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Last updated: Aug 18, 2022
7 min read

Over-the-counter Viagra and Viagra alternatives: what are my options?

chimene richalinnea zielinski

Medically Reviewed by Chimene Richa, MD

Written by Linnea Zielinski

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Needing a little help to get an erection isn’t uncommon. One study estimated that nearly 20% of men over 20 in the United States experience erectile dysfunction (ED) at some point in their lives, and that number generally goes up with age (Selvin, 2007). 

Despite how common erectile dysfunction is, many people don’t want to talk about it—even with their healthcare providers. One large study estimated that only around 60% of men who experience ED seek help from a medical professional for their condition (Rosen, 2004). 

It’s no wonder so many people seek out pills like Viagra over-the-counter (OTC). While many are curious about the best OTC ED pills, you can’t get erectile dysfunction drugs like Viagra over-the-counter. However, many other safe options are available to you. Read on to learn more about ED treatment options.  

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Can you get over-the-counter Viagra?

The short (and probably disappointing) answer is no. You can’t get prescription-only ED medications like Viagra over-the-counter. Since 2017, Viagra has been available over-the-counter in the United Kingdom, but there are currently no public efforts to do the same in the US (Bulik, 2017). However, that doesn’t mean getting the treatment you need is difficult. It’s easier than ever to get ED medications safely and discreetly.

Viagra is the most well-known drug for treating erectile dysfunction, but it’s by no means the only option available. It’s part of a class of drugs called PDE-5 inhibitors, which includes: 

These drugs can help treat ED by improving blood flow to the penis, allowing for harder, longer-lasting erections. The US Food and Drug Administration (FDA) requires a prescription for all of these medications, including the brand name and generic versions.

Warnings, risks, and side effects

You might see some sources online claiming to offer OTC Viagra. Steer clear. Viagra is one of the most counterfeited drugs in the world. Pfizer, the company that makes brand-name Viagra, has found dangerous substances like printer ink, amphetamines (“speed”), and metronidazole (an antibiotic) in these counterfeit Viagra pills (Pfizer, n.d.).

Viagra and other erectile dysfunction medications come with a risk of potentially dangerous side effects and drug interactions, which is why medical advice from your healthcare provider is essential. 

The possible side effects of Viagra and other PDE-5 inhibitors include headache, flushing, upset stomach, vision changes, low blood pressure, stuffy or runny nose, muscle pain, nausea, dizziness, or rash. Priapism, a painful and persistent erection lasting longer than four hours, is a rare but serious potential side effect of ED meds. It’s a medical emergency requiring immediate attention from a healthcare professional to prevent permanent injury (FDA, 2014-b).

5 potential over-the-counter Viagra substitutes

While you can’t get the “real deal” over-the-counter, there are some viagra alternatives available OTC that are advertised as treatments for ED. Certain supplements marketed as “natural Viagra” include horny goat weed, red ginseng, yohimbine, l-arginine, and DHEA. 

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

Red ginseng or Korean ginseng

A study published in 2018 examined 24 different controlled trials with more than 2,000 participants. They concluded that Korean red ginseng might be an effective erectile dysfunction treatment but called for further research to verify their findings (Borrelli, 2018).

Horny goat weed

The effects of this dietary supplement haven’t been tested for treating ED in humans, so we don’t know for sure that it works. However, horny goat weed contains a compound called icariin, which inhibits PDE-5, just like Viagra, Levitra, and Cialis, making it a promising option for treating erectile dysfunction (Dell’Agli, 2008).

Yohimbe/yohimbine

Studies on using yohimbine to treat ED in humans are limited. One study suggests that yohimbe may help men with mild erectile dysfunction successfully achieve and maintain an erection long enough to have sex. More research is needed since this study only included 18 participants (Guay, 2002).

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. In fact, some research suggests the supplement may be as effective for treating high blood pressure as lifestyle changes such as diet and exercise (Khalaf, 2019). The research on l-arginine for ED is not as clear, but some small studies have shown that it may make it easier to get an erection or make sex more satisfying, at least when compared to a placebo (Rhim, 2019). 

DHEA (dehydroepiandrosterone)

DHEA is a hormone produced by your body that helps make sex hormones like estrogen and testosterone. Although taking supplements containing DHEA can boost levels of DHEA in the body, studies have found they don’t significantly impact testosterone levels and may even increase estrogen levels (Kovac, 2015). High estrogen levels may be associated with erectile dysfunction (Zuniga, 2019). 

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

Where to get Viagra safely and discreetly

While you can’t get Viagra or other PDE-5 inhibitors OTC, 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. Some companies offer specific brands, generic versions only, or a combination. 

It’s worth knowing about the generic version since there can be a serious price difference between Viagra and its generic alternative (GoodRx, 2021). 

Sildenafil is the active ingredient in Viagra and “generic Viagra,” but it’s also used for treating conditions other than ED. Revatio (see Important Safety Information), for example, is also sildenafil, but it comes in different doses than Viagra and is used to treat a lung condition called pulmonary arterial hypertension (PAH) (Barnett, 2006). Generic versions of Revatio may be prescribed off-label to treat ED since sildenafil is the active ingredient.

