Over-the-counter Viagra: 13 alternatives

Erectile dysfunction (ED) affects millions of people worldwide, with around 18 million affected in the United States alone. So, it’s no wonder so many folks seek out pills like Viagra over the counter (OTC).

Over-the-counter Viagra (sildenafil) isn’t available in the U.S., because its active ingredient, sildenafil, can interact with other medications and health conditions. A healthcare provider can assess whether it’s safe for you and discuss all of your medication options.

That said, for those looking for ED pills like Vardenafil, Levitra, or Viagra over the counter, there are supplements and natural remedies available without a prescription that may help support erectile function (but they won’t compare to prescription medication). We’ve covered 13 of the most common substitutes for Viagra below that you can get over the counter and discussed whether they actually work (though, of course, none will work as well as prescription medication).

No, you cannot buy Viagra over the counter in the United States. Viagra is a prescription medication approved by the Food and Drug Administration (FDA) to treat ED, meaning you need a licensed healthcare provider’s prescription to get it legally.

There are many websites or stores claiming to sell Viagra without a prescription, or pills like Viagra over the counter, but the truth is not only is it possible they do not work, they may not be safe. Counterfeit ED drugs could contain harmful contaminants or undisclosed ingredients, such as amphetamines, compounds found in printer ink, or even antibiotics. 

Some supplements marketed as Viagra alternatives may contain hidden prescription-strength ingredients, sometimes including medications used off-label for erectile dysfunction. And if your healthcare provider hasn’t okayed the medication for you, it could be risky to take. 

Luckily, there are both over-the-counter “natural” alternatives to Viagra you can try (though with questionable efficacy) and ways to get real, prescription medication without leaving the comfort of your home.

How do you get a Viagra prescription easily?

Now that you know you need a script, let’s go over the several ways you can obtain a prescription for Viagra.

Visit your primary care physician

Talking to your primary healthcare provider is a great starting point if you’re experiencing ED. They’re trained to handle a wide range of health concerns, including sexual health, so it’s perfectly normal to discuss these topics. During your visit, your provider will likely:

• Ask about your symptoms, such as difficulty getting or maintaining an erection.

• Review your medical history, lifestyle, and any medications you’re taking to rule out underlying causes like heart disease or diabetes.

• Discuss the potential risks, benefits, and alternatives to Viagra, including other ED treatments.

If they determine that Viagra is a suitable option for you, they’ll provide a prescription. If not, they may recommend alternative treatments or lifestyle changes that could help.

Remember, healthcare providers regularly deal with ED cases—there’s no need to feel awkward about it. ED is common and may affect up to 50% of people between the ages of 40 and 70.

See a urologist

If you’d prefer to see a specialist, a urologist may be a better option. Urologists specialize in male reproductive health and are highly experienced in treating ED. They can help address underlying causes like hormonal imbalances or conditions such as Peyronie’s disease. 

Depending on your specific needs, a urologist may also recommend advanced treatment options that primary care providers may not offer, such as penile injections or penis pumps. They may also recommend over-the-counter options such as cock rings, or other options that primary care providers may have less knowledge about or experience with.

Keep in mind, though, that you may need a referral from your primary care provider to see a urologist. If you experience symptoms such as pain with erections or if your primary care physician thinks you may have more specialized issues that need to be addressed by a Urologist, they will provide you with a referral to Urology. You can request your primary care provider for a referral as well.

Try an online medical consultation

If convenience is your top priority, online healthcare platforms like Ro make it easy to get a Viagra prescription without leaving home if you qualify based on a virtual assessment from a healthcare professional.

This option is ideal for saving time and avoiding the potential discomfort of in-person visits. Many platforms also offer generic sildenafil, which is more affordable and just as effective as brand-name Viagra.

Ro can simplify the process of getting ED treatment by offering:

• Health assessments: Start by filling out a detailed questionnaire about your medical history, current medications, and ED symptoms. This ensures the healthcare provider has all the necessary information to recommend the right treatment.

• Licensed provider evaluations: Within 24 hours, a licensed healthcare professional reviews your information and determines whether Viagra or another ED medication is appropriate for you. If additional details are needed, they may follow up with questions.

• Prescription and discreet delivery: If it’s prescribed, genuine Viagra or its generic version (sildenafil) is prepared and shipped in discreet packaging directly to your door. Ro partners with FDA-regulated pharmaceutical manufacturers, ensuring the authenticity and quality of the medication.

• Ongoing support: Ro provides unlimited free follow-ups, so if you need to adjust your dosage or have questions about your treatment, healthcare professionals are available to assist you.

