Over-the-counter Viagra alternatives
Reviewed by Yael Cooperman, MD, Ro,
Written by Linnea Zielinski
Reviewed by Yael Cooperman, MD, Ro,
Written by Linnea Zielinski
last updated: Jan 10, 2024
7 min read
Key takeaways
Viagra isn’t available over the counter, but there may be alternatives you can try.
The most effective way to treat erectile dysfunction is by talking to your doctor, or an online provider such as Ro, about whether a prescription medication such as Viagra may be right for you.
Here's what we'll cover
Needing a little help to get an erection isn't uncommon. One large study found that about half of men in the US experience erectile dysfunction (ED) at some point in their lives, making it a prevalent issue. But despite how common it 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, even though treatment is safe, effective, and readily available.
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 in the United States. However, many other safe options are available, and getting prescription medications without having to visit a doctor in person has never been easier. Read on to learn more about over-the-counter Viagra alternatives.
Viagra Important Safety Information: Read more about serious warnings and safety info.
Can you get over-the-counter Viagra?
The short (and probably disappointing) answer is no, you can’t get Viagra over-the-counter in the US. Viagra, which is FDA-approved to treat erectile dysfunction, is a safe and effective way to get harder, longer-lasting erections. But despite how safe the medication is, it still requires a prescription from a licensed healthcare provider.
If you come across a website or store offering OTC Viagra, be wary. 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.
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 like 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.
When it comes to treating ED, Viagra is the most well-known medication available, but there are others, too. It’s part of a class of prescription drugs called PDE-5 inhibitors, which includes:
Viagra (generic: sildenafil)
Levitra (generic: vardenafil)
Stendra (generic: avanafil)
These drugs can help treat ED by improving blood flow to the penis, allowing for harder, longer-lasting erections.
The reason that these medications require a prescription from a licensed healthcare provider is that while they are considered to be safe, they aren’t right for everyone. Your doctor will evaluate your medical history to understand if Viagra or one of the many alternatives is right for you.
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.
Tadalafil is the active ingredient in Cialis® and generic Cialis®. It’s a powerful pill with longer lasting effects than Viagra®. Starting at $8/pill. Learn more about tadalafil.
6 potential over-the-counter Viagra alternatives
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, propionyl-L-carnitine, 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:
1. 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.
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.
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.
The impact of ginseng on ED is minimal.
2. Horny goat weed
Available as a component of various supplements, 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.
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. Studies of horny goat weed in rats had positive results. While horny goat weed is included in many over-the-counter ED supplements, there haven’t been any solid randomized controlled studies showing the effectiveness of this supplement in men 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, an herb that 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 to treat ED in humans are limited. One small study suggests that yohimbe may help men with mild erectile dysfunction successfully achieve and maintain an erection long enough to have sex.
A review of eight studies found that taking yohimbe supplements may improve erectile function in men with ED when combined with other treatments, but their research isn’t particularly robust or convincing. Also, 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.
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 such as 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 make it easier to get an erection 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 may include diarrhea.
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 like Viagra with over-the-counter propionyl-L-carnitine or L-arginine may be more effective than Viagra alone.
Pros of propionyl-L-carnitine for ED:
When combined with other supplements, propionyl-L-carnitine may improve the symptoms of ED.
For men 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 like nausea, vomiting, diarrhea, stomach cramps, and a “fishy” body odor.
Propionyl-L-carnitine can interact with medications and may produce muscle weakness or seizures in people with certain health conditions.
6. DHEA (dehydroepiandrosterone)
DHEA is a hormone produced by your body that is used as a building block for 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. High estrogen levels may be associated with erectile dysfunction.
Bottom line? DHEA probably isn’t a slam dunk for treating your ED. You’re better off asking a healthcare provider about prescription options.
Pros of DHEA for ED:
DHEA may increase levels of DHEA, 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.
Where to get Viagra pills safely and discreetly
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. 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 generic Viagra come in three doses: 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 men 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.
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.
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.
