) answer is no, you can’t get Viagra over the counter in the US. 

Viagra (sildenafil), which is FDA-approved to treat erectile dysfunction, is a safe and effective way to get harder, longer-lasting erections. Despite how commonly the medication is used, though, it still requires a prescription from a licensed healthcare provider. 

If you come across a website or store offering “pills like Viagra over the counter” or “OTC Viagra,” be wary. Viagra is one of the most counterfeited drugs in the world, according to the drug’s manufacturer, Pfizer. In fact, Pfizer, has found dangerous substances, such as printer ink, amphetamines ("speed"), and metronidazole (an antibiotic), in these counterfeit Viagra pills.

Luckily, there are both over-the-counter “natural” alternatives to Viagra you can try and ways to get real, prescription medication without ever leaving the comfort of your home. If you’re looking for ED treatment, safe and reputable telehealth companies, such as Ro, can give you online access to licensed healthcare professionals who can evaluate your symptoms and prescribe medication to treat ED that will be shipped straight to your door.

And while Viagra is seemingly the most well-known medication for ED, it’s actually just one of a few well-researched and safe ED drugs—all of which, like Viagra, are part of a drug class known as phosphodiesterase 5 (PDE5) inhibitors. In addition to sildenafil, the generic version of Viagra, these include Cialis (tadalafil), Levitra (vardenafil), and Stendra (avanafil). Sometimes, too, these medications are combined. Ro Sparks, for example, features both of the active ingredients in Viagra and Cialis (sildenafil and tadalafil). 

PDE5 is an enzyme in the body that breaks down chemicals responsible for erections. When PDE5 is blocked through the effects of Viagra or other PDE5 inhibitors, these chemicals don’t get broken down and as a result, tissues in the penis stay relaxed and engorged with blood (i.e. hard). 

The reason that these meds require a prescription from a licensed healthcare provider is that while they are considered to be safe, they aren’t right for everyone. Your provider will evaluate your medical history to understand if Viagra or one of the many alternatives is right for you.

While you can’t get the “real deal” without an Rx, there are some pills like Viagra over the counter that are advertised as treatments for ED. Certain supplements marketed as "natural Viagra" include horny goat weed, red ginseng, yohimbine, l-arginine, propionyl-L-carnitine, and DHEA, though remember they don’t have the same ingredients and aren’t regulated in the same way that prescription medications are. 

It's also important to note that studies have not directly compared these herbal supplements and prescription erectile dysfunction drugs, such as Viagra. That being said, some of these herbal remedies do show promise for improving erections. Here's what you need to know about them:

1. Red ginseng or Korean ginseng

A 2018 study examined 24 different controlled trials with more than 2,000 participants. They concluded that Korean red ginseng—an herbal root commonly produced by steaming and drying—might be an effective ED treatment but called for further research to verify their findings.

A later 2021 review of nine studies with a total of nearly 600 participants with mild-to-moderate ED found that while ginseng supplements do have a positive effect on ED, the effect is small when compared to a placebo. They did find, however, that ginseng improved men’s satisfaction with sex. Follow up data was limited and most men were only followed for 12 weeks. 

Pros of ginseng for ED:

• Ginseng supplements may have a positive effect on erectile function.

• Ginseng may improve men’s satisfaction with sex.

Cons of ginseng for ED:

• Ginseng can have negative side effects, including headache, sleepiness, and stomach discomfort.

• Ginseng may react negatively with other medications, including blood thinners. 

• The impact of ginseng on ED is minimal.

2. Horny goat weed

Available as a component of various supplements, horny goat weed—another traditional Chinese medicinal herb—contains a compound called icariin. As the active ingredient, icariin inhibits PDE-5 just like Viagra, Levitra, and Cialis, making it a potentially promising (though less powerful) option for treating erectile dysfunction.

Horny goat weed also goes by the names epimedium and yin yang huo when it's used in traditional Chinese medicine as an ED treatment. While horny goat weed is included in many over-the-counter ED supplements, there haven’t been any randomized controlled studies showing the effectiveness of this supplement in people with ED. The bottom line is that more research is needed before scientists can say definitively how it affects erections in humans.

Pros of horny goat weed for ED:

• It contains icariin, which inhibits PDE-5, just like Viagra and other ED pills.

• It has been used in traditional Chinese medicine to treat ED.

Cons of horny goat weed for ED:

• The research on whether it helps with ED is minimal and mostly involves animal studies.

• Side effects can include abdominal discomfort and nausea.

3. Yohimbe/yohimbine

Studies on using yohimbine—a substance derived from specific tree bark that’s traditionally been used in West African medicine—to treat ED in humans are limited. One small study suggests that yohimbe may help about half of men with mild erectile dysfunction successfully achieve and maintain an erection long enough to have sex. 

However, the body of research isn’t particularly strong. A review of eight studies found that taking yohimbe supplements may improve erectile function in men with ED when combined with other treatments, but the research isn’t particularly robust or convincing. Furthermore, other studies have found that the supplement isn’t any better than a placebo.

Pros of yohimbe for ED:

• This natural extract has been shown in some small studies to potentially improve erectile function.

• Yohimbe may help men with mild ED last longer in bed.