Rather than turn to “over the counter” Viagra pills, services like Ro offer a safer and more convenient alternative, ensuring you receive authentic medications with ongoing healthcare provider support.

Keep in mind that Ro is not meant to be a substitute for primary care, and you should still follow up with your regular provider to ensure the rest of your health is in good shape.

There are several reasons someone might consider an alternative to Viagra. While Viagra is one of the most widely recognized treatments for erectile dysfunction, it isn’t always the best fit for everyone. Some people experience unwanted side effects, while others may have medical conditions or take medications that make Viagra unsafe.

Sexual activity can put stress on your heart, so it may not be safe if you have a history of heart disease or other heart conditions. For people with high blood pressure, medications like Cialis or Viagra are usually safe, but your healthcare provider might recommend monitoring your blood pressure or adjusting your dose if needed. If you’re concerned about your heart health, it’s a good idea to talk to your provider.

Viagra, like any prescription drug, can cause some side effects, some of which are mild and temporary. 

Common side effects can include:

• Headaches

• Facial flushing

• Indigestion

• Muscle aches and back pain

• Stuffy nose

• Nausea

While more uncommon, vision changes (such as mild blurring, color shifts, or increased light sensitivity) can also occur.

Most of these side effects go away on their own as the medication leaves your system. But in addition to side effects, drug interactions can be another reason that someone may consider Viagra alternatives.

For example, those who take nitrates for chest pain or certain blood pressure medications should avoid Viagra or may be prescribed Viagra at a lower dosage, as the combination can cause a dangerous drop in blood pressure.

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. 

FDA-approved prescription options for ED

While some may seek alternatives, there are several FDA-approved prescription medications available for treating ED. The main options include:

• Sildenafil (Viagra): This can be taken about 1 hour before sexual activity, with effects lasting about 4 hours.

• Tadalafil (Cialis): Cialis can be taken either daily as a lower dose or as needed 30 minutes before sexual activity. Effects can last up to 36 hours.

• Vardenafil: The medication Vardenafil typically works within 15 to 60 minutes, with effects lasting 4 to 5 hours after taking it.

• Avanafil (Stendra): This is one of the newer ED medication options that can work in as little as 15 minutes for higher doses (100–200 mg) or 30 minutes for lower doses (50 mg).

All of these medications require a prescription and a medical evaluation to ensure they're safe and appropriate for your specific situation. 

While Viagra and similar ED medications require a prescription, there are many over-the-counter natural aphrodisiacs and supplements that are marketed as alternatives to Viagra. Many of these options contain ingredients that claim to support blood flow, help you last longer, enhance libido, or improve overall sexual health. 

But again, it’s important to remember that these aren’t true alternatives to Viagra but instead natural options some people try if they want to steer clear of medication at first. Results can vary, and what works for one person may not work for another. Not to mention these products are not FDA-regulated and may be associated with side effects and risks as well.

Before starting any new supplement, it's important to consult a healthcare provider—especially if you have underlying health conditions or are taking medications—to ensure it's safe for you. 

A quick look at the top OTC Viagra alternatives:

1. Red ginseng (Korean ginseng)

2. Horny goat weed

3. Yohimbe/yohimbine

4. L-arginine

5. Propionyl-L-carnitine

6. DHEA (dehydroepiandrosterone)

7. Muira puama

8. Pycnogenol

9. Citrulline

10. Niacin

11. Vitamin D

12. Ginkgo biloba

13. Maca root

1. Red ginseng or Korean ginseng

Red ginseng, also known as Korean ginseng, is a popular herbal supplement that has been traditionally used for various health benefits, including improving sexual function. Derived from the root of the ginseng plant, it is typically produced through a steaming and drying process.

Ginseng contains natural compounds called ginsenosides, which may promote the production of nitric oxide. Nitric oxide can help relax the smooth muscles in and around the penis, potentially improving blood flow to help you get an erection.

A 2018 study analyzing 24 different controlled trials with over 2,000 participants suggested that red ginseng might have a positive effect on erectile function. However, the researchers emphasized the need for more studies to confirm these findings. 

Similarly, a 2021 review of nine studies involving nearly 600 participants with mild to moderate ED found that while ginseng supplements may have a small positive impact on ED, the effect was relatively modest compared to a placebo.

Despite its potential benefits, ginseng isn’t without risks. Common side effects include headaches, digestive issues, and sleep disturbances such as insomnia. More serious risks include interactions with certain medications, particularly blood thinners, calcium channel blockers, and statins.