Viagra and generic Viagra come in three doses: 25 mg, 50 mg, and 100 mg (FDA, 2014-b). But PAH medications like Revatio used off-label to treat ED expand the dosages available. 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 (FDA, 2014-a). 

The recommended starting dose for men with ED is 50 mg of sildenafil, though your care 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.

Viagra alternatives: cock rings and penis pumps

In addition to erectile dysfunction drugs like Viagra and other supplements, products like cock rings and penis pumps can help you get and keep an erection during sex. 

A cock ring is a band you wear around your penis. It works by restricting blood flow out of the penis, which can help you maintain a firmer erection. A penis pump, or vacuum constriction device (VCD), uses a vacuum pump to pull blood into the penis. A cock ring can be used to maintain an erection once the penis is erect. 

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 potential 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.

References

  1. Barnett, C. F. & Machado, R. F. (2006). Sildenafil in the treatment of pulmonary hypertension. Vascular Health and Risk Management, 2(4), 411–422. doi: 10.2147/vhrm.2006.2.4.411. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994020/
  2. Borrelli, F., Colalto, C., Delfino, D. V., et al. (2018). Herbal dietary supplements for erectile dysfunction: A systematic review and meta-analysis. Drugs, 78(6), 643-673. doi:10.1007/s40265-018-0897-3. Retrieved from https://link.springer.com/article/10.1007/s40265-018-0897-3
  3. Bulik, B. (2017). OTC Viagra: Pfizer snags nod for nonprescription sales of the little blue pill for men in the U.K. Retrieved on Aug. 25, 2020 from https://www.fiercepharma.com/marketing/otc-viagra-pfizer-snags-nod-for-non-prescription-sales-uk 
  4. Dell’Agli, M., Galli, G. V., Cero, E. D., et al. (2008). Potent inhibition of human phosphodiesterase-5 by icariin derivatives. Journal of Natural Products, 71(9), 1513-1517. doi:10.1021/np800049y. Retrieved from https://pubs.acs.org/doi/10.1021/np800049y
  5. Dhaliwal, A. & Gupta, M. (2022). PDE5 inhibitor. StatPearls. Retrieved on Aug. 17, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK549843/ 
  6. Food and Drug Administration (FDA-a). (2014). REVATIO (sildenafil) label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021845s011,022473s004,0203109s002lbl.pdf 
  7. Food and Drug Administration (FDA-b). (2014). VIAGRA (sildenafil citrate) label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf 
  8. Guay, A. T., Spark, R. F., Jacobson, J., et al. (2002). Yohimbine treatment of organic erectile dysfunction in a dose-escalation trial. International Journal of Impotence Research, 14(1), 25-31. doi:10.1038/sj.ijir.3900803. Retrieved from https://www.nature.com/articles/3900803
  9. GoodRx. (2021). Sildenafil. Retrieved on Nov. 23, 2021 from https://www.goodrx.com/sildenafil 
  10. Khalaf, D., Krüger, M., Wehland, M., et al. (2019). The effects of oral l-arginine and l-citrulline supplementation on blood pressure. Nutrients, 11(7), 1679. doi:10.3390/nu11071679. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683098/
  11. Kovac, J. R., Pan, M., Arent, S., & Lipshultz, L. I. (2015). Dietary adjuncts for improving testosterone levels in hypogonadal males. American Journal of Men’s Health, 10(6), NP109-NP117. doi:10.1177/1557988315598554. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1557988315598554#_i7
  12. Loran, O. B., Ströberg, P., Lee, S. W., et al. (2009). ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Sildenafil citrate 100 mg starting dose in men with erectile dysfunction in an international, double-blind, placebo-controlled study: effect on the sexual experience and reducing feelings of anxiety about the next intercourse attempt. The Journal of Sexual Medicine, 6(10), 2826-2835. doi:10.1111/j.1743-6109.2009.01428.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19817982/
  13. Pfizer. (n.d.). Avoid Counterfeit VIAGRA (sildenafil citrate). Retrieved on Aug. 17, 2022 from https://www.viagra.com/en/avoid-counterfeits 
  14. Rhim, H. C., Kim, M. S., Park, Y., et al. (2019). The potential role of arginine supplements on erectile dysfunction: A systematic review and meta-analysis. The Journal of Sexual Medicine, 16(2), 223-234. doi:10.1016/j.jsxm.2018.12.002. Retrieved from https://www.jsm.jsexmed.org/article/S1743-6095(18)31362-6/pdf
  15. Rosen, R. C., Fisher, W. A., Eardley, I., et al. (2004). The multinational Mens Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Current Medical Research and Opinion, 20(5), 607–617. doi:10.1185/030079904125003467. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15171225/ 
  16. Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and risk factors for erectile dysfunction in the U.S. The American Journal of Medicine, 120(2), 151-157. doi:10.1016/j.amjmed.2006.06.010. Retrieved from https://www.amjmed.com/article/S0002-9343(06)00689-9/fulltext
  17. Zuniga, K. B., Margolin, E. J., Fazio, A. D., et al. (2019). The association between elevated serum oestradiol levels and clinically significant erectile dysfunction in men presenting for andrological evaluation. Andrologia, 51(9), E13345. doi:10.1111/and.13345. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31317572/