Cons of yohimbe for ED:

• More research needs to be done to evaluate the efficacy of yohimbe as a natural treatment for ED.

• While yohimbe is safe in small doses, excess amounts can lead to stomach pain or discomfort, increased heart rate, high blood pressure, and anxiety.

• Many supplements that claim to have yohimbe are improperly labeled and have unknown quantities of the supplement in them. Since supplements are not regulated, this can be dangerous. 

4. L-arginine

This amino acid has been shown to lower blood pressure by boosting the production of nitric oxide in the body, a chemical that plays an essential role in erections by facilitating blood flow into the penis. In fact, some research suggests the supplement may be as effective for treating high blood pressure as lifestyle changes (e.g.diet and exercise). 

The research on L-arginine for ED is not as clear, but some small studies have shown that L-arginine supplements may improve sexual satisfaction or make sex more satisfying when compared to a placebo. 

Pros of L-arginine for ED:

• Taking arginine supplements can improve orgasmic and erectile function.

• L-arginine may also make sex more satisfying for men with mild-to-moderate ED.

Cons of L-arginine for ED:

• More studies are needed to evaluate the efficacy of arginine supplements for ED.

• Around 8% of men may experience side effects, which can include diarrhea. Side effects can be more common at higher dosages, as well. 

5. Propionyl-L-carnitine

Propionyl-L-carnitine is a molecule with antioxidant properties that is produced naturally in our bodies. In one small study, men with erectile dysfunction were given a supplement combining propionyl-L-carnitine, L-arginine, and niacin for three months. The supplement improved erections for 40% of the participants, with nearly 80% experiencing at least a partial response.

Other research has found that combining PDE-5 inhibitors, such as Viagra, with over-the-counter propionyl-L-carnitine or L-arginine may be more effective than Viagra alone without increasing the risk of side effects.

Pros of propionyl-L-carnitine for ED:

• When combined with other supplements, propionyl-L-carnitine may improve the symptoms of ED, though data is limited.

• For patients taking Viagra, supplementing with propionyl-L-carnitine may further improve their erections.

Cons of propionyl-L-carnitine for ED:

• While propionyl-L-carnitine is considered to be relatively safe, it can lead to side effects, such as nausea, vomiting, diarrhea, stomach cramps, and a “fishy” body odor.

• Propionyl-L-carnitine can interact with medications, and its use should be discussed with your healthcare provider. .

6. DHEA (dehydroepiandrosterone)

DHEA is a hormone produced by your body that is used as a building block for sex hormones, such as estrogen and testosterone. Although taking supplements containing DHEA can boost levels of DHEA in the body, studies have found they don’t significantly impact total testosterone levels and may even increase estrogen levels. High estrogen levels may be associated with erectile dysfunction. 

Bottom line? DHEA probably isn’t a slam dunk for treating your ED. You’re likely better off asking a healthcare provider about prescription options.

Pros of DHEA for ED:

• DHEA supplements may increase levels of DHEA in your body, a key hormone involved in sexual function.

• DHEA supplements may lead to increased levels of free testosterone but not necessarily total testosterone.

Cons of DHEA for ED:

• DHEA may increase estrogen levels, which can contribute to ED.

• The research on DHEA is mixed when it comes to treating ED.

While you can’t get Viagra or other PDE-5 inhibitors over the counter, these medications are easy to get if you have a prescription, so don’t be afraid to discuss your options with a healthcare provider. It’s easier than ever to get ED meds online, shipped discreetly to your home, from a reputable source (think: Ro). Some companies offer specific brands, generic versions only, or a combination. 

It's worth knowing about the generic version since there can be a significant price difference between Viagra and its generic alternative. 

Viagra and the generic of Viagra come in a variety of dosage strengths; the brand-name version, for example, is available in 25 mg, 50 mg, and 100 mg. The same active ingredient, sildenafil, is also available in a medication called Revatio. While Revatio is technically prescribed to treat a lung condition, since it contains the same active ingredient as Viagra, it is sometimes prescribed off-label to treat ED. In addition to the 20 mg dose Revatio comes in, it can also be prescribed in 40 mg, 60 mg, 80 mg, and 100 mg doses. 

The recommended starting dose for people with ED is 50 mg of sildenafil, though your healthcare provider might up your dose to 100 mg if 50 mg doesn’t do the trick or lower your dose to 25 mg if you find that 50 mg causes intolerable side effects. Some people are started on lower dosages at first due to other health conditions or medications they are taking, which is decided by their healthcare provider. 

Whatever method you choose to treat erectile dysfunction, ED is a common problem and nothing to be ashamed of. Talk to your healthcare provider about any prescription drugs or supplements you're taking to ensure there's no potentially dangerous drug interaction before starting Viagra, generic sildenafil, or any other ED drugs. Also, discuss any health conditions you may have, such as heart disease or high blood pressure. They'll work with you to get you on the right medication regimen to improve your sex life and sexual function.

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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

May 09, 2024

Written by

Linnea Zielinski

Fact checked by

Raagini Yedidi, MD

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About the medical reviewer

Raagini Yedidi, MD

Raagini Yedidi, MD, is an internal medicine resident and medical reviewer for Ro.