2. Horny goat weed

Horny goat weed, also known as epimedium or yin yang huo in traditional Chinese medicine, is another herbal remedy that’s commonly found in over-the-counter supplements marketed for erectile dysfunction. The herb contains a compound called icariin, which may help inhibit phosphodiesterase type 5 (PDE-5)—the same enzyme targeted by prescription ED medications like Avanafil, Viagra, and Cialis.

By blocking PDE-5, icariin could potentially improve blood flow to the penis, supporting better erectile function. Of course, its effect is much weaker than the effect of prescription medications.

Although horny goat weed has been used for centuries in traditional medicine, scientific evidence in humans remains limited. Most of the available research comes from animal studies. For example, a study on rats suggested that icariin might have both PDE-5 inhibiting properties and neurotrophic effects, meaning it could support nerve health.

However, without robust clinical trials involving people, it’s hard to say how well these findings translate to human use.

Keep in mind that using horny goat weed isn’t without risks. Common side effects include nausea, abdominal discomfort, and dizziness. Additionally, because it may interact with medications—particularly those for blood pressure or heart conditions—it’s essential to speak with a healthcare provider before trying it.

3. Yohimbe/yohimbine

Yohimbe works by blocking certain receptors in the nervous system called alpha-2 adrenergic receptors. This action may increase nerve activity and blood flow, which can help improve erectile function.

Unlike prescription medications that work by relaxing blood vessels directly, yohimbine stimulates the nervous system to promote better blood flow and increase sexual arousal.

While it has a long history of traditional use and some evidence from animal studies, research on its effectiveness for treating erectile dysfunction in humans shows mixed results.

A small clinical study showed that yohimbine helped about half of the men with mild ED successfully achieve and maintain an erection during sexual activity. Additionally, a systematic review of eight studies found that yohimbine, either alone or in combination with other supplements, significantly improved erectile function compared to placebo, but the research isn’t particularly robust or convincing. Furthermore, other studies have found that the supplement isn’t any better than a placebo.

While yohimbine may offer some potential benefits for men with mild ED, there are important risks to be aware of. Common side effects include gastrointestinal issues like stomach pain and cardiovascular effects like increased heart rate, high blood pressure, and palpitations.

Since many over-the-counter yohimbe supplements are not well-regulated, they can contain varying or unknown amounts of yohimbine, making it difficult to predict how your body will react. If you’re considering yohimbe, consult a healthcare provider to ensure it’s safe based on your health history and current medications.

4. L-arginine

L-arginine is an amino acid that helps the body produce proteins, but it also plays an important role in blood flow by increasing nitric oxide levels. Nitric oxide relaxes blood vessels, making it easier for blood to circulate throughout the body—a process that’s crucial for achieving and maintaining an erection.

Given its role in improving blood circulation, researchers have explored whether L-arginine could also help treat ED. Research using higher doses—between 1,500 to 5,000 mg—indicated that L-arginine may help improve erectile function and sexual satisfaction for men with mild to moderate ED.

A meta-analysis of 10 studies found that people taking these higher doses reported noticeable improvements in both their ability to achieve erections and overall sexual satisfaction.

While L-arginine may be promising, it’s not without side effects. Around 8% of people taking the supplement reported mild issues like nausea, abdominal cramps, and diarrhea, particularly at higher doses.

5. Propionyl-L-carnitine

Propionyl-L-carnitine is a molecule with antioxidant properties that the body produces naturally. It plays an important role in energy production and blood flow, which has led researchers to explore its potential for improving erectile function.

One small study found that when men with erectile dysfunction took a supplement combining propionyl-L-carnitine, L-arginine, and niacin for three months, about 40% experienced noticeable improvement in their erections, while nearly 80% reported at least some level of benefit.

Interestingly, research also suggests that combining antioxidants such as propionyl-L-carnitine with PDE-5 inhibitors, such as Viagra, may lead to better results than taking Viagra alone. This combination might work by improving nitric oxide availability, which helps blood vessels relax and improves blood flow—a critical factor in achieving and maintaining erections.

Since oxidative stress can reduce nitric oxide levels, adding an antioxidant like propionyl-L-carnitine may help boost the effectiveness of ED medications.

While propionyl-L-carnitine shows promise, it’s not without potential downsides. Common side effects include nausea, stomach cramps, diarrhea, and, in some cases, a fishy body odor. 

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. 

Because testosterone plays a key role in sexual function, DHEA supplements have been explored as a potential way to improve ED, particularly in those with low levels of DHEA or testosterone.