Balasubramanian, A., Thirumavalavan, N., Srivatsav, A., et al. (2019). An Analysis of Popular Online Erectile Dysfunction Supplements. The Journal of Sexual Medicine, 16(6), 843–852. doi:10.1016/j.jsxm.2019.03.269. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9555224/
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/
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%2Fs40265-018-0897-3
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
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
Deveci, S., (2004). Sublingual sildenafil in the treatment of erectile dysfunction: faster onset of action with less dose. International Journal of Urology: Official Journal of the Japanese Urological Association, 11(11), 989-992. doi: 10.1111/j.1442-2042.2004.00933.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15509203/
Dhaliwal, A. & Gupta, M. (2022). PDE5 inhibitor. StatPearls. Retrieved on Aug. 17, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK549843/
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
Feldman, H. A., Goldstein, I., Hatzichristou, D. G., et al. (1994). Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. The Journal of Urology, 151(1), 54–61. Retrieved from https://pubmed.ncbi.nlm.nih.gov/8254833/
Food and Drug Administration (FDA-b). (2014). VIAGRA (sildenafil citrate) label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf
Gianfrilli, D., Lauretta, R., Di Dato, C., et al. (2012). Propionyl-L-carnitine, L-arginine and niacin in sexual medicine: a nutraceutical approach to erectile dysfunction. Andrologia, 44 Suppl 1, 600–604. doi:10.1111/j.1439-0272.2011.01234.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21966881/
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
GoodRx. (2021). Sildenafil. Retrieved on Nov. 23, 2021 from https://www.goodrx.com/sildenafil
Kearney, T., Tu, N., & Haller, C. (2010). Adverse drug events associated with yohimbine-containing products: a retrospective review of the California Poison Control System reported cases. The Annals of Pharmacotherapy, 44(6), 1022–1029. doi:10.1345/aph.1P060. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20442348/
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/
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
Lee, H. W., Lee, M. S., Kim, T. H., et al. (2021). Ginseng for erectile dysfunction. The Cochrane Database of Systematic Reviews, 4(4), CD012654. doi:10.1002/14651858.CD012654.pub2. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094213/
National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Horny Goat Weed. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK583203/
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/
Mykoniatis, I., Pyrgidis, N., Sokolakis, I. (2021). Assessment of Combination Therapies vs Monotherapy for Erectile Dysfunction: A Systematic Review and Meta-analysis. JAMA Network Open, 4(2), e2036337. doi:10.1001/jamanetworkopen.2020.36337. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893498/
Office of Dietary Supplements. (2023). Carnitine. National Institutes of Health. Retrieved from https://ods.od.nih.gov/factsheets/Carnitine-HealthProfessional/
Pfizer. (n.d.). Avoid Counterfeit VIAGRA (sildenafil citrate). Retrieved on Aug. 17, 2022 from https://www.viagra.com/en/avoid-counterfeits
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://pubmed.ncbi.nlm.nih.gov/30770070/
Rosen, R. C., Fisher, W. A., Eardley, I., et al. (2004). The multinational Men's 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/
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
Shindel, A. W., Xin, Z. C., Lin, G., et al. (2010). Erectogenic and neurotrophic effects of icariin, a purified extract of horny goat weed (Epimedium spp.) in vitro and in vivo. The Journal of Sexual Medicine, 7(4 Pt 1), 1518–1528. doi:10.1111/j.1743-6109.2009.01699.x. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551978/
Tam, S. W., Worcel, M., & Wyllie, M. (2001). Yohimbine: a clinical review. Pharmacology & Therapeutics, 91(3), 215–243. https://doi.org/10.1016/s0163-7258(01)00156-5. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0163725801001565?via%3Dihub
Wibowo, D. N. S. A., Soebadi, D. M., & Soebadi, M. A. (2021). Yohimbine as a treatment for erectile dysfunction: A systematic review and meta-analysis. Turkish Journal of Urology, 47(6), 482–488. doi:10.5152/tud.2021.21206. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612744/
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/