While taking DHEA supplements can help increase DHEA levels in the body, the effect on testosterone levels isn’t as clear. Some studies suggest that while DHEA may slightly increase free testosterone, it doesn’t significantly raise total testosterone—and it may even lead to higher estrogen levels, which could contribute to ED rather than help it.

Though DHEA supplements are widely available and often marketed as a natural way to improve libido and energy, the scientific evidence on their ability to improve erections remains inconsistent.

7. Muira puama

Muira puama, a plant native to Brazil, has been used in Amazonian medicine for centuries to boost sexual desire and function in both men and women. While it’s well-known in traditional medicine, scientific research is still limited and researchers still don’t fully understand how it works.

Some researchers believe its bioactive compounds may enhance nitric oxide production and improve blood flow, both of which are essential for healthy erectile function.

Current research on muira puama’s effects on ED remains limited. An animal study found that combining muira puama with supplements like L-citrulline and ginger improved age-related ED. In a small study with 54 participants, those taking Revactin®—a supplement containing muira puama and other ingredients—reported better erectile function after three months.

However, since Revactin® includes multiple components, it’s unclear how much of the benefit came specifically from muira puama.

Most reported side effects, like headaches, heartburn, and sleep issues, are mild. 

8. Pycnogenol

Pycnogenol, an extract from French maritime pine bark, is known for its antioxidant properties and potential health benefits, including improved circulation and cardiovascular support.

It contains proanthocyanidins and flavonoids, which help stimulate nitric oxide production—a key factor in relaxing blood vessels and promoting healthy blood flow, both of which are important for achieving and maintaining erections.

Studies indicate that Pycnogenol may be particularly effective when combined with L-arginine, an amino acid that also supports nitric oxide production. A meta-analysis of three clinical trials involving 184 men with mild to moderate ED found that those taking the combination experienced significant improvements in erectile function, satisfaction during intercourse, and overall sexual well-being.

However, the studies did not show any impact on testosterone levels, and the quality of evidence was limited.

While these findings are promising, more robust research is needed to establish long-term safety and efficacy.

9. Citrulline

Citrulline is a non-essential amino acid that increases nitric oxide production in the body. Nitric oxide can help relax blood vessels and enhance blood flow, both of which are important for healthy erectile function.

Unlike L-arginine, which the body converts directly into nitric oxide but is quickly metabolized by the liver, citrulline is better absorbed and is later converted into L-arginine in the kidneys. This improved conversion process could make citrulline a promising supplement for enhancing blood circulation and supporting erectile function.

A small clinical trial involving 24 men with mild ED tested the effects of citrulline. Participants took a placebo for one month, then switched to daily citrulline for another month. After taking citrulline, 50% reported harder erections, compared to only 8.3% during the placebo phase.

They also experienced more frequent sexual activity, and no side effects were reported. Those who noticed improvements were highly satisfied with the treatment.

While more studies are needed to confirm long-term benefits, citrulline may be a helpful option for mild to moderate ED. 

10. Niacin

Niacin, also known as vitamin B3, plays an essential role in the body by helping to improve blood circulation and lower cholesterol levels. Given its role in vascular health, researchers have explored whether niacin might benefit people with ED, especially those with underlying conditions like dyslipidemia (abnormal cholesterol levels).

Since healthy blood flow is crucial for achieving and maintaining erections, the idea is that improving lipid profiles and enhancing circulation could help improve ED symptoms.

A clinical trial involving 160 men with ED and dyslipidemia tested the effects of daily niacin supplementation over 12 weeks. Results showed that men with moderate to severe ED experienced significant improvements in erectile function compared to those in the placebo group.

11. Vitamin D

Vitamin D plays a vital role in many key body functions, including immune health, hormone balance, and maintaining proper blood vessel function. Since healthy blood flow is critical for erectile function, researchers have explored whether vitamin D deficiency could contribute to ED.

In one study involving over 3,000 men, those with low vitamin D levels were found to be 30% more likely to experience ED compared to men with sufficient levels, even after accounting for other health factors such as lifestyle and existing conditions.

Despite the observational evidence linking low vitamin D to ED, clinical trials haven’t shown that supplementation can improve erectile function. In a large trial of over 11,000 older men, those who took high doses of vitamin D for three years showed no significant difference in ED prevalence compared to those who took a placebo, even though their vitamin D levels increased substantially.

12. Ginkgo biloba 

Ginkgo biloba, an ancient tree native to China, has long been used in traditional medicine to treat a variety of conditions, including respiratory issues and cognitive decline. Today, Ginkgo extract—derived from its leaves—is used as a dietary supplement for improving circulation and brain function and has been explored as a potential over-the-counter treatment for ED.

Some studies suggest that Ginkgo biloba may help boost levels of nitric oxide, a compound that relaxes blood vessels and improves circulation. Better circulation means more blood can reach the penis during arousal, potentially supporting erectile function.

There’s also some evidence that Ginkgo might help men experiencing sexual dysfunction caused by antidepressants. However, a 2021 study of existing research found that the data supporting Ginkgo’s effectiveness for ED is limited and inconsistent, meaning it’s not yet a proven solution.

While Ginkgo biloba is generally safe for most people, it can cause side effects like headaches, upset stomach, nausea, or changes in blood pressure. Since Ginkgo may affect blood clotting, it’s important to consult a healthcare provider before using it, especially if you’re on blood thinners or have a bleeding disorder.

13. Maca root

Maca root, derived from the Lepidium meyenii plant native to the Andes, has been traditionally used to boost fertility and sexual function in both men and women. Maca is packed with nutrients and bioactive compounds, such as macamides, macaene, and phytosterols, which are believed to contribute to its potential benefits for sexual health.

Today, maca supplements are commonly marketed as natural enhancers of libido and sexual performance. Several small studies have explored the effectiveness of maca for this purpose. In one small clinical trial, healthy adult men who took maca experienced a noticeable increase in sexual desire compared to those who received a placebo.

Another small study focused on men with erectile dysfunction and found that maca supplementation significantly improved their erectile function. Overall, while some evidence supports maca’s potential benefits, the data remains limited, and more thorough research is needed to draw reliable conclusions.

While many OTC supplements and natural remedies for ED may seem appealing, their safety and effectiveness aren’t guaranteed.

Unlike prescription medications, dietary supplements are not regulated by the U.S. FDA to the same rigorous standards. One of the primary concerns with OTC treatments is the presence of hidden ingredients.

Some products marketed as “natural” may contain prescription-strength compounds, such as sildenafil (the active ingredient in Viagra), without disclosing this on the label.

These unlisted ingredients can pose serious health risks, particularly for people who take medications for other conditions or have underlying health concerns. Since the amount of active ingredients can vary from batch to batch, it’s difficult to predict how your body will react, increasing the risk of harmful side effects.

Potential side effects

Even when OTC supplements contain only herbal ingredients, they are not without risks. Many compounds that show promise in animal studies have not been thoroughly tested in humans. This means that their long-term safety and potential side effects are largely unknown. Potentially even more concerning, however, are the possible interactions between these supplements and other medications, especially since some supplements contain active ingredients found in prescription medications without disclosing them. For example, taking an OTC product that unknowingly contains sildenafil while also using nitrates (commonly prescribed for heart disease) can cause a drop in blood pressure.

Additionally, combining ED treatments with certain medications, such as alpha-blockers, can lead to cardiovascular complications such as dizziness, fainting, or other serious side effects. 

Given these risks, it’s a good idea to consult a healthcare provider before trying any OTC treatment for ED and ensure it’s safe for you to try. 

Before turning to supplements or medications, some may find improvement with natural lifestyle modifications. Improving your overall health not only makes you feel better overall, but may help to improve some symptoms of ED.

Some effective natural strategies include:

• Eating a balanced diet: Choosing a diet rich in fruits, vegetables, whole grains, and lean protein can support healthy blood flow and cardiovascular health.

• Exercising regularly: Cardiovascular exercise, like running or cycling, improves circulation and helps maintain a healthy weight, both of which may help improve sexual performance. Check with your healthcare provider before making drastic changes in your routine, especially if you have a history of heart disease.

• Managing stress and mental health: Anxiety, depression, and stress may contribute to problems with erectile function. Seeking help from a therapist or practicing mindfulness techniques can help address these conditions and improve confidence.

If you are unsure which option is best for you, consulting a healthcare provider can help you find the most effective solution for your needs.

Erectile dysfunction is not uncommon so it’s no surprise that you have probably come across many “over the counter” Viagra alternatives.  Before you decide to try an OTC ED medication, here’s what to keep in mind:

• Viagra is not available over the counter in the U.S. You need a prescription from a licensed healthcare provider to get it safely and legally.

• Many supplements are marketed as natural alternatives to Viagra, including red ginseng, L-arginine, and yohimbe—but their effectiveness and safety aren’t guaranteed and they may be associated with unwanted side effects.

• Always talk to a healthcare provider before trying any treatment—especially over-the-counter supplements that may interact with other medications or health conditions.